COVID-19-associated stress cardiomyopathy differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2]

Overview

COVID-19-associated stress cardiomyopathy must be differentiated from other diseases that cause left ventricular dysfunction such as acute myocardial infarction (STEMI and NSTEMI) and viral myocarditis.

Differential Diagnosis

Disease Can Present With Cardiac Enzymes Catecholamine Levels ECG Findings Echocardiography Findings Prognosis
Stress cardiomyopathy Chest pain, dyspnea ↑ Transiently elevated ST elevation in precordial leads LV regional dysfunction Very good
Pheochromocytoma Chest pain, dyspnea Can be positive Persistently elevated ST elevation in precordial leads LV regional dysfunction Good to poor - it varies if disease is localized or diffuse (95% to 50% survival in 5 years)[1]
Anterior MI Chest pain, dyspnea ↑↑↑ - ST elevation in precordial leads Dysfunction at area of infarction Variable - depends on the coronary lesion and treatment varying from 3 - 13% mortality in 30 days[2]
Myocarditis Chest pain, dyspnea, fever May be acutely elevated - May show atrial fibrillation, LBBB or AV block Diffuse hypokinesia Extremely variable
Dilated Cardiomyopathy Dyspnea, dyspnea on exertion, cough, edema, fatigue Usually negative - May show atrial fibrillation, LBBB or AV block LV enlargement Poor - almost 50% of the patients die in 5 years[3]
Hypertrophic Cardiomyopathy Chest pain, dyspnea, syncope, sudden cardiac death Usually negative - Common findings include: LV hypertrophy, systolic anterior motion of the mitral valve, asymmetric septal hypertrophy Generably good with up to 2/3 of the patients having a normal life, and a 1% cardiac annual mortality[4]
COVID-19-associated Stress Cardiomyopathy Chest pain, dyspnea ↑ Transiently elevated ST elevation in precordial leads LV regional dysfunction Very good - but hospitalizations may be longer in comparison to regular stress cardiomyopathy[5]


References

  1. ↑ "Cancer.net - Statistics of Pheochromocytoma and Paraganglioma". Cancer.net. 07/18/2020. Check date values in: |date= (help)
  2. ↑ "ACLS.com - MI prognosis and predictors of mortality". ACLS.com. 07/18/2020. Check date values in: |date= (help)
  3. ↑ "StatPearls". 2020. PMID 28722940.
  4. ↑ Ten Cate FJ (1996). "Prognosis of hypertrophic cardiomyopathy". J Insur Med. 28 (1): 42–5. PMID 10163618.
  5. ↑ Jabri A, Kalra A, Kumar A, Alameh A, Adroja S, Bashir H, Nowacki AS, Shah R, Khubber S, Kanaa'N A, Hedrick DP, Sleik KM, Mehta N, Chung MK, Khot UN, Kapadia SR, Puri R, Reed GW (July 2020). "Incidence of Stress Cardiomyopathy During the Coronavirus Disease 2019 Pandemic". JAMA Netw Open. 3 (7): e2014780. doi:10.1001/jamanetworkopen.2020.14780. PMC 7348683 Check |pmc= value (help). PMID 32644140 Check |pmid= value (help).
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