Differential Diagnosis of Myocardial Injury in the SARS-CoV-2 Era – Myocarditis Versus Acute Coronary Syndrome

COVID-19 is a disease caused by the new coronavirus discovered in 2019, which may lead to a severe acute respiratory syndrome and has a major impact on public health worldwide, being declared a pandemic by World Health Organization. In Italy, and especially in the region of Lombardia, the healthcare system has faced a huge overload, which led to significant consequences on cardiology resources. The accessibility to cardiology care units has been drastically reduced, and scheduled interventions, such as elective primary percutaneous coronary interventions, have been significantly delayed. During this time, there was a global concern regarding the management of the SARS-CoV-2 pandemic, but also the management of main cardiovascular emergencies. Under usual circumstances, the differential diagnosis of myocardial injury does not confront many difficulties. Unfortunately, there are several limitations in the management of patients with SARS-CoV-2 infection in the current pandemic state. The aim of the present manuscript is to provide an overview on the main causes of myocardial injury during the COVID-19 pandemic.