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COVID-19 Myocarditis — EECC MCQ

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ModerateGeneral CardiologyCOVID-19 MyocarditisEECC

A 35-year-old man develops chest pain and troponin elevation 2 weeks after a COVID-19 infection. ECG shows diffuse ST elevation. CMR shows biventricular dysfunction (LVEF 40%), diffuse myocardial oedema on T2 mapping, and patchy non-ischaemic LGE. What is the most likely diagnosis and recommended management?

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Correct answer: A — COVID-19-associated myocarditis — supportive care with standard HF therapy, avoidance of exercise for 3-6 months, and CMR follow-up to assess recovery

COVID-19-associated myocarditis is a recognised cardiac complication of SARS-CoV-2 infection, occurring through direct viral cardiotropism or immune-mediated mechanisms. CMR findings of diffuse oedema and non-ischaemic LGE with biventricular dysfunction are diagnostic. The 2025 ESC Myocarditis/Pericarditis Guidelines apply the same diagnostic and management framework to COVID-19 myocarditis as to other viral myocarditides: supportive care, GDMT for heart failure, avoidance of competitive sport and intense exercise for at least 3-6 months with repeat CMR before return to activity. NSAIDs/colchicine should be avoided in acute myocarditis (unlike pericarditis). Immunosuppression is not routinely recommended for viral myocarditis.

Reference: ESC (2025): Guidelines for Myocarditis and Pericarditis