Severe Acute Respiratory Syndrome Coronavirus Associated Myocarditis


  • Frans E. N. Wantania Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Prof. dr. R. D. Kandou Hospital, Manado, Indonesia
  • Ribka E. Wowor Department of Public Health, Faculty of Public Health, Sam Ratulangi University, Manado, Indonesia
  • Ridwan Tandiawan Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Prof. dr. R. D. Kandou Hospital, Manado, Indonesia



Myocarditis, SARS-CoV-2, COVID-19


Myocardial injury is common in patients with coronavirus disease 2019 (COVID-19). Among COVID-19 related myocardial injuries, etiology may vary, including myocarditis, myocardial infarct, sepsis-associated myocardial injury, and/or stress-induced cardiomyopathy. More data from prospective cohorts and case series are needed to understand the exact mechanism of COVID-19 associated myocardial injuries. It is clinically suspected that myocarditis is the cause of myocardial injury. However, myocarditis has a heterogeneous clinical presentation and tends to be underdiagnosed in critically ill COVID-19 patients. Due to the potential of rapid deterioration in the patient’s condition, it is imperative to recognize myocarditis as a sequel to COVID-19, and a multidisciplinary team should be formed for managing all clinically suspected patients with COVID-19 associated myocarditis. Further studies are needed to recognize better and understand the relationship between myocarditis and COVID-19.


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Lie SA, Wong SW, Wong LT, Wong TG, Chong SY. Practical considerations for performing regional anesthesia: Lessons learned from the COVID-19 pandemic. Can J Anaesth. 2020;67(7):885-92. PMid:32212103 DOI:

Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA. 2020;323(16):1612-4. PMid:32191259 DOI:

Alhogbani T. Acute myocarditis associated with novel Middle East respiratory syndrome coronavirus. Ann Saudi Med. 2016;36(1):78-80. PMid:26922692 DOI:

Pirzada A, Mokhtar AT, Moeller AD. COVID-19 and myocarditis: What do we know so far? CJC Open. 2020;2(4):278-85. PMid:32691024 DOI:

Siripanthong B, Nazarian S, Muser D, Deo R, Santangeli P, Khanji MY, et al. Recognizing COVID-19-related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm. 2020;17(9):1463-71. PMid:32387246 DOI:

Yajima T, Knowlton KU. Viral myocarditis: From the perspective of the virus. Circulation. 2009;119(19):2615-24. PMid:19451363 DOI:

Schenk T, Enders M, Pollak S, Hahn R, Huzly D. High prevalence of human parvovirus B19 DNA in myocardial autopsy samples from subjects without myocarditis or dilative cardiomyopathy. J Clin Microbiol. 2009;47(1):106-10. PMid:19005147 DOI:

Hu H, Ma F, Wei X, Fang Y. Coronavirus fulminant myocarditis treated with glucocorticoid and human immunoglobulin. Eur Heart J. 2021;42(2):206. PMid:32176300 DOI:

Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol. 2020;75(18):2352-71. PMid:32201335 DOI:

Hendren NS, Drazner MH, Bozkurt B, Cooper LT Jr. Description and proposed management of the acute COVID-19 cardiovascular syndrome. Circulation. 2020;141(23):1903-14. PMid:32297796 DOI:

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395(10229):1054-62. PMid:32171076 DOI:

Tian S, Hu W, Niu L, Liu H, Xu H, Xiao SY. Pulmonary pathology of early-phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer. J Thorac Oncol. 2020;15(5):700-4. PMid:32114094 DOI:

Chen L, Li X, Chen M, Feng Y, Xiong C. The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2. Cardiovasc Res. 2020;116(6):1097-100. PMid:32227090 DOI:

Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D, et al. Cardiac Involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):819-24. PMid:32219357 DOI:

Metkus TS, Sokoll LJ, Barth AS, Czarny MJ, Hays AG, Lowenstein CJ, et al. Myocardial injury in severe COVID-19 compared with non-COVID-19 acute respiratory distress syndrome. Circulation. 2020;143(6):553-65. PMid:33186055 DOI:

Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, et al. 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(33):2636-48. PMid:23824828 DOI:

Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, et al. COVID-19 and cardiovascular disease. Circulation. 2020;141(20):1648-55. PMid:32200663 DOI:

Chu GC, Flewitt JA, Mikami Y, Vermes E, Friedrich MG. Assessment of acute myocarditis by cardiovascular MR: Diagnostic performance of shortened protocols. Int J Cardiovasc Imaging. 2013;29:1077-83. PMid:23404383 DOI:

Tschöpe C, Cooper LT, Torre-Amione G, Van Linthout S. Management of myocarditis-related cardiomyopathy in adults. Circ Res. 2019;124(11):1568-83. DOI:

Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A Trial of lopinavir-ritonavir in adults hospitalized with severe COVID-19. N Engl J Med. 2020;382(19):1787-99. PMid:32187464 DOI:

Coyle J, Igbinomwanhia E, Sanchez-Nadales A, Danciu S, Chu C, Shah N. A recovered case of COVID-19 myocarditis and ARDS treated with corticosteroids, tocilizumab, and experimental AT-001. JACC Case Rep. 2020;2(9):1331-6. PMid:32368755 DOI:




How to Cite

Wantania FEN, Wowor RE, Tandiawan R. Severe Acute Respiratory Syndrome Coronavirus Associated Myocarditis. Open Access Maced J Med Sci [Internet]. 2021 Aug. 22 [cited 2024 Feb. 23];9(F):299-304. Available from:



Narrative Review Article