Cardiovascular manifestations and treatment considerations in COVID-19

Heart. 2020 Aug;106(15):1132-1141. doi: 10.1136/heartjnl-2020-317056. Epub 2020 Apr 30.

Abstract

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.

Keywords: cardiac risk factors and prevention; myocarditis; systemic inflammatory diseases.

Publication types

  • Review

MeSH terms

  • Angiotensin Receptor Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme 2
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Anticoagulants / therapeutic use
  • Azithromycin / therapeutic use
  • Betacoronavirus
  • Biomarkers / blood
  • COVID-19
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / therapy
  • Chloroquine / therapeutic use
  • Comorbidity
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / mortality
  • Cytokine Release Syndrome / epidemiology
  • Disseminated Intravascular Coagulation / epidemiology
  • Extracorporeal Membrane Oxygenation
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Immunosuppressive Agents / therapeutic use
  • Influenza, Human / mortality
  • Lung / metabolism
  • Lung / pathology
  • Myocardium / metabolism
  • Myocardium / pathology
  • Pandemics
  • Peptidyl-Dipeptidase A / metabolism
  • Pneumonia, Viral / epidemiology*
  • SARS-CoV-2
  • Severe Acute Respiratory Syndrome / mortality
  • Troponin / blood
  • Venous Thromboembolism / epidemiology
  • Venous Thromboembolism / prevention & control

Substances

  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Anticoagulants
  • Biomarkers
  • Immunosuppressive Agents
  • Troponin
  • Hydroxychloroquine
  • Azithromycin
  • Chloroquine
  • Peptidyl-Dipeptidase A
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2