NICE COVID-19 rapid guideline: acute myocardial injury

Diagnosing acute myocardial injury in patients with suspected or confirmed COVID-19


1. Be aware that 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


2. Be aware that acute myocardial injuries in patients with COVID-19 include:

  • acute coronary syndromes
  • arrhythmias
  • cardiac arrest
  • cardiogenic shock
  • cardiomyopathy
  • heart failure
  • myocarditis
  • pericarditis and pericardial effusion


3. Be aware that symptoms suggesting acute myocardial injury in patients with COVID-19 include:

  • chest pain
  • palpitation
  • severe fatigue
  • shortness of breath


Guideline concerning diagnostic tests:

  • In 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 CG.
  • Use the following test results to help inform a diagnosis:

o   Evolving ECG changes suggesting myocardial ischemia

o   NT-proBNP level above 400 ng/L

o   High levels of high sensitivity troponin (hs)cTnI or hs-cTnT), particularly levels increasing over time


Be 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