Challenges of Diagnosing Viral Myocarditis in Adolescents in the Era of COVID-19 and MIS-C

Table 2

Comparison of key features of pediatric myocarditis, myocardial infarction, MIS-C (focusing on cardiovascular manifestations), and COVID-19-related myocarditis.

	Acute myocarditis [8–10]	Acute myocardial infarction [10–12]	MIS-C [13–16]	COVID-19-related myocarditis [17]
Fever	May be present	Unlikely	Persistent	Common
Clinical symptoms	Resting tachycardia, chest pain, palpitations, shortness of breath, respiratory distress, abdominal pain, and vomiting	Can present with chest pain	Multisystem involvement, including rash, tachycardia, abdominal pain, vomiting, diarrhea, and conjunctivitis	Shortness of breath, respiratory distress, chest pain, abdominal pain, vomiting, diarrhea, etc.
Cardiac biomarkers (troponin I or T)	Elevated	Elevated	Elevated (mild to moderate)	Elevated
Inflammatory markers (CRP, ESR, ferritin, etc.)	Often elevated	Normal	Elevated	Elevated
Echocardiogram findings	Regional wall motion abnormalities; decreased LV systolic function	Coronary arteries may be normal or anomalous	Coronary artery dilatation; systolic dysfunction that resolves; and persistent diastolic dysfunction	Reduced LV ejection fraction and pericardial effusion

COVID-19-related myocarditis features include data from adults.