While the Twitter drama about CMRs in COVID-19 continues, Big 10 football resumes, and we start doing CMRs on all SARS-CoV-2 positive Big 10 athletes irrespective of symptoms, here’s a reminder that cardiomyopathy can indeed occur during or after COVID-19.

Cardiomyopathy can newly occur during or after COVID-19 for many reasons:

1 - Known heart disease that gets worse.

2 - Undiagnosed disease that is first observed during or after COVID-19... I have seen genetic and toxic cardiomyopathies, but it could be any cardiomyopathy.

3 - Stress cardiomyopathy.

4 - Acute MI.

5 - Viral myocarditis possibly due to co-existing/secondary infections or direct injury from SARS-CoV-2 (the latter appears to be unlikely).

The inflammatory stress of COVID-19 presumably triggers some of these acute presentations, while others may incidentally occur or be detected during the COVID-19 illness.

Here are the LGE images for the cases above:

Patients with cardiomyopathies are at increased risk of severe COVID-19 illness. This possibly applies to those with previously undiagnosed cardiomyopathies also.

CMR is the best imaging technique to help distinguish these possibilities and identify the cause of the cardiomyopathy, so the patients can receive appropriate cause-specific treatments. #whyCMR