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Here’s the background: Myocarditis appears to result from the direct infection of the virus attacking the heart, or possibly as a consequence of the inflammation triggered by the body’s overly aggressive immune response. And it is not age-specific: In The Lancet, doctors recently reported on an 11-year-old child with multisystem inflammatory syndrome (MIS-C)—a rare illness—who died of myocarditis and heart failure. At autopsy, pathologists were able to identify coronavirus particles present in the child’s cardiac tissue, helping to explain the virus’ direct involvement in her death. In fact, researchers are reporting the presence of viral protein in the actual heart muscle, of six deceased patients. Of note is the fact that these patients were documented to have died of lung failure, having had neither clinical signs of heart involvement, nor a prior history of cardiac disease.
Ossama Samuel, associate chief of cardiology at Mount Sinai Beth Israel in New York, told me about a cluster of younger adults developing myocarditis, some of them a month or so after they had recovered from COVID-19. One patient, who developed myocarditis four weeks after believing he had recovered from the virus, responded to a course of steroid treatment only to develop a recurrence in the form of pericarditis (an inflammation of the sac surrounding the heart). A second patient, in her 40s, now has reduced heart function from myocarditis, and a third—an athletic man in his 40s—is experiencing recurring and dangerous ventricular heart rhythms, necessitating that he wear a LifeVest defibrillator for protection. His MRI also demonstrates fibrosis and scarring of his heart muscle, which may be permanent, and he may ultimately require placement of a permanent defibrillator.
This is an incredibly tricky diagnosis. Patients with myocarditis often experience symptoms like shortness of breath, chest pain, fever and fatigue—while some have no symptoms at all. J.N., a health care provider who asked that his full name not be used, told me that COVID-19 symptoms first appeared in his case in late March. He ultimately was hospitalized at Mount Sinai Medical Center after developing unrelenting fevers spiking to 104 degrees, chest tightness, nausea, vomiting and diarrhea.
“Even the Advil and acetaminophen wouldn’t help my fevers,” said J.N. Just 34 years old, he was diagnosed with COVID-induced myocarditis and severe heart failure. Doctors admitted him to the intensive care unit and placed him on a lifesaving intra-aortic balloon pump due to the very poor function of his heart. He spent two weeks in the hospital, has suffered recurrences since his discharge, and now says, “I’m very careful. I’m very concerned about the length of time I’ve been feeling sick, and if these symptoms are lifelong or will go away anytime soon.” J.N. said that everyday activities, like carrying his one-year-old daughter up a flight of stairs, leave him feeling winded and fatigued. He has been unable to work since March.
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