Episode 099: Myocarditis in Asymptomatic COVID-19 Isn’t Real with Dr. Rohin Francis

Okay, so today's title to the show is a little provocative. But it's meant to convey the most important takeaway from the discussion. Although there has been a lot of talk over the last few weeks about the occurrence of lingering myocarditis in patients who have recovered from COVID-19 and in athletes who had an asymptomatic infection, it's important that we cut through the hysteria. Even though inflammation or scarring was seen on extremely sensitive cardiac MRI scans - this does not mean that there will be lasting or debilitating heart disease in these people in the future.

To explain the controversy, I brought Dr. Rohin Francis onto the show. He is an interventional cardiologist from London who is getting his PhD in cardiac MRI. He runs the Medlife Crisis YouTube page where he goes in depth in this and other controversies in medicine. It is true that one cannot in medicine say anything is definitively true - it is probably safe to say that the findings here suggest that there is nothing special to worry about with myocarditis and COVID-19.

One of the most important details that is lost in all the headline writing about myocarditis is that if you are asymptomatic (from a heart standpoint) you don't have myocarditis. We don't have any idea what the clinical significance of the findings on cardiac MRI suggestive of inflammation or scarring are. In fact, these same findings are sometimes present in elite athletes who are without disease or who have recovered from common viruses like a cold.

This is not to say that myocarditis or heart failure isn't a problem in those afflicted with COVID-19. That is a real problem and can cause morbidity and mortality. However, it is important to separate those who have this non-clinical finding on a sensitive cardiac scan versus those who had clinical manifestations of heart disease. And although we can't definitively say that there will be no long term consequences from an asymptomatic COVID-19 infection it is probably safe to say that it is very unlikely.