key: cord-0802137-uan47pm5 authors: Singh, Manavotam; Mehta, Neil; Hayat, Fatima; Soria, Cesar E.; Hashim, Hayder; Satler, Lowell F.; Barac, Ana title: Recurrent Chest Pain after COVID-19: Diagnostic Utility of Cardiac Magnetic Resonance Imaging date: 2021-08-21 journal: CJC Open DOI: 10.1016/j.cjco.2021.08.003 sha: 406461e272619edd1677cc5d4e708c7f98da4d31 doc_id: 802137 cord_uid: uan47pm5 We report a case of myocarditis in an adult patient with recent COVID-19 infection presenting as recurrent ST-segment elevation, mimicking coronary vasospasm. This case highlights the wide range of presentations of COVID-19 related myocarditis. The novel teaching point is that COVID-19 myocarditis can present with acute manifestations such as chest pain and transient ST-segment elevation even several weeks after complete recovery from initial infection. CMR should be considered in patients with chest pain syndromes and angiographically normal coronary arteries as the presence of LGE and high T2 signal can be diagnostic. A follow up CMR may be used to assess resolution. A case of myocarditis in young adult without cardiovascular risk factors and had history of complete recovery from mild COVID-19 infection six weeks prior, who presented with transient and recurrent STsegment elevation. This case highlights the wide range of presentations of COVID-19 related myocarditis and demonstrates the advantages of cardiac magnetic resonance imaging in delineating the etiology of myocardial injury. We report a case of myocarditis in an adult patient with recent COVID-19 infection presenting as recurrent ST-segment elevation, mimicking coronary vasospasm. This case highlights the wide range of presentations of COVID-19 related myocarditis. The novel teaching point is that COVID-19 myocarditis can present with acute manifestations such as chest pain and transient ST-segment elevation even several weeks after complete recovery from initial infection. CMR should be considered in patients with chest pain syndromes and angiographically normal coronary arteries as the presence of LGE and high T2 signal can be diagnostic. A follow up CMR may be used to assess resolution. A 25-year-old male with a history of mild Coronavirus Disease-2019 (COVID-19) infection, characterized with low grade fever and malaise for several days, with complete recovery six weeks prior presented to the emergency room with intermittent episodes of substernal chest pain with radiation to both arms. He denied diaphoresis and shortness of breath. On initial evaluation, the patient was awake and conversant with heart rate of 82 beats per minute, blood pressure of 131/73mm Hg, temperature of 36.4 degree Celsius, and oxygen saturation of 100% on room air. While in the emergency room, he infection. The treatment for COVID-19 myocarditis remains uncertain, with options including corticosteroids, IL-6 inhibitors, and antivirals. Given clinical improvement and the lack of data on the use of immunosuppressive therapy, our patient was treated supportively with plans for follow-up cardiac MRI as an outpatient. He was additionally advised to restrict physical activity for three to six months, a recommendation consistent with the American Heart Association/American College of Cardiology scientific statement on myocarditis. (6) Our findings of residual LGE on follow-up CMR imaging, several months after the acute myocarditis have been previously described in non-COVID-19 myocarditis. (7) While baseline LGE represents a known predictor of cardiac mortality, the long term impact of persistent LGE on cardiac events during follow-up remains uncertain.(8) Further study will be needed to determine whether COVID-19 myocarditis has similar outcomes compared to myocarditis of other causes. -COVID-19 myocarditis can present with acute manifestations such as chest pain and transient ST-segment elevation even several weeks after complete recovery from initial infection. -CMR should be considered in patients with chest pain syndromes and angiographically normal coronary arteries as the presence of LGE and high T2 signal can be diagnostic. -A follow up CMR may be used to assess resolution. COVID-19 myocarditis is highly variable in presentation. We report a case of COVID-19 myocarditis developing six weeks after initial COVID-19 infection and presenting with transient and recurrent inferior ST-segment elevation, mimicking coronary vasospasm. This case demonstrates the clinical utility of cardiac MRI in the diagnosis of myocarditis in the setting of an atypical presentation. The clinical course in this case was mild and the patient improved with supportive management. Cardiac T2 mapping: robustness and homogeneity of standardized in-line analysis ST-Segment Elevation in Patients with Covid-19 -A Case Series Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of Myocardial Infarction With Nonobstructive Coronary Arteries in Women Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations Recognizing COVID-19-related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Other Cardiomyopathies, and Myocarditis: A Scientific Statement From the American Heart Association and American College of Cardiology Cardiac magnetic resonance imaging in myocarditis reveals persistent disease activity despite normalization of cardiac enzymes and inflammatory parameters at 3-month follow-up Long-term follow-up of biopsy-proven viral myocarditis: predictors of mortality and incomplete recovery