Keywords
cardiovascular disease
heart failure
critical care
Categories
How to Cite
Abstract
COVID-19 disease, while primarily a respiratory disease, has proven itself a multi-system disorder with profound cardiovascular sequelae. In patients with SARS-CoV-2 infection, effective early diagnosis and management of concomitant cardiovascular manifestations of the disease are key to favorable outcomes. Here we present a case series of three patients with varied cardiovascular presentations of severe COVID-19 illness: cardiogenic shock from Takotsubo cardiomyopathy, arrhythmia in a patient with suspected hydroxychloroquine-associated cardiomyopathy, and right-sided heart failure with obstructive shock in the setting of massive pulmonary embolism. Through our experience, we aim to provide a better understanding of the unique spectrum of the cardiovascular effects of severe COVID-19 disease to guide management of the critically ill.
References
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. https://doi.org/10.1016/S0140-6736(20)30566-3
Cappelletti S, Ciallella C, Aromatario M, Ashrafian H, Harding S, Athanasiou T. Takotsubo Cardiomyopathy and Sepsis: A Systematic Review. Angiology. 2017;68(4):288-303. https://doi.org/10.1177/0003319716653886
Shi S, Qin M, Shen B, et al.. Association of Cardiac Injury with Mortality in Hospitalized Patients with COVID-19 in Wuhan, China. JAMA Cardiol. Published online 2020. https://doi.org/10.1016/10.1001/jamacardio.2020.0950
Guo T, Fan Y, Chen M, et al. Cardiovascular Implications of Fatal Outcomes of Patients with Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):811-818. https://doi.org/10.1001/jamacardio.2020.1017
Oudit GY, Kassiri Z, Jiang C, et al. SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Invest. 2009;39(7):618-625. https://doi.org/10.1111/j.1365-2362.2009.02153.x
Akhmerov A, Marbán E. COVID-19 and the Heart. Circ Res. Published online 2020:1443-1455. https://doi.org/10.1161/CIRCRESAHA.120.317055
Menter T, Haslbauer JD, Nienhold R, et al. Post‐mortem examination of COVID19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings of lungs and other organs suggesting vascular dysfunction. Histopathology. Published online May 4, 2020:his.14134. https://doi.org/10.1111/his.14134
Wichmann D, Sperhake J-P, Lü M, et al. Autopsy Findings and Venous Thromboembolism in Patients With COVID-19 A Prospective Cohort Study. Published online 2020. https://doi.org/10.7326/M20-2003
Jackson SP, Darbousset R, Schoenwaelder SM. Thromboinflammation: Challenges of therapeutically targeting coagulation and other host defense mechanisms. Blood. 2019;133(9):906-918. https://doi.org/10.1182/blood-2018-11-882993
Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost. 2020;18(7):1559-1561. https://doi.org/10.1111/jth.14849
Stevenson P, Aljaafareh A, Alnuaimat H. Etiology and Prognostic Impact of Mcconnell’s Sign in Medical ICU. Chest. 2017;152(4):A615. https://doi.org/10.1016/j.chest.2017.08.647
Joyce E, Fabre A, Mahon N. Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: Key diagnostic features and literature review. Eur Hear J Acute Cardiovasc Care. 2013;2(1):77-83. https://doi.org/10.1177/2048872612471215
Tönnesmann E, Stroehmann I, Kandolf R, et al. Cardiomyopathy caused by longterm treatment with chloroquine: A rare disease, or a rare diagnosis? J Rheumatol. 2012;39(5):1099-1103. https://doi.org/10.3899/jrheum.110959
Ratliff NB, Estes ML, Myles JL, Shirey EK, McMahon JT. Diagnosis of Chloroquine Cardiomyopathy by Endomyocardial Biopsy. N Engl J Med. 1987;316(4):191-193. https://doi.org/10.1056/NEJM198701223160405
Horby P, Mafham M, Linsell L, et al. Effect of Hydroxychloroquine in Hospitalized Patients with COVID-19: Preliminary results from a multi-centre, randomized, controlled trial. medRxiv. Published online 2020:2020.07.15.20151852. https://doi.org/10.1101/2020.07.15.20151852
Cavalcanti AB, Zampieri FG, Rosa RG, et al. Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19. N Engl J Med. Published online 2020. https://doi.org/10.1056/nejmoa2019014
Mitjà O, Corbacho-Monné M, Ubals M, Tebe C, Peñafiel J. Hydroxychloroquine for Early Treatment of Adults with Mild Covid-19: A Randomized- Controlled Trial. Clin Infect Dis. 2020;(ciaa1009). https://doi.org/10.1093/cid/ciaa1009
Skipper CP, Pastick KA, Engen NW, et al. Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19. Ann Intern Med. Published online 2020:1-10. https://doi.org/10.7326/m20-4207
Gautret P, Lagier J-C, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. Published online March 2020:105949. https://doi.org/10.1016/j.ijantimicag.2020.105949
Chen J, Liu D, Liu L, et al. A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19). J Zhejiang Univ (Med Sci). 2020;49(February):1-10. https://doi.org/10.3785/j.issn.1008-9292.2020.03.03
Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA - J Am Med Assoc. 2020;323(11):1061-1069. https://doi.org/10.1001/jama.2020.1585
Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. Published online 2020. https://doi.org/10.1016/j.thromres.2020.04.013
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