Approach to Acute Cardiovascular Complications in COVID-19 Infection

Circ Heart Fail. 2020 Jul;13(7):e007220. doi: 10.1161/CIRCHEARTFAILURE.120.007220. Epub 2020 Jun 5.

Abstract

The novel coronavirus disease 2019, otherwise known as COVID-19, is a global pandemic with primary respiratory manifestations in those who are symptomatic. It has spread to >187 countries with a rapidly growing number of affected patients. Underlying cardiovascular disease is associated with more severe manifestations of COVID-19 and higher rates of mortality. COVID-19 can have both primary (arrhythmias, myocardial infarction, and myocarditis) and secondary (myocardial injury/biomarker elevation and heart failure) cardiac involvement. In severe cases, profound circulatory failure can result. This review discusses the presentation and management of patients with severe cardiac complications of COVID-19 disease, with an emphasis on a Heart-Lung team approach in patient management. Furthermore, it focuses on the use of and indications for acute mechanical circulatory support in cardiogenic and/or mixed shock.

Keywords: acute coronary syndrome; cardiovascular diseases; coronavirus; heart failure; myocardial infarction; shock, cardiogenic.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Acute Coronary Syndrome / complications
  • Acute Coronary Syndrome / therapy*
  • Anti-Bacterial Agents / adverse effects
  • Antiviral Agents / therapeutic use
  • Arrhythmias, Cardiac / chemically induced
  • Arrhythmias, Cardiac / complications
  • Arrhythmias, Cardiac / therapy*
  • Azithromycin / adverse effects
  • Betacoronavirus
  • COVID-19
  • Cardiotonic Agents / therapeutic use
  • Chronic Disease
  • Coronavirus Infections / complications
  • Coronavirus Infections / therapy*
  • Cytokine Release Syndrome / complications
  • Cytokine Release Syndrome / therapy
  • Enzyme Inhibitors / adverse effects
  • Extracorporeal Membrane Oxygenation
  • Heart Failure / etiology
  • Heart Failure / therapy*
  • Heart-Assist Devices
  • Humans
  • Hydroxychloroquine / adverse effects
  • Intra-Aortic Balloon Pumping
  • Myocardial Infarction / complications
  • Myocardial Infarction / therapy
  • Myocarditis / complications
  • Myocarditis / therapy*
  • Pandemics
  • Percutaneous Coronary Intervention
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / therapy*
  • SARS-CoV-2
  • Shock, Cardiogenic / etiology
  • Shock, Cardiogenic / therapy
  • Thromboembolism

Substances

  • Anti-Bacterial Agents
  • Antiviral Agents
  • Cardiotonic Agents
  • Enzyme Inhibitors
  • Hydroxychloroquine
  • Azithromycin