Potential mechanisms of myocardial injury and diagnostic limitations due to COVID-19
| Potential mechanism of myocardial injury | Standard method of diagnosis | Limitations to diagnostic modalities in setting of COVID-19 pandemic |
| Acute coronary syndrome | Trajectory of troponin and ECG changes; coronary angiography | Risk for healthcare worker exposure; higher threshold before taking patients to cardiac catheterisation lab in setting of myocardial injury |
| Cytokine release syndrome-induced myocardial dysfunction | Inflammatory and cardiac biomarker testing (often need to exclude coexisting cardiac diagnoses) | Minimal exposure with biomarker testing if timed with other blood draws; but limited by risk for exposure when excluding underlying cardiovascular disease |
| Myocarditis | Cardiac MRI for tissue characterisation (Lake Louise criteria); trajectory of cardiac biomarkers; endomyocardial biopsy in selected cases | Risk for exposure during transport and contamination of MRI scanner; risk for healthcare worker exposure in cases requiring biopsy |
| Progression of existing cardiovascular disease or demand ischaemia | Review of prior medical records and clinical history; cardiovascular disease-specific testing | Limited by risk for exposure if assessing for underlying cardiovascular disease |
| Stress-induced cardiomyopathy | Accurate clinical history taking for physical and psychological stressors; cardiac imaging patterns of wall motion abnormality that typically do not fit within a coronary distribution; diagnosis of exclusion (typically after excluding coronary artery disease) | None directly, but limited by risk for exposure when excluding underlying cardiovascular disease |