COVID-19-associated stress cardiomyopathy differential diagnosis: Difference between revisions

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* 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]].
* 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]].


{| class="wikitable"
!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)<ref>{{Cite web|url=https://www.cancer.net/cancer-types/pheochromocytoma-and-paraganglioma/statistics#:~:text=Localized%20pheochromocytomas%20have%20a%205,or%20paraganglioma%20are%20an%20estimate.|title=Cancer.net - Statistics of Pheochromocytoma and Paraganglioma|last=|first=|date=07/18/2020|website=Cancer.net|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
|-
|[[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<ref>{{Cite web|url=https://acls.com/free-resources/knowledge-base/acute-coronary-syndrome/myocardial-infarction-prognosis-and-predictors-of-mortality|title=ACLS.com - MI prognosis and predictors of mortality|last=|first=|date=07/18/2020|website=ACLS.com|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
|-
|[[Myocarditis]]
|[[Chest pain]], [[dyspnea]], [[fever]]
|May be acutely elevated
| -
|May show [[atrial fibrillation]], [[Left bundle branch block|LBBB]] or [[AV block]]
|Diffuse [[hypokinesia]]
|Extremely variable
|-
|[[Dilated cardiomyopathy|Dilated Cardiomyopathy]]
|[[Dyspnea]], [[dyspnea on exertion]], [[cough]], [[edema]], [[fatigue]]
|Usually negative
| -
|May show [[atrial fibrillation]], [[Left bundle branch block|LBBB]] or [[AV block]]
|[[LV]] enlargement
|Poor - almost 50% of the patients die in 5 years<ref name="pmid28722940">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28722940 | doi= | pmc= | url= }}</ref>
|-
|[[Hypertrophic Cardiomyopathy]]
|[[Chest pain]], [[dyspnea]], [[syncope]], [[sudden cardiac death]]
|Usually negative
| -
|Common findings include:
* [[Right axis deviation|Right]] or [[left axis deviation]]
* [[Bundle branch block|BBB]]
* [[Sinus bradycardia]]
|[[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<ref name="pmid10163618">{{cite journal| author=Ten Cate FJ| title=Prognosis of hypertrophic cardiomyopathy. | journal=J Insur Med | year= 1996 | volume= 28 | issue= 1 | pages= 42-5 | pmid=10163618 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10163618  }}</ref>
|-
|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<ref name="pmid32644140">{{cite journal |vauthors=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 |title=Incidence of Stress Cardiomyopathy During the Coronavirus Disease 2019 Pandemic |journal=JAMA Netw Open |volume=3 |issue=7 |pages=e2014780 |date=July 2020 |pmid=32644140 |pmc=7348683 |doi=10.1001/jamanetworkopen.2020.14780 |url=}}</ref>
|}




== References ==
== References ==
{{reflist|2}}
{{reflist|2}}

Revision as of 22:04, 18 July 2020

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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