Management of COVID-19 Related Myocarditis: A Systematic Review

Abstract

On January 7 in China, one patient was identified with a new corona virus in throat culture, and World Health Organization called it severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Herein, we aimed to summarize overall data for COVID-19 disease related myocarditis and its treatment. In the initial stages, patients developed symptoms of severe acute respiratory infection and afterwards other serious symptoms such as septic shock, metabolic acidosis, coagulation disorders, multiple organ failure problems developed. Complications were mostly associated with pneumonia (91.1%) and acute respiratory distress syndrome. Before the Coronavirus Disease 2019 (COVID-19) infection, the presence of cardiovascular diseases has been found to increase the severity and side effects of primary respiratory syndrome. Since management of COVID-19 related myocarditis is crucial, 114 publications indexed in Pubmed between Dec 10, 2019 and October 16, 2020 were scanned extensively in this review in order to summarize the treatment options of COVID-19 related myocarditis. Analysis of 44.672 COVID-19 cases showed an increased risk of mortality in elderly people (14.8% for patients over 80 years old) and patients with cardiovascular disease (10.5%). Patients with diabetes (7.3%) and hypertension (6%) also demonstrated an increased risk of mortality. The rate of underlying chronic respiratory disease was 6.3%. Arrhythmia was found in 16.7% and acute heart injury existed in 7.2% of 138 hospitalized COVID-19 patients. ACE inhibitors or ARBs should be administered in patients with wall motion abnormality or heart failure with reduced EF. Diuretics should be considered in patients with volume overload and torsemide should be preferred as first option. Non-steroidal antiinflammatory drugs and cardiac glycosides should be avoided. Physical activity should be restricted until the disease resolved. IVIG and interferon therapy are feasible treatment options with reasonable side effect profile.

Keywords

• covid-19
• myocarditis
• arrhythmia
• diuretics
• systematic review