An overview of the cardiovascular implications of COVID-19 from a global perspective is presented in a recent publication in Canadian Journal of Cardiology (2020;36[7]:1068-1080. doi:10.1016/j.cjca.2020.05.018).
The clinical presentation of COVID-19 includes respiratory symptoms, but it is now known that the virus can potentially cause serious cardiovascular consequences.
“This article provides a comprehensive overview of the pathophysiology and cardiovascular implications of COVID-19, its impact on existing pathways of care, the role of modern technologies to tackle the pandemic, and a proposal of novel management algorithms for the most common acute cardiac conditions,” wrote Marouane Boukhris, MD, Division of Cardiology, Centre Hospitalier de l’Université de Montréal (CHUM) (Montréal, Québec, Canada) and colleagues.
Researchers reviewed published literature and assessed early reports on medRXiv during the study. All literature was critically reviewed to identify selective reporting and biased data in the published literature.
The study identified several factors that may contribute to the cardiovascular consequences of COVID-19 including the adrenergic drive, systemic inflammatory milieu and cytokine-release syndrome caused by SARS-CoV-2, direct viral infection of myocardial and endothelial cells, hypoxia due to respiratory failure, electrolytic imbalances, fluid overload, and side effects of certain COVID-19 medications.
Cardiac patient care is also impacted by COVID-19. Elective procedures have been cancelled and the efficiency of existing pathways of urgent care is reduced. Additionally, COVID-19 resulted in a decrease in health care service use for acute conditions.
Modern technologies such as telemedicine and information dissemination through social media and apps are being used as an approach to help manage the pandemic.
“Several cardiovascular manifestations have been observed in COVID-19 patients, including myocardial injury, myocarditis, ACS, pulmonary embolism, stroke, arrhythmias, heart failure, and cardiogenic shock,” noted Dr Boukhris and colleagues.
“COVID-19 has profoundly reshaped usual pathways of care of both elective and acute cardiac patients,” they continued. “Further research is needed to define the pathophysiology of COVID-19 precisely and to identify and properly evaluate drugs targeting the most relevant mechanisms that characterize severe manifestations of the disease.”—Lisa Kuhns
