Covid 19 and myocarditis – current challenges: Myocardial damage vs acute myocarditis
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Abstract
Background: Coronavirus infection disease 2019 (COVID-19) is a disease caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), which has rapidly spread worldwide in December 2019. Besides the symptoms of acute respiratory distress and multiorgan failure, the cardiac involvement with acute myocardial injury is also a possible clinical scenario(1) Despite the initial opinion that high troponin levels increase mortality in patients, it is clear today that abnormal troponin are not necessarily a sign of acute myocarditis. The aim of this presentation is to show the diagnostic process for the occurrence of myocarditis in Covid-19 infection compared to the diagnostic process for myocarditis with other viruses called cardiotropic viruses.
The presentation refers mainly to the desire for paediatric cardiologists to learn about the fundamental difference in the approach to a child with SARS-CoV-2 compared to myocarditis of another etiolgy. From daily practice, it seems that with Covid-19 infection, more attention is paid to possible damage to the myocardium (due to elevated troponin levels), and too little attention is paid to other symptoms. This primarily refers to coagulation disorders that can develop diffuse intravascular coagulopathy as circulus vitiosus with tragic consequences.
This presentation is the experience from the perspective of paediatric cardiologists and has no basis for statistical analysis. It is aimed at the need for scientific research into the causes and consequences of various changes in the heart musculature caused by Covod-19 infection (most often in the context of multisystem inflammatory syndrome) in relation to extensive changes in the heart musculature in the case of infection with cardiotropic viruses.(2,3)
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References
2. Pereira MFB, Litvinov N, Farhat SCL, Eisencraft AP, Gibelli MABC, Carvalho et al. Clinical spectrum with high mortality in pediatric patie with COVID-19and multisystem inflamatory sindrome. Clinics (Sao Paulo). 2020;75:e2209
3. Safadi MAP, Silva CAAD. The challenging and unpredictable spectrum of COVID-19 in children and adolescents. Rev Paul Pediatr. 2020; 39:e202 0192.
4. Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF,et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020;383(4):334-46.
5. Fremed MA, Lytrivi ID, Liberman L, Anderson BR, Barry OM, Choudhury TA, et al. Cardiac workup and monitoring in hospitalised children with COVID- 19. Cardiol Young. 2020;30(7):907-10.
6. Dolhnikoff M, Ferreira Ferranti J, de Almeida Monteiro RA, Duarte-Neto AN, Soares Gomes-Gouvêa M, Viu Degaspare N, et al. SARS-CoV-2 in cardiac tissue of a child with COVID-19-related multisystem inflammatory syndrome. Lancet Child Adolesc Health. 2020;4(10):790-4
7. Sandoval Y, Januzzi JL Jr, Jaffe AS. Cardiac Troponin for Assessment of Myocardial Injury in COVID-19: JACC Review Topic of the Week. J Am Coll Cardiol. 2020;76(10):1244-58.
8. Castiello T, Georgiopoulos G, Finocchiaro G, Claudia M, Andrea Gianatti A, Delialiss D et al. COVID 19 and myocarditis: a systematic review and overview of current challenges. Heart Failure Reviews (2022) 27:251–261.
9. Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK,Bassiri H, et al. American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 1. Arthritis Rheumatol. 2020;72(11):1791-805.
10. Aretz HT, Billingham ME, Edwards WD, Factor SM, Fallon JT, Fenoglio JJ Jr, Olsen EG, Schoen FJ. Myocarditis: a histopathologic definition and classification. Am J Cardiovasc Pathol. 1987; 1: 3–14.
11. Malčić I, Jelašić D, Šarić D i sur. Dijagnostička vrijednost biopsije miokarda i suvremena analiza bioptata u dijagramu dijagnostičkog toka primarnih i drugih kardiomiopatija u djece. Diagnostic value of myocardial biopsy in the diagnostic algorithm in cardiomyopathies in children. Liječ Vjesn 2004;26: 227–34.