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Published on September 29, 2020

Most former COVID patients don’t need a cardiac MRI

Myocarditis

Signs of myocarditis – a potentially dangerous and relatively rare inflammation of heart muscle – have been found in two studies of people following mild to moderate cases of COVID-19 infection. So, does that mean anyone who caught the virus should have a cardiac MRI?

“I don’t think that’s really useful,” said Elissa Thompson, MD, a cardiologist at Cape Cod Healthcare Cardiovascular Center in Hyannis. The heart-imaging procedure should be reserved for people who are sick enough to be hospitalized, not all former coronavirus patients, she said.

Health experts don’t yet know how many people might develop myocarditis following COVID-19 infections, Dr. Thompson said. They also don’t know whether the myocarditis will resolve over time, affect part or all of the heart, or cause serious damage, such as possibly fatal arrhythmias or heart failure. 

Proving whether the coronavirus caused a patient’s myocarditis is difficult, too, she said, as confirmation would require taking a biopsy of heart tissue to search for evidence of the virus, and the body may have cleared the virus by the time a biopsy of the inflamed heart is considered.

“It’s usually viral,” she said. “But most of the time when people get myocarditis, we don’t know what virus caused it.”

Other viruses that can cause myocarditis include Coxsackie virus (an enterovirus), parvovirus B19 (causes fifth disease) and herpes virus 6, according to the Myocarditis Foundation. Some bacterial infections (including the STD chlamydia), tick-borne diseases (Lyme, ehrlichiosis and babesiosis), as well as fungal infections, and exposures to toxins, alcohol, radiation and some drugs can cause myocarditis.

“It’s not common – less than 100 student (college) athletes a year get myocarditis,” Dr. Thompson said. “In my career, I’ve seen two or three cases.”

Dr. Thompson had her own concerns around COVID-19 and myocarditis, having contracted the coronavirus in March.

“I had a cough and wasn’t able to smell, and pretty severe heart pain,” she said. “I thought I might have had myocarditis.”

But at that time, due to the shutdown, having a cardiac MRI was an unlikely option, she said, so she rode out the illness at home with her husband and kids. She said she believes she has since fully recovered.

Studies Start Furor

The concern that COVID-19 infections might cause myocarditis started with a German study published July 27, 2020 in JAMA Cardiology that found cardiac involvement in 78 of 100 patients who had recently recovered from infection, and cardiac inflammation in 60 patients. Subsequently, a study at Ohio State University published Sept. 11, 2020 in JAMA Cardiology looked at college athletes who had mild or asymptomatic cases of COVID-19. It found four of 26 athletes had cardiac MRIs indicating myocarditis and eight other athletes had results suggesting prior myocarditis.

On Sept. 9, 2020 a group of doctors, researchers and imaging specialists wrote a letter to 18 American and European medical and imaging societies, urging the professional groups to offer clear guidance discouraging cardiac MRIs for asymptomatic former COVID-19 patients. The group cited the public alarm news reports of the studies had caused, and the uncertainty of what the study results meant. It said the studies didn’t prove COVID-19 caused the indications of myocarditis, and that more research was needed.

In reaction, the Big Ten college football conference announced in mid-September that all student athletes with COVID-19 will have to undergo testing, including bloodwork, an electrocardiogram, an echocardiogram and a cardiac MRI and be cleared by a cardiologist before being allowed to play.

Dr. Thompson said any student athlete who has been diagnosed with myocarditis shouldn’t play or perform heavy exertion for three to six months.

Signs of Myocarditis

Worried that the coronavirus may have caused you to develop myocarditis? Dr. Thompson listed some of the symptoms:

  • Difficulty breathing while lying down.
  • Chest pain with exertion.
  • Feeling of chest tightness.
  • Unusual shortness of breath.

Contact your doctor if you have these symptoms, she said. They may be caused by COVD-19 or another illness, but they should be checked out.