Síndrome inflamatória multissistêmica e o coração: estudo sobre a relação entre a Covid-19 e a inflamação cardíaca em adultos e crianças

Abstract

Multisystem Inflammatory Syndrome (MIS) associated with COVID-19 has emerged as a highly severe condition, characterized by an exacerbated inflammatory response and significant cardiovascular involvement. Although initially described in children, growing evidence indicates that adults may also develop significant manifestations, including myocarditis, pericarditis, arrhythmias, and ventricular dysfunction, particularly in the presence of pre-existing comorbidities that intensify the inflammatory state. However, gaps remain in the understanding of the immunological mechanisms involved, the actual extent of cardiac damage, and the effectiveness of available therapeutic strategies, making this topic especially relevant to clinical practice. The objective of this study is to systematically review the literature in order to identify the main cardiac manifestations associated with MIS in adults, analyze the immunological mechanisms underlying myocardial inflammation, and evaluate the diagnostic and therapeutic approaches most frequently reported in clinical practice. To this end, a qualitative review was conducted based on a structured search of databases such as PubMed, SciELO, LILACS, Embase, and Web of Science, including publications from 2020 to 2025 in Portuguese, English, and Spanish that directly addressed the relationship between COVID-19, MIS, and cardiovascular involvement. The results indicate that cardiac inflammation in MIS is primarily related to cytokine storm, hypercoagulability, and endothelial dysfunction, frequently aggravated by hypertension, diabetes, and obesity. The most common clinical manifestations include ventricular dysfunction, electrocardiographic abnormalities, and an increased thrombotic risk. Cardiac magnetic resonance imaging stood out as a sensitive method for detecting persistent inflammation, while intravenous immunoglobulin, corticosteroids, and biological agents demonstrated benefits in several reports, although no consolidated therapeutic consensus has yet been established. Overall, the evidence reinforces the need for long-term follow-up, multidisciplinary management, and further research to standardize clinical approaches and improve care for adults with post-COVID-19 MIS.