Myocarditis in Patients with COVID-19

SARS-CoV-2 is an enveloped RNA beta coronavirus, identified as the pathogen responsible for coronavirus disease 2019 (COVID-19). It primarily affects the respiratory system; however, cardiovascular complications have been found in 30% of hospitalized patients, associated with worse outcomes. The virus can invade human host cell by binding with high affinity the Angiotensin Converting Enzyme 2 (ACE 2) receptor, which is expressed especially in the lungs and heart, where the human immune response can lead to an inflammation of the myocardium itself. Patients with myocarditis commonly experience nonspecific signs and symptoms; laboratory tests often revealed elevated marker of myocardial necrosis and inflammation while electrocardiogram in most patients have demonstrated features similar to an acute coronary syndrome. Echocardiography is the first method of investigation to evaluate the left ventricular systolic function. In suspected case, Cardiac Magnetic Resonance Imaging (CMRI) is acknowledged as the non-invasive gold standard test for myocarditis, also useful in assessing prognosis. Endomyocardial biopsy (EMB), although considered a gold standard for the diagnostic confirmation of myocarditis, is an invasive procedure that cannot be performed in all patients. Current management is mainly supportive in association with glucocorticoids.