Diagnosing acute myocardial injury in patients with suspected or confirmed COVID-19-NICE guidelines
3.1Be aware that acute myocardial injury and its complications:
- were observed in 9.5% of all patients dying in Italy with COVID-19 (up to 13 April 2020)
- display symptoms and signs similar to respiratory complications of COVID-19
- may develop at any stage of COVID-19.
3.2Be aware that acute myocardial injuries in patients with COVID-19 include:
- acute coronary syndromes
- cardiac arrest
- cardiogenic shock
- heart failure
- pericarditis and pericardial effusion.
3.3Be aware that symptoms suggesting acute myocardial injury in patients with COVID-19 include:
- chest pain
- severe fatigue
- shortness of breath.
3.4In 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.
3.5Be 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.