scholarly journals Cardiovascular manifestations and treatment considerations in COVID-19

Heart ◽  
2020 ◽  
Vol 106 (15) ◽  
pp. 1132-1141 ◽  
Author(s):  
Yu Kang ◽  
Tiffany Chen ◽  
David Mui ◽  
Victor Ferrari ◽  
Dinesh Jagasia ◽  
...  
Keyword(s):  
Mechanical Circulatory Support ◽  
Myocardial Injury ◽  
Cardiovascular Complications ◽  
Stress Cardiomyopathy ◽  
Circulatory Support ◽  
Fatality Rate ◽  
Coronary Syndrome ◽  
Acute Myocardial Injury ◽  
Treatment Considerations ◽  
Continued Use

Since its recognition in December 2019, covid-19 has rapidly spread globally causing a pandemic. Pre-existing comorbidities such as hypertension, diabetes, and cardiovascular disease are associated with a greater severity and higher fatality rate of covid-19. Furthermore, COVID-19 contributes to cardiovascular complications, including acute myocardial injury as a result of acute coronary syndrome, myocarditis, stress-cardiomyopathy, arrhythmias, cardiogenic shock, and cardiac arrest. The cardiovascular interactions of COVID-19 have similarities to that of severe acute respiratory syndrome, Middle East respiratory syndrome and influenza. Specific cardiovascular considerations are also necessary in supportive treatment with anticoagulation, the continued use of renin-angiotensin-aldosterone system inhibitors, arrhythmia monitoring, immunosuppression or modulation, and mechanical circulatory support.

scholarly journals Approach to Acute Cardiovascular Complications in COVID-19 Infection

2020 ◽  
Vol 13 (7) ◽  
Author(s):  
Lauren S. Ranard ◽  
Justin A. Fried ◽  
Marwah Abdalla ◽  
D. Edmund Anstey ◽  
Raymond C. Givens ◽  
...  
Keyword(s):  
Mechanical Circulatory Support ◽  
Myocardial Injury ◽  
Cardiovascular Complications ◽  
Circulatory Support ◽  
Cardiac Complications ◽  
Team Approach ◽  
The Novel ◽  
Global Pandemic ◽  
Novel Coronavirus ◽  
Acute Mechanical Circulatory Support

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.

scholarly journals Adverse Cardiovascular Effects of Anti-COVID-19 Drugs

2021 ◽  
Vol 12 ◽  
Author(s):  
Dongling Liu ◽  
Xiang Zeng ◽  
Zufeng Ding ◽  
Fenghua Lv ◽  
Jawahar L. Mehta ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Adverse Effects ◽  
Myocardial Injury ◽  
Cardiovascular Effects ◽  
Cardiovascular Complications ◽  
Therapeutic Interventions ◽  
Risk Of Death ◽  
Cardiovascular Comorbidities ◽  
Global Pandemic ◽  
Acute Myocardial Injury

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19 infection is the cause of the ongoing global pandemic. Mortality from COVID-19 infection is particularly high in patients with cardiovascular diseases. In addition, COVID-19 patients with preexisting cardiovascular comorbidities have a higher risk of death. Main cardiovascular complications of COVID-19 are myocardial infarction, myocarditis, acute myocardial injury, arrhythmias, heart failure, stroke, and venous thromboembolism. Therapeutic interventions in terms of drugs for COVID-19 have many cardiac adverse effects. Here, we review the relative therapeutic efficacy and adverse effects of anti-COVID-19 drugs.

Abstract 14455: Hidden in Plain Sight: An Elusive Cause of Cardiogenic Shock

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sarah Chuzi ◽  
Anjan Tibrewala ◽  
Fei Li Kuang ◽  
Benjamin Freed ◽  
Esther Vorovich ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Mitral Valve ◽  
Cardiogenic Shock ◽  
Myocardial Injury ◽  
Hypereosinophilic Syndrome ◽  
Cardiac Biomarkers ◽  
Primary Data ◽  
Circulatory Support ◽  
Chronic Obstructive ◽  
Coronary Syndrome

A 54-year-old man with chronic obstructive pulmonary disease (COPD) presented with three days of chest pain, dyspnea on exertion, and orthopnea. Physical examination revealed jugular venous distention and lower extremity edema. Cardiac biomarkers were elevated. The differential diagnosis for the clinical presentation included: acute coronary syndrome, and type II myocardial infarction or myocardial injury due to acute decompensated heart failure. External records demonstrated recurrent admissions for similar signs and symptoms, with negative coronary angiogram. Shortly after admission, the patient developed acute cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation. Echocardiogram revealed biventricular failure and a possible mitral valve vegetation. The differential diagnosis was refined to include myocarditis (infectious and noninfectious causes), bacterial versus marantic endocarditis, and infiltrative cardiomyopathies. Transesophageal echocardiography revealed mass-like, bileaflet thickening of the mitral valve, not consistent with true vegetation. Infectious, rheumatologic, and hypercoagulable workups were negative. Given the lack of a unifying diagnosis, a right ventricular (RV) endomyocardial biopsy was pursued. This revealed myocardial necrosis and fibrosis, and a mural thrombus with extensive eosinophils. The primary data was then revisited, which revealed history of peripheral eosinophilia that was intermittently suppressed by steroids given for COPD. Cardiac magnetic resonance imaging (MRI) demonstrated diffuse biventricular subendocardial late gadolinium enhancement and RV thrombi. Evaluation for underlying causes of eosinophilia was negative leading to the diagnosis of Loeffler’s endocarditis due to idiopathic hypereosinophilic syndrome. This case demonstrates: (1) the important role of cardiac MRI in the evaluation of both unexplained myocardial injury and new cardiomyopathy, (2) a rare case of Loeffler’s endocarditis requiring mechanical circulatory support, and (3) the consequences of both availability bias and failure to fully “unpack” the primary diagnostic data, which rendered the true etiology of the patient’s cardiogenic shock “hidden in plain sight.”

scholarly journals Multidisciplinary approach and early use of percutaneous mechanical circulatory support devices in patients with cardiogenic shock

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Venuti ◽  
M Gramegna ◽  
L Baldetti ◽  
F Calvo ◽  
V Pazzanese ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mortality Rate ◽  
Adverse Events ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Multidisciplinary Approach ◽  
Circulatory Support ◽  
Coronary Syndrome ◽  
Early Use

Abstract Background Despite progresses in the reperfusion strategies, the prognosis of patients with cardiogenic shock (CS) remains poor with a high in-hospital mortality rate. Percutaneous mechanical circulatory support systems (pMCS) reducing afterload, preload and myocardial oxygen demand, preventing compensatory tachycardia and increasing mean arterial pressure, lead to improve end-organ perfusion. Since CS progression to a refractory shock state is deleterious, timing of treatment represents a crucial issue in these patients. Purpose The aim of our study was to assess whether a multidisciplinary approach and an early use of pMCS could be safe and effective in improving CS patients' outcome. Methods We examined the outcome in terms of one-month survival of 62 patients (75.8% males, mean age 67.7±12.2 years) admitted between January and December 2018 to our Cardiac Intensive Care Unit (CICU) with cardiogenic shock due to acute coronary syndrome (ACS), acute heart failure (AHF) and other causes in 43.5%, 21.6%, 35.4% of cases respectively. For each patient, a Multidisciplinary Shock Team (CS-Team) including critical care specialists, interventional cardiologists and advanced heart failure specialists, was involved and the early use of pMCS was considered. Results Overall, 52 (83.9%) CS patients underwent pMCS implant, including intra-aortic ballon pump counterpulsation (IABP), Impella system (Impella), venous-arterial extracorporeal membrane oxygenation (VA ECMO) in 67.7%, 46.7%, 11.3% of cases respectively. Median time from the first CS-Team contact to the pMCS implantation was 32.5 (30–60) minutes. Among ACS-CS group, AHF-CS group and CS-due to other causes group, pMCS were implanted in 25 (92.5%), 12 (92.3%) and 15 (68.1%) patients respectively. Lower extremities ischemia, gastrointestinal/intracerebral and life-threatening bleeding and ischemic stroke were observed as pMCS related adverse events in 9.7%, 6.4%, 1.6%, 3.2%, 6.4% of cases respectively. At one month, 56 (90.3%) CS patients were discharged alive while 6 (9.7%) CS patients died during the CICU stay. Conclusion A multidisciplinary approach of CS patients, contemplating an early and extensive use of pMCS, may be effective in the reduction of in-hospital mortality rate with a low and acceptable occurrence of pMCS related adverse events. Funding Acknowledgement Type of funding source: None

scholarly journals Mechanical Circulatory Support for Cardiovascular Complications in a Young COVID-19 Patient

2020 ◽  
Author(s):  
Aron Popov ◽  
Rafal Berger ◽  
Christian Schlensak ◽  
Malte Bongers ◽  
Helene Haeberle ◽  
...  
Keyword(s):  
Mechanical Circulatory Support ◽  
Cardiovascular Complications ◽  
Circulatory Support

scholarly journals Therapeutic Implications of COVID-19 for the Interventional Cardiologist

2020 ◽  
pp. 107424842098273
Author(s):  
Matthew Kelham ◽  
Fizzah A. Choudry ◽  
Stephen Hamshere ◽  
Anne-Marie Beirne ◽  
Krishnaraj S. Rathod ◽  
...  
Keyword(s):  
Myocardial Injury ◽  
Evidence Base ◽  
Cardiovascular Complications ◽  
Review Of The Literature ◽  
Therapeutic Implications ◽  
Pulmonary Manifestations ◽  
Acute Myocardial Injury ◽  
Coronary Syndromes ◽  
Prognostic Importance ◽  
Cardiovascular Services

Although COVID-19 is viewed primarily as a respiratory disease, cardiovascular risk factors and disease are prevalent among infected patients and are associated with worse outcomes. In addition, among multiple extra-pulmonary manifestations, there has been an increasing recognition of specific cardiovascular complications of COVID-19. Despite this, in the initial stages of the pandemic there was evidence of a reduction in patients presenting to acute cardiovascular services. In this masterclass review, with the aid of 2 exemplar cases, we will focus on the important therapeutic implications of COVID-19 for interventional cardiologists. We summarize the existing evidence base regarding the varied cardiovascular presentations seen in COVID-19 positive patients and the prognostic importance and potential mechanisms of acute myocardial injury in this setting. Importantly, through the use of a systematic review of the literature, we focus our discussion on the observed higher rates of coronary thrombus burden in patients with COVID-19 and acute coronary syndromes.

scholarly journals Mechanical Circulatory Support in Management of Cardiogenic Shock and Myxedema Coma

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Jelena Z. Arnautovic ◽  
Randi Connor-Schuler ◽  
Randy Ip
Keyword(s):  
Thyroid Hormone ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Hormone Replacement ◽  
Circulatory Support ◽  
Overt Hypothyroidism ◽  
Coronary Syndrome ◽  
Myxedema Coma ◽  
Ischemic Coronary Artery Disease ◽  
Artery Disease

The cardiovascular system is a major target of thyroid hormone action and the two systems are closely interlinked. It can be greatly impacted even with subtle alterations in thyroid function. Caution is needed when implementing thyroid hormone replacement in patients with severe hypothyroidism, especially in the setting of ischemic coronary artery disease. If not properly treated, myxedema may ensue. Given the high mortality of myxedema coma, supportive care may not always suffice and patients may require more invasive interventions. We present a challenging case of a patient with overt hypothyroidism with concurrent acute coronary syndrome which subsequently lead to myxedema coma and cardiogenic shock. A transcaval approach for the delivery of an Impella 5.0 (Abiomed Inc., Danvers, MA) was utilized in supporting this patient. To our knowledge, this is the first reported case that describes the use of a mechanical circulatory support in treating myxedema-induced cardiovascular collapse.

scholarly journals Novel Coronavirus-Induced Right Ventricular Failure and Point of Care Echocardiography: A Case Report

Cardiology ◽  
2020 ◽  
Vol 145 (7) ◽  
pp. 467-472 ◽  
Author(s):  
Lu Chen ◽  
Gautham Upadhya ◽  
Uta S. Guo ◽  
Pooja Belligund ◽  
David K. Lee ◽  
...  
Keyword(s):  
Myocardial Injury ◽  
Point Of Care ◽  
Clinical Information ◽  
Cardiovascular Complications ◽  
Cor Pulmonale ◽  
Protective Equipment ◽  
Point Of Care Ultrasound ◽  
Ventricular Failure ◽  
Acute Myocardial Injury ◽  
Novel Coronavirus

Various cardiovascular complications have been reported in patients with coronavirus disease 2019. Common complications include acute myocardial injury, myocarditis, arrhythmia, pericarditis, heart failure, and shock. We present a case of cor pulmonale diagnosed with serial point of care ultrasound. Given the current shortage of personal protective equipment (PPE) and high infectivity of this virus, we acknowledge the utility of this tool in obtaining important clinical information while minimizing exposure and PPE consumption.

Sign in / Sign up

Export Citation Format

Share Document