FRAMINGHAM, Mass. — Patients who wind up hospitalized with COVID-19 and recover can likely claim one advantage over those who battle the infection at home. At least they’ll know, if an ECG and blood test are done, whether the virus has attacked the heart to cause acute myocarditis.
"Myocarditis is an inflammatory condition of the heart muscle that is most commonly caused by a viral infection," said James Alderman, MD, a cardiologist at Metrowest Medical Center in Framingham.
During the surge in COVID-19 patients in spring, doctors at Metrowest noticed something unusual about some of those subsequently diagnosed with myocarditis.
"There were times where we would see abnormalities on the EKG that were suggestive or absolutely diagnostic of acute myocarditis and the person being admitted to the hospital might have no cardiac symptoms at all," Alderman said. "They would come in with their cough, their fever, their GI symptoms... and it was just an incidental finding."
But it was a crucial finding.
Undiagnosed myocarditis can be dangerous in the long term if it causes significant damage to heart tissue. Arrhythmias can result -- especially if the impaired heart is put under stress, such as during athletics. Some of these can be mild -- but others can result in sudden cardiac arrest.
“There’s actually no known effective treatment for myocarditis,” Alderman said. “Which has been an incredibly frustrating situation when we see these deathly ill patients, young patients coming in with COVID myocarditis.”
Alderman remembers one patient last spring in particular.
“I still have nightmares about this 43-year-old woman who worked in a nursing home who had a large exposure to the virus and came in with multiple symptoms,” he said. “She was sick but awake, alert, using her cell phone. Within 5 hours she was dead.”
“We hear a bolus of steroids can be helpful,” Alderman said. ”Then there are other studies saying steroids are of no benefit. Remdesivir may be helpful. We certainly will use it But whether it actually helps is hard to say.”
The problem, Alderman said, is that sometimes the cardiac injury is linked to what is known as a 'cytokine storm' -- which is actually the body acting as its own worst enemy.
“It’s the body mounting an intense immunological defense against the virus,” Alderman said. “The worst cases of myocarditis complicating COVID is actually from that cytokine storm.”
Those patients, he suggests, have a poor prognosis: "(With) the amount of cellular injury... the die may be already cast by the time they come in that sick to the hospital."
One of those affected by COVID-19 myocarditis is Red Sox pitcher Eduardo Rodriguez. He reportedly has a mild form -- as many cases of myocarditis turn out to be -- and is expected to recover.
But he is nonetheless out for the season.
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RESOURCES:
- Massachusetts Coronavirus Information
- Boston Coronavirus Information
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