Differentiating COVID-associated myocarditis from other Diseases

• Pericardial effusion may be detectable

• Non-specific:may show nonspecific ST-T abnormalities, sinus tachycardia and conduction abnormalities (such as bundle-branch blocks or atrioventricular conduction delays)

• Non-specific: In fulminant myocarditis, cardiac chamber sizes are usually normal with an increased septal thickness (secondary to acute myocardial edema), whereas in acute myocarditis marked left ventricular dilation and normal wall thickness might be seen.
• Pericardial effusion may be be seen.

• CMR: T2-weighted edema imaging shows the presence of “acute myocardial inflammation”. “Late gadolinium enhancement (LGE) imaging” can demonstrate myocardial damage.

• No specific X-ray findings

• ST elevation MI (STEMI)
• Non-ST elevation MI (NSTEMI) or Non Q wave

• Localized wall motion abnormalities
• Diffuse hypokinesia
• Left ventricular ejection fraction was lower than 50% in about 61% of the individuals.

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• Takotsubo-shaped heart, in which there is apical ballooning and narrowing of the proximal portion near the great vessels.

• ST elevation in the precordial leads
• T wave inversion
• Q wave formation
• QT prolongation
• New-onset bundle branch block (BBB)
• Rarely, malignant ventricular arrhythmias may be seen

• Apical ballooning
• Apical or mid-segment dyskinesia or akinesia
• Left ventricular systolic dysfunction
• Reduced ejection fraction

• CT: Regional abnormalities in the wall motion of the heart, along with absence of coronary atherosclerosis.
• CMR: Absence of gadolinium hyper-enhancement; also shows absence of irreversible damage, regional wall abnormalities with extent and segmental LV dysfunction.

• Cardiomegaly
• Pulmonary edema (interstitial, alveolar)

• Left ventricular hypertrophy
• Low-voltage QRS
• Non-specific ST-T change

• Systoloic dysfunction (in HFrEF)
• Diastoic dysfunction (in HFpEF)
• COVID-19-associated stress cardiomyopathy (apical ballooning)

• CT: Cardiomegaly, Pulmonary edema
• CMR: Signs of underlying myocarditis may be seen.

• Lobar Consolidation

• Prolonged PR interval
• Transient T wave inversions

• CT: Lobar Consolidation

• Bilateral ground-glass opacities

• Signs of RV dysfunction/RV dilatation may be seen.

• CT: Bilateral ground-glass opacities

• May show Fleischner sign (enlarged pulmonary artery), Hampton hump, Westermark’s sign

• Non-specific:may show S1Q3T3 pattern

• May show signs of RV strain, RV dilatation, RV dysfunction (if large PE)

• On CT angiography: Intra-luminal filling defect
• On MRI: Narrowing of involved vessel
• No contrast seen distal to obstruction
• Polo-mint sign (partial filling defect surrounded by contrast)

• Increased D-dimer, fibrinogen, and fibrin degradation products levels
• May have symptoms and/or signs of accompanying DVT