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Key Clinical Updates in Infectious Myocarditis

COVID-19 myocarditis has been reported between 3% and 58% of infected people based on underlying myocardial risk and imaging.

For COVID-19 related myocarditis, treatment is generally supportive.

A 2020 review noted that of the attempted therapies, such as remdesivir, glucocorticoids, IL-6 inhibitors (tocilizumab), IVIG, and colchicine, only corticosteroids appeared to have any favorable effect on outcomes.

ESSENTIALS OF DIAGNOSIS

  • Often follows an upper respiratory infection.

  • May present with chest pain (pleuritic or nonspecific) or signs of heart failure.

  • Echocardiogram documents cardiomegaly and contractile dysfunction. Initial heart size is generally normal with thickened walls.

  • Myocardial biopsy, though not sensitive, may reveal a characteristic inflammatory pattern. MRI has a role in diagnosis.

  • COVID-19 myocarditis impacts between 3% and 58% of people with COVID-19 based on underlying myocardial risk and imaging.

GENERAL CONSIDERATIONS

Cardiac dysfunction due to primary myocarditis is presumably caused by either an acute viral infection or a post viral immune response. Secondary myocarditis is the result of inflammation caused by nonviral pathogens, medications, chemicals, physical agents, or inflammatory diseases (such as systemic lupus erythematosus). The list of both infectious and noninfectious causes of myocarditis is extensive (Table 10–13).

Table 10–13.Causes of myocarditis.

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