- Detailed history and physical examination.
- 12-lead ECG on initial visit and periodically, as needed.
- Serum high-sensitivity troponin, NT-proBNP (according to index of clinical suspicion).
- Echocardiography to assess for global and regional wall motion abnormalities and function.
- Cardiac rhythm monitoring.
- Cardiac MRI, as clinically indicated.
- Cardiac autoantibody titres may be helpful but not in the acute phase.

University of Michigan - Ann Arbor

University of Texas at Austin

Cardiac injury and acute myocarditis are well-established results of viral infections. In regards to COVID-19, reports of myocyte necrosis and mononuclear cell infiltrates suggests that myocarditis could be important in the occurrence of cardiac injury in patients. Mycarditis has the potential to turn into a conduciton block, tachyarrhythmia, and impairment of left ventricular function. Though the details of these findings are still unclear. 
Clinically, COVID-19 related myocarditis may only manifest as mild chest pain and could be rather indistinguishable from other causes in most patients. Sympotoms of myocarditis in COVID-19 patients usually do not present themselves until 10-14 days after the initial onset of symptoms. Data suggests that the delay in myocardial inflammation has to two with two pathogenic mechanisms. First, 'cytokine storm' promotes subclinical autoimmune myocarditis. Secondly, myocardial damage and/or molecular mimicry "initiate a de Novo autoimmune reaction". 


COVID-19 and Myocarditis 

Guzik, T. J., Mohiddin, S. A., Dimarco, A., Patel, V., Savvatis, K., Marelli-Berg, F. M., Madhur, M. S., Tomaszewski, M., Maffia, P., D'Acquisto, F., Nicklin, S. A., Marian, A. J., Nosalski, R., Murray, E. C., Guzik, B., Berry, C., Touyz, R. M., Kreutz, R., Wang, D. W., Bhella, D., . . . Mclnnes, I. B. (2020). COVID-19 and the cardiovascular system: Implications for risk assessment, diagnosis, and treatment options. Cardiovascular Research, 116(10). https://doi.org/10.1093/cvr/cvaa106

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