Differentiating COVID-associated myocarditis from other Diseases

Jump to navigation Jump to search

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mounika Reddy Vadiyala, M.B.B.S.[2]


Overview

COVID-19-associated myocarditis must be differentiated from other causes of dyspnea and chest pain, elevated cardiac biomarkers, ventricular dysfunction such as including Acute Coronary Syndrome, Stress-induced cardiomyopathy (Takotsubo cardiomyopathy) and Heart failure.

Differential Diagnosis

COVID-19-associated myocarditis must be differentiated from other causes of dyspnea and chest pain, elevated cardiac biomarkers, ventricular dysfunction such as including acute coronary syndrome, stress-induced cardiomyopathy (takotsubo cardiomyopathy) and heart failure.

Diseases Symptoms Physical Examination Diagnostic tests Other Findings
Dyspnea on Exertion Chest Pain Hemoptysis Fever Tachypnea Tachycardia Chest X-ray ECG Echocardiography CT scan and CMR
COVID-19-associated myocarditis - Increased cardiac troponin level
COVID-19-associated myocardial infarction - ✔(Low-grade) ✔/- ✔/-
  • No specific X-ray findings
  • Localized wall motion abnormalities
  • Diffuse hypokinesia
  • Left ventricular ejection fraction was lower than 50% in about 61% of the individuals.

-

Increased cardiac troponin levels
COVID-19-associated stress cardiomyopathy - -
  • CT: Regional abnormalities in the wall motion of the heart, along with absence of coronary atherosclerosis.
  • CMR: Absence of gadolinium hyper-enhancement; also shows absence of irreversible damage, regional wall abnormalities with extent and segmental LV dysfunction.
Increased cardiac troponin and pro-BNP level, transient increase in catecholamine levels.
COVID-19-associated heart failure - - Increased NT-proBNP and cardiac troponins levels
COVID-19-associated pneumonia ✔ (Pleuritic) ✔ (Usually high) - Increased inflammatory markers, including ESR, hs-CRP
COVID-19-associated acute respiratory distress syndrome - -
  • Signs of RV dysfunction/RV dilatation may be seen.
-
COVID-19-associated pulmonary embolism ✔ (Usually sudden-onset) ✔ (Pleuritic) ✔ (If massive PE) ✔ (Low-grade)
  • Non-specific:may show S1Q3T3 pattern
  • May show signs of RV strain, RV dilatation, RV dysfunction (if large PE)
  • On CT angiography: Intra-luminal filling defect
  • On MRI: Narrowing of involved vessel
  • No contrast seen distal to obstruction
  • Polo-mint sign (partial filling defect surrounded by contrast)


References