scholarly journals Cardiac magnetic resonance imaging in early diagnostics of myocardial inflammation after COVID-19: Case series and literature review

2021 ◽  
Vol 2 (4) ◽  
pp. 323-336
Author(s):  
Marija Zdravković ◽  
Slobodan Klašnja ◽  
Maja Popović ◽  
Predrag Đuran ◽  
Andrea Manojlović ◽  
...  

Although, in the beginning, it was considered a respiratory infection with bilateral pneumonia as its main manifestation, COVID-19 is more of a multisystemic disease with various extrapulmonary manifestations. Cardiovascular manifestations are caused by direct viral involvement or by the effects of different cytokines on the myocardium and can occur during the acute phase of the disease or in the post-acute stadium. The most common cardiovascular symptoms in the post-acute COVID-19 stadium are fatigue, shortness of breath, chest pain, and palpitations. Routine cardiovascular diagnostics in these patients is usually without significant findings, although underlying myocardial inflammation may be present. Myocardial damage can also be the substrate for the worsening of heart failure and different potentially life-threatening arrhythmias, which is extremely important for further treatment and prognosis. Cardiac magnetic resonance imaging is a sophisticated, non-radiating imaging modality that can provide important information regarding left and right ventricle volumes and function, tissue characterization, and scar quantification. It is the golden standard in non-invasive diagnostics of myocarditis. In patients with prior COVID-19 infection and cardiovascular symptoms, typical signs of myocarditis, including myocardial edema, necrosis, and myocardial scarring, may be seen in cardiac magnetic resonance. Also, there are sophisticated cardiac magnetic resonance imaging modalities that can register subtle changes in the myocardium, in terms of myocardial inflammation, without visible signs in standard sequences. We present a case series of patients with different myocardial inflammation patterns, followed by a comprehensive review of potential pathophysiological mechanisms, complications, treatment and prognosis of patients with myocarditis or pericarditis after COVID-19.

Author(s):  
Ali Kemal Erenler ◽  
Ali Kemal Erenler ◽  
Seval Komut ◽  
Ahmet Baydin

In the beginning of December 2019, an outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was determined in Wuhan, Hubei, China. Besides its predominant respiratory system-related symptoms, cardiovascular involvement has also been described in adults with direct and indirect cardiac injury. Pre-existing cardiovascular disease and cardiac risk factors have been shown to increase the risk of cardiac complications of COVID-19 infection. However, it is also known that healthy and asymptomatic COVID-19 survivors suffer cardiac damage-related complications. Cardiac Magnetic Resonance Imaging (CMRI) is known to be the reference non-invasive standard to present cardiac function and tissue characterization. It is recommended as an effective and efficient diagnostic imaging choice to obtain critical information for clinical diagnosis and decision-making. In this article, we sought the usefulness of CMRI in cardiovascular complications related to COVID-19.


Author(s):  
Guido Claessen ◽  
André La Gerche

Cardiac magnetic resonance imaging (CMR) has become an extremely valuable tool in the detection of cardiac pathology because of its accuracy in assessing cardiac structure and function, and its ability to provide tissue characterization. In this chapter we discuss the role of CMR in the evaluation of athletes, in whom it can be challenging to differentiate physiological changes from underlying myocardial pathology. It is fundamental to distinguish athletes undergoing CMR because of concerning symptoms from athletes evaluated for screening purposes with little pre-test probability for disease. We will briefly highlight state-of-the-art imaging sequences and post-processing techniques that are being used to assess cardiac morphology, function, and viability in athletes. Finally, we will discuss CMR findings present in inherited and acquired cardiomyopathies and how to distinguish these from physiological changes observed in highly trained athletes.


2020 ◽  
Vol 4 (4) ◽  
pp. 1-5
Author(s):  
Anthony Matta ◽  
Khaled Elenizi ◽  
Frederic Bouisset ◽  
Jerome Roncalli

Abstract Background Kounis syndrome is the occurrence of acute coronary syndrome precipitated by an allergic reaction in the presence or absence of underlying coronary artery disease. The syndrome is explained by the effect of released inflammatory mediators on the coronary arteries and platelets. Case summary We report an uncommon case of Kounis syndrome Type II in a 65-year-old man 24 h after being bitten by a hymenoptera. Clinical context, electrocardiogram, coronary angiography, and enhanced cardiac magnetic resonance imaging (MRI) imaging modality are presented. Discussion Awareness and understanding of this syndrome is essential for starting early and appropriate therapy, thereby preventing life-threatening events. Accordingly, we highlight the importance of enhanced cardiac MRI to complete the assessment of this entity.


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