{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:43:06Z","timestamp":1777858986155,"version":"3.51.4"},"reference-count":86,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Prim Care Community Health"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>COVID-19 was initially considered to be a respiratory illness, but current findings suggest that SARS-CoV-2 is increasingly expressed in cardiac myocytes as well. COVID-19 may lead to cardiovascular injuries, resulting in myocarditis, with inflammation of the heart muscle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>This systematic review collates current evidence about demographics, symptomatology, diagnostic, and clinical outcomes of COVID-19 infected patients with myocarditis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In accordance with PRISMA 2020 guidelines, a systematic search was conducted using PubMed, Cochrane Central, Web of Science and Google Scholar until August, 2021. A combination of the following keywords was used: SARS-CoV-2, COVID-19, myocarditis. Cohorts and case reports that comprised of patients with confirmed myocarditis due to COVID-19 infection, aged &gt;18\u2009years were included. The findings were tabulated and subsequently synthesized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In total, 54 case reports and 5 cohorts were identified comprising 215 patients. Hypertension (51.7%), diabetes mellitus type 2 (46.4%), cardiac comorbidities (14.6%) were the 3 most reported comorbidities. Majority of the patients presented with cough (61.9%), fever (60.4%), shortness of breath (53.2%), and chest pain (43.9%). Inflammatory markers were raised in 97.8% patients, whereas cardiac markers were elevated in 94.8% of the included patients. On noting radiographic findings, cardiomegaly (32.5%) was the most common finding. Electrocardiography testing obtained ST segment elevation among 44.8% patients and T wave inversion in 7.3% of the sample. Cardiovascular magnetic resonance imaging yielded 83.3% patients with myocardial edema, with late gadolinium enhancement in 63.9% patients. In hospital management consisted of azithromycin (25.5%), methylprednisolone\/steroids (8.5%), and other standard care treatments for COVID-19. The most common in-hospital complication included acute respiratory distress syndrome (66.4%) and cardiogenic shock (14%). On last follow up, 64.7% of the patients survived, whereas 31.8% patients did not survive, and 3.5% were in the critical care unit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>It is essential to demarcate COVID-19 infection and myocarditis presentations due to the heightened risk of death among patients contracting both myocardial inflammation and ARDS. With a multitude of diagnostic and treatment options available for COVID-19 and myocarditis, patients that are under high risk of suspicion for COVID-19 induced myocarditis must be appropriately diagnosed and treated to curb co-infections.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501327211056800","type":"journal-article","created":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T06:53:58Z","timestamp":1638428038000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":33,"title":["COVID-19 Infection and Myocarditis: A State-of-the-Art Systematic Review"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2021-1660","authenticated-orcid":false,"given":"Vikash","family":"Jaiswal","sequence":"first","affiliation":[{"name":"AMA School of Medicine, Makati, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5132-7455","authenticated-orcid":false,"given":"Zouina","family":"Sarfraz","sequence":"additional","affiliation":[{"name":"Fatima Jinnah Medical University, Lahore, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8206-5745","authenticated-orcid":false,"given":"Azza","family":"Sarfraz","sequence":"additional","affiliation":[{"name":"The Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7566-3843","authenticated-orcid":false,"given":"Dattatreya","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Jinan University, Guangdong, P.R. China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nitya","family":"Batra","sequence":"additional","affiliation":[{"name":"Maulana Azad Medical College, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5819-4157","authenticated-orcid":false,"given":"Gazala","family":"Hitawala","sequence":"additional","affiliation":[{"name":"RNT Medical College, Udaipur, Rajasthan, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sadia","family":"Yaqoob","sequence":"additional","affiliation":[{"name":"Jinnah Medical and Dental College, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhinav","family":"Patel","sequence":"additional","affiliation":[{"name":"Northwestern University, Chicago, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Preeti","family":"Agarwala","sequence":"additional","affiliation":[{"name":"Rajshahi Medical College and Hospital, Rajshahi, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0027-3175","authenticated-orcid":false,"family":"Ruchika","sequence":"additional","affiliation":[{"name":"JJM Medical college, Davangere, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muzna","family":"Sarfraz","sequence":"additional","affiliation":[{"name":"King Edward Medical University, Lahore, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6429-797X","authenticated-orcid":false,"given":"Shehar","family":"Bano","sequence":"additional","affiliation":[{"name":"Fatima Jinnah Medical University, Lahore, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nishwa","family":"Azeem","sequence":"additional","affiliation":[{"name":"Lahore General Hospital, Lahore, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6390-9658","authenticated-orcid":false,"given":"Sidra","family":"Naz","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akash","family":"Jaiswal","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Science, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prachi","family":"Sharma","sequence":"additional","affiliation":[{"name":"King George Medical University, Lucknow, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaurav","family":"Chaudhary","sequence":"additional","affiliation":[{"name":"King George Medical University, Lucknow, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,12,2]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2020.07.003"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/21501327211039709"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/21501327211023726"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.016219"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2020.100618"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocs.14596"},{"key":"e_1_3_3_8_2","unstructured":"Myocarditis and pericarditis following mRNA COVID-19 vaccination | CDC. Accessed September 2 2021. https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/vaccines\/safety\/myocarditis.html"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.14470"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2020.05.001"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-020-00717-0"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMC2109975."},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7035e5"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2020.04.080"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.31744\/einstein_journal\/2020RC5876"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2020.10.012"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2020.06.005"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2020.06.003"},{"issue":"6","key":"e_1_3_3_19_2","article-title":"Coronavirus (COVID-19) fulminant myopericarditis and acute respiratory distress syndrome (ARDS) in a middle-aged male patient","volume":"12","author":"Hussain H","year":"2020","unstructured":"Hussain H, Fadel A, Alwaeli H, Guardiola V. Coronavirus (COVID-19) fulminant myopericarditis and acute respiratory distress syndrome (ARDS) in a middle-aged male patient. Cureus. 2020;12(6):e8808.","journal-title":"Cureus"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2020-236218."},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-020-01424-5"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30912-0"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2020.08.185"},{"issue":"9","key":"e_1_3_3_24_2","first-page":"1331","article-title":"A recovered case of COVID-19 myocarditis and ARDS treated with corticosteroids, tocilizumab, and experimental AT-001","volume":"2","author":"Coyle J","year":"2020","unstructured":"Coyle J, Igbinomwanhia E, Sanchez-Nadales A, Danciu S, Chu C, Shah N. A recovered case of COVID-19 myocarditis and ARDS treated with corticosteroids, tocilizumab, and experimental AT-001. Case Rep. 2020;2(9):1331-1336.","journal-title":"Case Rep"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.120.010897"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2020.08.282"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2020.08.537"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrcr.2020.08.001"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrcr.2020.09.003"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrcr.2020.05.020"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.1096"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.047164"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.acci.2020.11.008"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzaa190"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000024552"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amsu.2021.102431"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jccase.2021.04.014."},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1177\/23247096211019559"},{"issue":"9","key":"e_1_3_3_39_2","first-page":"1326","article-title":"Cardiac tamponade secondary to COVID-19","volume":"2","author":"Dabbagh MF","year":"2020","unstructured":"Dabbagh MF, Aurora L, D\u2019Souza P, Weinmann AJ, Bhargava P, Basir MB. Cardiac tamponade secondary to COVID-19. Case Rep. 2020;2(9):1326-1330.","journal-title":"Case Rep"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.recesp.2020.04.001"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.050097"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.12805"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.5811\/cpcem.2020.6.47856"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00414-020-02500-z"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa253"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.12958"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjco.2020.06.008"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-020-01943-0"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1828"},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000002788"},{"key":"e_1_3_3_51_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30937-5"},{"issue":"5","key":"e_1_3_3_52_2","first-page":"446","article-title":"Terra incognita: clinically suspected myocarditis in a SARS-CoV-2 positive patient","volume":"130","author":"Warcho\u0142 I","year":"2020","unstructured":"Warcho\u0142 I, D\u0119bska-Koz\u0142owska A, Karcz-Socha I, Ksi\u0105\u017cczyk M, Szyma\u0144ska K, Lubi\u0144ski A. Terra incognita: clinically suspected myocarditis in a SARS-CoV-2 positive patient. Pol Arch Intern Med. 2020;130(5):446-448.","journal-title":"Pol Arch Intern Med"},{"key":"e_1_3_3_53_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeaa166"},{"key":"e_1_3_3_54_2","doi-asserted-by":"publisher","DOI":"10.1136\/BCR-2020-240095"},{"key":"e_1_3_3_55_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa190"},{"key":"e_1_3_3_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjms.2020.11.001"},{"key":"e_1_3_3_57_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2020.05.100"},{"key":"e_1_3_3_58_2","doi-asserted-by":"publisher","DOI":"10.1136\/BCR-2021-244027"},{"key":"e_1_3_3_59_2","doi-asserted-by":"publisher","DOI":"10.1177\/2324709621999954."},{"key":"e_1_3_3_60_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2020.05.003"},{"key":"e_1_3_3_61_2","doi-asserted-by":"publisher","DOI":"10.1136\/BCR-2020-237553"},{"key":"e_1_3_3_62_2","doi-asserted-by":"publisher","DOI":"10.1093\/EURHEARTJ\/EHAA288"},{"key":"e_1_3_3_63_2","doi-asserted-by":"publisher","DOI":"10.1016\/J.JCCASE.2021.03.009"},{"key":"e_1_3_3_64_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa286"},{"key":"e_1_3_3_65_2","doi-asserted-by":"publisher","DOI":"10.21037\/cdt.2020.03.08"},{"key":"e_1_3_3_66_2","doi-asserted-by":"publisher","DOI":"10.12890\/2020_001672."},{"key":"e_1_3_3_67_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.carrev.2020.05.009"},{"key":"e_1_3_3_68_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2020.08.012"},{"key":"e_1_3_3_69_2","doi-asserted-by":"publisher","DOI":"10.1002\/EHF2.13136"},{"key":"e_1_3_3_70_2","doi-asserted-by":"publisher","DOI":"10.1002\/jcla.23654"},{"key":"e_1_3_3_71_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ihj.2020.10.005"},{"key":"e_1_3_3_72_2","unstructured":"Mayo Clinic. C-reactive protein test - Mayo Clinic. Accessed September 13 2021. https:\/\/www.mayoclinic.org\/tests-procedures\/c-reactive-protein-test\/about\/pac-20385228"},{"key":"e_1_3_3_73_2","unstructured":"Mayo Clinical Laboratories. DIMER. Clinical: D-dimer plasma. Accessed September 13 2021. https:\/\/www.mayocliniclabs.com\/test-catalog\/Clinical+and+Interpretive\/602174"},{"issue":"4","key":"e_1_3_3_74_2","first-page":"251","article-title":"The interleukin-1, interleukin-2, interleukin-6 and tumour necrosis factor alpha serological levels in localised and systemic sclerosis","volume":"36","author":"Alecu M","year":"1998","unstructured":"Alecu M, Geleriu L, G\u0103l\u0103\u0163escu L. The interleukin-1, interleukin-2, interleukin-6 and tumour necrosis factor alpha serological levels in localised and systemic sclerosis. Rom J Intern Med. 1998;36(4):251-259.","journal-title":"Rom J Intern Med"},{"key":"e_1_3_3_75_2","unstructured":"University of Rochester Medical Center. Troponin - Health Encyclopedia - University of Rochester Medical Center. Accessed September 13 2021. https:\/\/www.urmc.rochester.edu\/encyclopedia\/content.aspx?contenttypeid=167&contentid=troponin"},{"key":"e_1_3_3_76_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2020.03.041"},{"key":"e_1_3_3_77_2","unstructured":"World Health Organization. Advice for the public. Published 2021. Accessed September 12 2021. https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/advice-for-public"},{"key":"e_1_3_3_78_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0800028"},{"key":"e_1_3_3_79_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2019.01.039"},{"key":"e_1_3_3_80_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjco.2020.05.005"},{"key":"e_1_3_3_81_2","doi-asserted-by":"publisher","DOI":"10.1172\/JCI137244"},{"key":"e_1_3_3_82_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0b013e3283620036"},{"key":"e_1_3_3_83_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.0950"},{"key":"e_1_3_3_84_2","doi-asserted-by":"publisher","DOI":"10.1016\/J.CARREV.2020.08.028"},{"key":"e_1_3_3_85_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-021-10087-9"},{"key":"e_1_3_3_86_2","doi-asserted-by":"publisher","DOI":"10.22037\/aaem.v9i1.1153."},{"key":"e_1_3_3_87_2","doi-asserted-by":"publisher","DOI":"10.3906\/SAG-2010-131"}],"container-title":["Journal of Primary Care &amp; Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21501327211056800","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21501327211056800","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21501327211056800","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:23:07Z","timestamp":1777508587000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21501327211056800"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":86,"alternative-id":["10.1177\/21501327211056800"],"URL":"https:\/\/doi.org\/10.1177\/21501327211056800","relation":{},"ISSN":["2150-1319","2150-1327"],"issn-type":[{"value":"2150-1319","type":"print"},{"value":"2150-1327","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1]]},"article-number":"21501327211056800"}}