American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
American Journal of Medical Case Reports. 2020, 8(9), 299-305
DOI: 10.12691/ajmcr-8-9-11
Open AccessLiterature Review

A Systematic Review of COVID-19 and Myocarditis

Pramod Theetha Kariyanna1, Bayu Sutarjono2, Ekjot Grewal3, Kamal Preet Singh1, Lyudmila Aurora1, Leanna Smith1, Harshith Priyan Chandrakumar4, Apoorva Jayarangaiah1, Sarah A. Goldman1, Moro O. Salifu1 and Isabel M. McFarlane1,

1Department of Internal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY 11203, USA

2Saba University School of Medicine, 27 Jackson Road, Devens, MA 01434, USA

3Department of Emergency Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY 11212, USA

4Division of Hematology and Oncology, Department of Internal Medicine, Albert Einstein College of medicine/NYC + HHC Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY, U.S.A- 1046

Pub. Date: June 05, 2020

Cite this paper:
Pramod Theetha Kariyanna, Bayu Sutarjono, Ekjot Grewal, Kamal Preet Singh, Lyudmila Aurora, Leanna Smith, Harshith Priyan Chandrakumar, Apoorva Jayarangaiah, Sarah A. Goldman, Moro O. Salifu and Isabel M. McFarlane. A Systematic Review of COVID-19 and Myocarditis. American Journal of Medical Case Reports. 2020; 8(9):299-305. doi: 10.12691/ajmcr-8-9-11


Background. The COVID-19 infection which emerged in December 2019, is caused by the virus SARS-CoV-2. Infection with this virus can lead to severe respiratory illness, however, myocarditis has also been reported. The purpose of this study is to identify the clinical features of myocarditis in COVID-19 patients. Methods. A systematic review was conducted to investigate characteristics of myocarditis in patients infected with COVID-19 using the search term “Coronavirus” or “COVID” and “myocarditis,” “heart,” or “retrospective.” Case reports and retrospective studies were gathered by searching Medline/Pubmed, Google Scholar, CINAHL, Cochrane CENTRAL, and Web of Science databases. 11 articles were selected for review. Results. COVID-19 myocarditis affected patients over the age of 50 and incidences among both genders were equally reported. Patients presented with dyspnea, cough, fever with hypotension and chest pain. Laboratory tests revealed leukocytosis with increased C-reactive protein, while arterial blood gas analysis demonstrated respiratory acidosis. All cardiac markers were elevated. Radiographic imaging of the chest showed bilateral ground glass opacities or bilateral infiltrates, while cardiac magnetic resonance imaging produced late gadolinium enhancements. Electrocardiography demonstrated ST-segment elevation or inverted T waves, while echocardiography revealed reduced left ventricular ejection fraction with cardiomegaly or increased wall thickness. Management with corticosteroids was favored in most cases, followed by antiviral medication. The majority of studies reported either recovery or no further clinical deterioration. Conclusion. Current available data on COVID-19 myocarditis is limited. Further research is needed to advance our understanding of COVID-19 myocarditis.

COVID-19 SARS-CoV-2 Myocarditis echocardiogram cardiac MRI electrocardiography

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020.
[2]  Joint Mission Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) 2020. Available from
[3]  Letko M, Marzi A, Munster V. Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B beta-coronaviruses. Nat Microbiol 2020.
[4]  Hamming I, Timens W, Bulthuis MLC, Lely AT, Navis GJ, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus: a first step in understanding SARS pathogenesis. J Pathol 2004; 203: 631-7.
[5]  Alhogbani T. Acute myocarditis associated with novel middle east respiratory syndrome coronavirus. Ann Saudi Med 2016; 36(1): 78-80.
[6]  Kociol RD, Cooper LT, Fang JC, Moslehi JJ, Pang PS, Sabe MA, Shah RV, Sims DB, Thiene G, Vardeny O, American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology. Recognition and initial management of fulminant myocarditis: a scientific statement from the American Heart Association. Circulation 2020; 141(6): e69-92.
[7]  Vos T, Barber RM, Bell B, Bertozzi-Billa A, Birkyukov S, Bolliger I, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden Disease Study 2013. Lancet 2015; 386: 743-800.
[8]  Kyto V, Saraste A, Voipio-Pulkki LM, Saukko P. Incidence of fatal myocarditis: a population-based study in Finland. Am J Epidemiol 2007; 165: 570-4.
[9]  Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic review and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535.
[10]  Deng Q, Hu B, Zhang Y, Wang H, Zhou X, Hu W, Cheng Y, Yan J, Ping H, Zhou Q. Suspected myocardial injury in patients with COVID-19: evidence from front-line clinical observation in Wuhan, China. Int J Cardiol 2020.
[11]  Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020..
[12]  Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, Currie M, Qureshi R, Mattis P, Lisy K, Mu P. Chapter 7: Systematic reviews of etiology and risk. In: Aromataris E, Munn Z (Editors). Joanna Briggs Institute Reviewer’s Manual. The Joanna Briggs Institute 2017.
[13]  Doyen D. Morceri P, Ducreux D, Dellamonica J. Myocarditis in a patient with COVID-19: a cause of raised troponin and ECG changes. Lancet 2020.
[14]  Hu H, Ma F, Wei X, Fang Y. Coronavirus fulminant myocarditis treated with glucocorticoid and human immunoglobulin. Eur J Heart 2020.
[15]  Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D, Cani DS, Cerini M, Farina D, Gavazzi E, Maroldi R, Adamo M, Ammirati E, Sinagra G, Lombardi CM, Metra M. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020.
[16]  Irabien-Ortiz A, Carreras-Mora J, Sionis A, Pamies J, Montiel J, Tauron M. Fulminant myocarditis due to COVID-19. Rev Esp Cardiol 2020.
[17]  Kim I, Kim JY, Kim HA, Han S. COVID-19-related myocarditis in a 21-year-old female patient. Eur J Heart 2020.
[18]  Paul J, Charles P, Richaud C, Caussin C, Diakov C. Myocarditis revealing COVID-19 infection in a young patient. Eur Heart J Cardiovasc Imaging 2020.
[19]  Sala S, Peretto G, Gramegna M, Palmisano A, Villatore A, Vignale D, De Cobelli F, Tresoldi M, Cappelletti AM, Basso C, Godino C, Esposito A. Acute myocarditis presenting as a reverse Tako-Tsubo syndrome in a patient with SARS-CoV-2 respiratory infection. Eur J Heart 2020.
[20]  Tavazzi G, Pellegrini C, Maurelli M, Belliato M, Sciutti F, Bottazzi A, Sepe PA, Resasco T, Camporotondo R, Bruno R, Baldanti F, Paolucci S, Pelenghi S, Iotti GA, Mojoli F, Arbustini E. Myocardial localization of coronavirusin COVID-19 cardiogenic shock. Eur J Heart Fail 2020.
[21]  Zeng J, Liu Y, Yuan J, Wang F, Wu W, Li J, Wang L, Gao H, Wang Y, Dong C, Li Y, Xie X, Feng C, Liu L. First case of COVID-19 infection with fulminant myocarditis complication: case report and insights. Preprints 2020.
[22]  Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, Li P, Zhou Y, Lin Y, Duan Q, Luo G, Fan S, Lu Y, Feng A, Zhan Y, Liang B, Cai W, Zhang L, Du X, Li L, Shu Y, Zou H. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: a systematic review and meta-analysis. J Infect 2020; S0163-4453(20)30170-5.
[23]  Cooper Jr LT. Myocarditis. N Engl J Med 2009; 360(15): 1526-38.
[24]  Smith SC, Ladenson JH, Mason JW, Jaffe AS. Elevations of cardiac troponin I associated with myocarditis. Experimental and clinical correlates. Circulation 1997; 95: 163-6.
[25]  Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, Wu Y, Zhang L, Y Z, Fang M, Yu T, Wang Y, Pan S, Zou X, Yuan S, Shang Y. Clinical course and outcomes of critically ill patients with SARS-CoV2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020.
[26]  Park JP, Song J-M, Kim S-H, et al. In-hospital prognostic factors in patients with acute myocarditis. J Am Coll Cardiol 2009; 53:A144-97(abstr 1042-178).
[27]  Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, Fu M, Heliö T, Heymans S, Jahns R, Klingel K, Linhart A, Maisch B, McKenna W, Mogensen J, Pinto YM, Ristic A, Schultheiss H, Swggewiss H, Tavazzi L, Thiene G, Yilmaz A, Charron P, Elliott P, European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013; 34: 2636-48, 2648a.
[28]  Nakashima H, Katayama T, Ishizaki M, Takeno M, Honda Y, Yano K. Q wave and non-Q wave myocarditis with special reference to clinical significance. Jpn Heart J 1998; 39:763-74.
[29]  Sagar S, Liu PP, Cooper Jr LT. Myocarditis. Lancet 2012; 379: 738-47.
[30]  Caforio ALP, Calabrese F, Angelini A, Tona F, Vinci A, Bottaro S, Ramondo A, Carturan E, Iliceto S, Thiene G, Daliento L. A prospective study of biopsy-proven myocarditis: Prognostic relevance of clinical and aetiopathogenetic features at diagnosis. Eur Heart J 2007; 28: 1326-33.
[31]  Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, Liu L, Shan H, Lei C, Hui DSC, Du B, Li L, Zeng g, Yuen K, Chen R, Tang C, Wang T, Chen P, /Xiang J, Li S, Wang J, Liang Z, Peng Y, Wei L, Liu Y, Hu Y, Peng P, Wang J, Liu J, Chen Z, Li G, Zheng Z, Qiu S, Luo J, Ye C, Zhu S, Zhong N, China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; NEJMoa2002032.
[32]  Winter M, Sulzgruber P, Koller L, Bartko P, Goliasch G, Niessner A. Immunomodulatory treatment for lymphocytic myocarditis - a systematic review and meta-analysis. Heart Fail Rev 2018; 23(4): 573-81.
[33]  Yen C, Hung M, Wong Y, Chang C, Lai C, Wu K. Role of intravenous immunoglobulin therapy in the survival rate of pediatric patients with acute myocarditis: a systematic review and meta-analysis. Sci Rep 2019; 9(1): 10459.
[34]  Sangli SS, Noronha SF, Mourad B, Jean R, Bohman JK, Seelhammer TG. A systematic review of preexisting sepsis and extracorporeal membrane oxygenation. ASAIO J 2020; 66(1): 1-7.
[35]  Hekimian G, Jovanovic T, Brechot N, Lebreton G, Leprince P, Trouillet J, Schmidt M, Nieszkowska A, Besset S, Chastre J, Combes A, Luyt C. When the heart gets the flu: fulminant influenza B myocarditis: a case-series report and review of the literature. J Crit Care 2018; 47: 61-5.
[36]  Yang Z, Liu J, Zhou Y, Zhao X, Zhao Q, Liu J. The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis. J Infect 2020; S0163-4453(20)30191-2.
[37]  Chen W, Guo Y, Zhang D, Zhang H. Long-term prognosis of suspected myocarditis and cardiomyopathy associated with viral infection of the myocardial tissue: a meta-analysis of cohort studies. Cardiovasc Ther 2019; 2019: 9342792.