Understanding long COVID myocarditis: A comprehensive review

In December 2019, the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a viral infection resulting in coronavirus disease 2019 (COVID-19), started in Wuhan, China. COVID-19 spread worldwide, leading to a pandemic that impacted health, society, and the economy despite numerous attempts by various countries to contain its spread. Initially, SARS-CoV-2 infection was considered a respiratory ailment, however, it was later found that this infection could also lead to severe consequences like thromboembolism, heart failure, myocarditis, multi-organ dysfunction, sepsis, etc [1]. According to the latest data from the World Health Organization (WHO), more than 772 million cases of COVID-19 have been reported, with about 7 million fatalities to date [2]. Thus, it is of utmost importance to recognize the potential complications associated with COVID-19. Myocarditis is a condition associated with inflammation of the myocardium along with vast symptomatology. However, its pathogenesis remains unclear. Given the lack of standardized protocols, its diagnostic and therapeutic management presents substantial challenges. While numerous cases of myocarditis during acute COVID-19 infection have been documented, reports concerning myocarditis associated with long COVID are limited [3]. The prevailing evidence predominantly focuses on the acute phase of infection among hospitalized COVID-19 patients, with a marked absence of studies examining cardiovascular (CV) outcomes in non-hospitalized individuals experiencing long-term COVID-19 symptoms [4]. Consequently, the exact incidence of myocarditis during the extended duration of COVID-19, known as long COVID, remains uncertain. Therefore, a thorough review of the available literature could be quite helpful in determining the gaps in knowledge and areas that call for more extensive research that could potentially provide substantial evidence for better management of long COVID myocarditis.

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