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Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome.
- Source :
-
Circulation [Circulation] 2020 Jun 09; Vol. 141 (23), pp. 1903-1914. Date of Electronic Publication: 2020 Apr 16. - Publication Year :
- 2020
-
Abstract
- Coronavirus disease 2019 (COVID-19) is a rapidly expanding global pandemic caused by severe acute respiratory syndrome coronavirus 2, resulting in significant morbidity and mortality. A substantial minority of patients hospitalized develop an acute COVID-19 cardiovascular syndrome, which can manifest with a variety of clinical presentations but often presents as an acute cardiac injury with cardiomyopathy, ventricular arrhythmias, and hemodynamic instability in the absence of obstructive coronary artery disease. The cause of this injury is uncertain but is suspected to be related to myocarditis, microvascular injury, systemic cytokine-mediated injury, or stress-related cardiomyopathy. Although histologically unproven, severe acute respiratory syndrome coronavirus 2 has the potential to directly replicate within cardiomyocytes and pericytes, leading to viral myocarditis. Systemically elevated cytokines are also known to be cardiotoxic and have the potential to result in profound myocardial injury. Prior experience with severe acute respiratory syndrome coronavirus 1 has helped expedite the evaluation of several promising therapies, including antiviral agents, interleukin-6 inhibitors, and convalescent serum. Management of acute COVID-19 cardiovascular syndrome should involve a multidisciplinary team including intensive care specialists, infectious disease specialists, and cardiologists. Priorities for managing acute COVID-19 cardiovascular syndrome include balancing the goals of minimizing healthcare staff exposure for testing that will not change clinical management with early recognition of the syndrome at a time point at which intervention may be most effective. This article aims to review the best available data on acute COVID-19 cardiovascular syndrome epidemiology, pathogenesis, diagnosis, and treatment. From these data, we propose a surveillance, diagnostic, and management strategy that balances potential patient risks and healthcare staff exposure with improvement in meaningful clinical outcomes.
- Subjects :
- Angiotensin-Converting Enzyme 2
Antiviral Agents therapeutic use
Arrhythmias, Cardiac etiology
Arrhythmias, Cardiac physiopathology
Arrhythmias, Cardiac therapy
Biomarkers
COVID-19
Cardiovascular Diseases diagnosis
Cardiovascular Diseases physiopathology
Cardiovascular Diseases therapy
Coronavirus Infections drug therapy
Coronavirus Infections therapy
Cytokine Release Syndrome etiology
Cytokine Release Syndrome physiopathology
Cytokine Release Syndrome therapy
Cytokines metabolism
Disease Management
Hemodynamics
Humans
Immunization, Passive
Immunoglobulins, Intravenous therapeutic use
Infectious Disease Transmission, Patient-to-Professional prevention & control
Interleukin-6 antagonists & inhibitors
Molecular Targeted Therapy
Myocarditis diagnosis
Myocarditis etiology
Myocarditis physiopathology
Myocarditis therapy
Organ Specificity
Pandemics
Peptidyl-Dipeptidase A physiology
Pneumonia, Viral drug therapy
Receptors, Virus physiology
Risk Factors
Serine Endopeptidases physiology
Severe Acute Respiratory Syndrome therapy
Spike Glycoprotein, Coronavirus physiology
Viral Tropism
COVID-19 Serotherapy
Cardiovascular Diseases etiology
Coronavirus Infections complications
Pneumonia, Viral complications
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4539
- Volume :
- 141
- Issue :
- 23
- Database :
- MEDLINE
- Journal :
- Circulation
- Publication Type :
- Academic Journal
- Accession number :
- 32297796
- Full Text :
- https://doi.org/10.1161/CIRCULATIONAHA.120.047349