Fig. 3
Timeline and investigations undertaken in the long COVID-19 patient with evidence of myocarditis on CMR. This patient presented first to the emergency department 36 days after diagnosis of COVID-19 with chest pain. 12-lead electrocardiogram (ECG) and cardiac biomarkers were all normal. On second presentation to the emergency department at 125 days post diagnosis, ECG and cardiac biomarkers were again normal. CMR during the study visit remonstrated evidence of prior myocarditis with subepicardial late gadolinium hyperenhancement (LGE) in the lateral wall at basal to mid-ventricular level (red arrows) in the short-axis (SAx) view (left) and 4 chamber (4Ch) view (right). 31P-CMRS demonstrated PCR/ATP ratio of 1.87. Other parameters were as follows: LV end-diastolic volume (LVEDV) 146 ml, LV ejection fraction (LVEF) 64%, right ventricular (RV) end diastolic volume (RVEDV) 151 ml, RV ejection fraction (RVEF) 68%, native T1 1221 ms, extracellular volume fraction (ECV) 21%, T2 43 ms, global longitudinal strain (GLS) -11.3 and myocardial perfusion reserve (MPR) 3.9