COVID-19 myocarditis: Features of echocardiography

COVID-19 myocarditis represents an important clinical condition, having a heterogeneous presentation from subclinical cases to cardiogenic shock requiring intensive level care. The exact physiopathological mechanisms of myocardial injury are not well established, contributing acute inflammation, vasoconstriction, and atherothrombosis. Bedside transthoracic echocardiography is rapid, noninvasive, and represents the initial exam to detect and monitor cardiac involvement and to guide therapeutic interventions in COVID-19 patients. During the COVID-19 pandemic, due to the high contagion risk associated with transthoracic echocardiography, all operators should have adhered to preventive measures. The two-dimensional (2D) echocardiographic features are not specific only for COVID-19 myocarditis and should be complemented by new echocardiographic applications, such as speckle tracking echocardiography analysis, to identify patients with a poor prognosis. Right ventricular failure is a common finding in patients with COVID-19 and is associated with a poor outcome. Transthoracic echocardiography can help clinicians diagnose right ventricular dysfunction both with conventional 2D parameters and with new echocardiographic applications, such as speckle tracking echocardiography or three-dimensional right ventricular ejection fraction.