Fig. 1

Electrocardiogram (ECG) and cardiovascular magnetic resonance (CMR) examples in troponin positive COVID-19. Potential diagnoses include: no abnormalities detected, myocarditis, infarction, dual pathology and pericardial inflammation. First example shows a normal 12-lead electrocardiogram (ECG) and a normal CMR study. Second example shows myocarditis, with anterolateral ST segment flattening. CMR shows normal function but patchy mid-wall enhancement in the anterior and inferior wall (red arrows) with T2 map showing co-localised oedema. The third example shows myocardial infarction with ECG anterolateral ST changes and thinning of left ventricular (LV) wall predominantly in the anterolateral segment on the short-axis image (red asterisk); corresponding LGE image shows an ischaemic pattern transmural scar (red arrow); T1 maps show elevated T1 values in the lateral wall. The fourth example shows a case of dual pathology due to myocarditis and infarction. The ECG shows hyperacute T-waves in the anterolateral leads and the CMR study shows a short-axis cine with increased signal intensity in the anterior/anteroseptal segment (red asterisk). The two LGE images reveal an ischaemic scar in this area extending from subendocardium as well as an area of sub-epicardial enhancement in the inferior wall consistent with myocarditis (red arrows). The last case presents pericardial inflammation. The ECG shows widespread concave ST-segment elevation. The 4-chamber cine is unremarkable, whereas the corresponding LGE images show pericardial enhancement (red arrows)