Post-coronavirus remote myocarditis: a case report and review of the literature

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for COVID-19, which was declared a global public health emergency in March 2020. Beyond respiratory disease, SARS-CoV-2 has demonstrated harmful effects on the cardiovascular system, including myocardial injury and myocarditis. Prior coronavirus infections, including MERS-CoV, have been associated with myocarditis through direct cardiomyocyte invasion, systemic inflammation, and immune-mediated mechanisms. Case presentation We present a 54-year-old woman with a family history of ischaemic heart disease who presented with chest pain and palpitations one year after COVID-19 infection. Echocardiography showed mild left ventricular dysfunction (ejection fraction 50%). Exercise stress testing revealed deep T-wave inversions in leads II, III, and V3–V6. Inflammatory markers were elevated (ESR 39 mm/h; CRP 24.6 mg/L). Coronary angiography demonstrated normal coronary arteries. Cardiac MRI fulfilled diagnostic criteria for remote myocarditis. Conclusions This case illustrates that COVID-19-associated myocarditis can present remotely, mimicking angina with ischaemic ECG changes, and underscores the importance of a structured diagnostic pathway including cardiac MRI when coronary anatomy is normal. Clinicians should maintain a high index of suspicion for myocarditis in patients with post-COVID cardiac symptoms, even when the acute infection occurred months earlier. Keywords chest pain; coronary artery disease; exercise stress test; cardiac MRI; myocarditis; COVID-19; case report