3 Diagnosing acute myocardial injury in patients with suspected or confirmed COVID-19

3 Diagnosing acute myocardial injury in patients with suspected or confirmed COVID-19

3.1 Be aware that acute myocardial injury and its complications:

3.2 Be aware that acute myocardial injuries in patients with COVID-19 include:

  • acute coronary syndromes

  • arrhythmias

  • cardiac arrest

  • cardiogenic shock

  • cardiomyopathy

  • heart failure

  • myocarditis

  • pericarditis and pericardial effusion.

3.3 Be aware that symptoms suggesting acute myocardial injury in patients with COVID-19 include:

  • chest pain

  • palpitation

  • severe fatigue

  • shortness of breath.

Diagnostic tests

3.4 In patients with symptoms or signs that suggest acute myocardial injury, measure high sensitivity troponin I (hs-cTnI) or T (hs-cTnT) and NT-proBNP, and perform an ECG.

Use the following test results to help inform a diagnosis:

  • evolving ECG changes suggesting myocardial ischaemia

  • NT-proBNP level above 400 ng/litre

  • high levels of high sensitivity troponin (hs-cTnI or hs-cTnT), particularly levels increasing over time.

3.5 Be aware that elevated troponin levels may reflect cardiac inflammatory response to severe illness rather than acute coronary syndrome, and should be considered in the clinical context.