While the majority of the current COVID-19 related news pertains to the care and treatment of patients with confirmed coronavirus cases, there is emerging data about the complications that can arise after a patient recovers from the virus.
New JAMA Study
A recent publication in the Journal of American Medical Association featured a case study involving a 53-year-old female patient in Italy, who presented in the emergency room with fatigue and symptoms of heart failure, a week after respiratory tract symptoms.
Before being admitted to the CCU, she tested positive for COVID-19. While in the CCU, she underwent a cardiac MRI exam which detected increased cardiac wall thickness along with many other indications that pointed towards an acute myopericarditis diagnosis.
What is Myocarditis?
Myocarditis is an inflammation of the cardiac muscle and is sometimes referred to as acute heart dysfunction. While relatively uncommon, myocarditis can arise in patients who have bacterial, fungal or viral infections that make their way into the heart tissue. Symptoms may appear subtle and difficult to identify in early-stage and mild cases. In more advanced cases, common symptoms may include fatigue, resting chest pain and fatigue.
Historically, the diagnosis has required electrocardiography or a biopsy to be performed on the cardiac tissue. With advancements in the field of nuclear medicine, PET and SPECT imaging that target inflammation or muscle injury are able to provide a non-invasive and highly sensitive option to identify the primary cause of myocarditis.
Are Myocarditis Diagnoses on the Rise?
Perhaps. One of the most common causes of myocarditis is tied to virus infections. While it is still being investigated, many researchers and physicians believe that the novel coronavirus will contribute to a sudden increase of myocarditis diagnoses and complications.
What the Medical Community Can Do to Prepare
With the spread of COVID-19 still on the rise, we are beginning to see more cases of myocarditis being diagnosed. As previously mentioned, it can be difficult to pick up on the often-subtle symptoms of a patient who has a mild case or is in the early stage of viral infection. It is imperative that we become more vigilant of these commonly overlooked symptoms, especially in patients that are impacted by the virus.
Some of the ways that healthcare providers can detect potential myocarditis in patients include:
- Laboratory testing – to include troponin levels
- Cardiac imaging:
- SPECT, Attenuation Correction SPECT or SPECT/CT
- PET or PET/CT
- MRI
- CT
- Ultrasound
- Electrocardiography
- Biopsy
Next steps
While the healthcare community is doing its best to contain and limit COVID-19 exposure and infections, the fact of the matter is that the viral infections are still on the rise.
It is important to not only treat the patient for the virus but to seek opportunities to treat other medical conditions brought on by the virus itself. Raising and spreading awareness of information is common practice with the medical community, and the sudden increase of patients having myocarditis diagnosis associated with a coronavirus infection is no exception.
Every healthcare facility should take a moment to re-evaluate how their radiology department is currently operating to ensure that, as more myocarditis cases are expected, they are able to handle the increased patient volumes.
Additional cardiac imaging exams may be needed, and it is imperative that your facility is prepared to address the sudden need.
If you find yourself in a situation where you may need additional imaging resources, consider reaching out to an organization like Digirad for turn-key cardiac imaging solutions (nuclear medicine and ultrasound) or DMS Health (SPECT/CT, PET/CT, MRI, CT, ultrasound, nuclear medicine) for interim or mobile imaging equipment solutions.
In the meantime, let’s continue to raise awareness and prepare for the future healthcare needs of our communities.
