[BostonCard]

1. Do we have enough MRI scans of people who haven't had Covid-19 to compare as a control group, and accurately conclude Covid-19 is reason for increased Myocarditis?  

Yes.  Cardiac MRIs are not common, but the technology has been around long enough that scans of healthy people exist for comparison.

2. Do we have any studies showing no Myocarditis before Covid-19 and having it after, in enough numbers to show causation?

No, because the procedure is not commonly done, particularly in healthy people, it's unlikely that anyone happened to have had an MRI done, but because the condition is fairly rare, you wouldn't expect any meaningful myocarditis pre-COVID. 

3. Is it only a matter of time before all infected by Covid-19 develop Myocarditis?

No.  It is unlikely that all patients with COVID-19 will develop myocarditis.  

4. BC mentioned two types exist. What is the Covid-19 one? More or less problematic? 

Not sure what you meant by "two types".  I mentioned that we are not sure if the mechanism is direct myocardial infection by COVID-19, or the effect of systemic inflammation that is turned on by COVID-19.  We don't have a ton of information about the pathophysiology of COVID-19 induced myocarditis.

Direct viral infection of the heart is probably a bit scarrier, based on the fact that viral myocarditis, when it occurs, can be severe enough to require a heart transplant.

Here's a figure from the European Society of Cardiology:

5. Will it go away, or is it a permanent condition?

I don't think we know yet.

6. If permanent, is there any data on long-term health and life expectancy with those who have Covid Myocarditis?

Probably a range between "asymptomatic" and "death/requiring heart transplant".  Not to be glib about it, but just as COVID-19 itself, there is likely going to be a brobdingnagian range.  Most of what we know is based on short term outcomes, and biomarkers of cardiovascular injury are associated with worse outcomes during the acute phases.  

7. How do you manage having Covid Myocarditis and is it best to shut down athletic activity like Eduardo Rodriguez was by the Red Sox?

I think there is a cardiologist lurking on the board (who posted at least once).  Hoping he will pipe in here. 

8. Can you do extra damage to your heart by exerting yourself while having Myocarditis and not knowing it?

I'd punt this to the cardiologist as well.  I think moderate exercise is probably ok, but strenuous exercise might be risky.

For what it is worth, both the American College of Cardiology and the European Society of Cardiology have COVID-19 guidelines.  A lot of it is focused on the acute effects, but they touch on chronic effects.

https://www.acc.org/latest-in-cardiology...descending
https://www.escardio.org/Education/COVID...9-Guidance



BC

[BostonCard]

1. Do we have enough MRI scans of people who haven't had Covid-19 to compare as a control group, and accurately conclude Covid-19 is reason for increased Myocarditis?  

Yes.  Cardiac MRIs are not common, but the technology has been around long enough that scans of healthy people exist for comparison.

2. Do we have any studies showing no Myocarditis before Covid-19 and having it after, in enough numbers to show causation?

No, because the procedure is not commonly done, particularly in healthy people, it's unlikely that anyone happened to have had an MRI done, but because the condition is fairly rare, you wouldn't expect any meaningful myocarditis pre-COVID. 

3. Is it only a matter of time before all infected by Covid-19 develop Myocarditis?

No.  It is unlikely that all patients with COVID-19 will develop myocarditis.  

4. BC mentioned two types exist. What is the Covid-19 one? More or less problematic? 

Not sure what you meant by "two types".  I mentioned that we are not sure if the mechanism is direct myocardial infection by COVID-19, or the effect of systemic inflammation that is turned on by COVID-19.  We don't have a ton of information about the pathophysiology of COVID-19 induced myocarditis.

Direct viral infection of the heart is probably a bit scarrier, based on the fact that viral myocarditis, when it occurs, can be severe enough to require a heart transplant.

Here's a figure from the European Society of Cardiology:

5. Will it go away, or is it a permanent condition?

I don't think we know yet.

6. If permanent, is there any data on long-term health and life expectancy with those who have Covid Myocarditis?

Probably a range between "asymptomatic" and "death/requiring heart transplant".  Not to be glib about it, but just as COVID-19 itself, there is likely going to be a brobdingnagian range.  Most of what we know is based on short term outcomes, and biomarkers of cardiovascular injury are associated with worse outcomes during the acute phases.  

7. How do you manage having Covid Myocarditis and is it best to shut down athletic activity like Eduardo Rodriguez was by the Red Sox?

I think there is a cardiologist lurking on the board (who posted at least once).  Hoping he will pipe in here. 

8. Can you do extra damage to your heart by exerting yourself while having Myocarditis and not knowing it?

I'd punt this to the cardiologist as well.  I think moderate exercise is probably ok, but strenuous exercise might be risky.

For what it is worth, both the American College of Cardiology and the European Society of Cardiology have COVID-19 guidelines.  A lot of it is focused on the acute effects, but they touch on chronic effects.

https://www.acc.org/latest-in-cardiology...descending
https://www.escardio.org/Education/COVID...9-Guidance



BC