CARDIOVASCULAR COMPLICATIONS IN COVID-19: CASE REPORT AND CONCISE REVIEW
Cardiovascular system is one of the most vulnerable during COVID-19. The main mechanisms of cardiac injury are: direct myocardial damage, mediated by viral binding to angiotensin-converting-ensyme-2, cardiac microvascular damage and thrombosis, caused by hypercoagulability.
Cardiovascular complications such as acute and chronic myocardial injury, myocarditis, myocardial infarction, pulmonary embolism, stress-cardiomyopathy, arterial and venous thrombosis and arrhythmic disorders are common among COVID-19 patients. Myocardial injury in COVID-19 could have different mechanisms and may occur at early and late stages of the COVID-19 disease, resulting in myocardial dysfunction and heart failure. Echocardiography is a first-line noninvasive imaging method to assess the cardiac injury during COVID 19 while cardiac magnetic resonance imaging is the best to identify myocardial oedema, inflammation and fibrosis. In this article we presented the analysis of experience of cardiologists in different countries concerning diagnostics ant treatment of COVID-19 related cardiovascular pathology and case reports from our own experience concerning cardiovascular complications of COVID-19. Laboratory diagnostics (troponin and brain-natriuretic peptide) and noninvasive imaging methods (echocardiography and cardiac magnetic resonance tomography) are essential to confirm the diagnosis of cardiac injury in COVID-19 and to evaluate the effect of the treatment. Long-term follow-up studies are needed to understand better the COVID-19 related cardiac pathology.
Szabo S. COVID-19: new disease and chaos with panic, associated with stress. Proc Shevchenko Sci Soc Med Sci [Internet]. 2020;59(1). Available from: https:/ /mspsss.org.ua/index.php/journal/article/view/281
Iba T, Connors JM, Levy JH. The coagulopathy, endotheliopathy, and vasculitis of COVID-19. Inflamm Res. 2020 Sep 12:1-9. doi: 10.1007/s00011-020-01401-6. Epub ahead of print. PMID: 32918567; PMCID: PMC7486586.
Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, Mehra MR, Schuepbach RA, Ruschitzka F, Moch H. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020 May 2;395(10234):1417-1418. doi: 10.1016/S0140-6736(20)30937-5. Epub 2020 Apr 21. PMID: 32325026; PMCID: PMC7172722.
Flammer AJ, Anderson T, Celermajer DS, et al. The assessment of endothelial function: from research into clinical practice. Circulation 2012; 126: 753-67.
Klok FA, Kruip M, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020;191:145-147.
Xie Y, Wang X, Yang P, Zhang S. COVID-19 complicated by acute pulmonary embolism. Radiol Cardiothorac Imag 2020;2(2):e200067.
Grillet F, Behr J, Calame P, et al. Acute pulmonary embolism associated with COVID-19 pneumonia detected by pulmonary CT angiography. Radiology 2020:201544.
Leonard-Lorant I, Delabranche X, Severac F, et al. Acute pulmonary embolism in COVID-19 patients on CT angiography and relationship to D-dimer levels. Radiology 2020;296(3):E189-E191. doi:10.1148/radiol.2020201561
Vernuccio F, Lombardo FP, Cannella R, et al. Thromboembolic complications of COVID-19: the combined effect of a pro-coagulant pattern and an endothelial thrombo-inflammatory syndrome [published online ahead of print, 2020 Aug 4]. Clin Radiol. 2020; 75(11): 804-810. doi:10.1016/j.crad.2020.07.019
Zhang Y, Xiao M, Zhang S, Xia P, Cao W, Jiang W, et al. Coagulopathy and antiphospholipid antibodies in patients with Covid-19. N Engl J Med 2020; 382: е38
Cosyns B, Lochy S, Luchian ML, et al. The role of cardiovascular imaging for myocardial injury in hospitalized COVID-19 patients, European Heart Journal - Cardiovascular Imaging, 2020; 21, (7): 709-714,
Li Y, Wang M, Zhou Y, et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. 2020. https://media.tghn.org/medialibrary/2020/06/Li_2020
Benussi A, Pilotto A, Premi E, et al. Clinical characteristics and outcomes of inpatients with neurologic disease and COVID-19 in Brescia, Lombardy, Italy. Neurology 2020; published online May 22. https://doi.org.10.1212/WNL.0000000000009848
Ellul MA, Benjamin L, Singh B, et al. Neurological associations of COVID-19, The Lancet Neurology, 2020; 19(9): 767-783.
Oxley TJ, Mocco J, Majidi S, et al. Large-vessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med 2020; 382: e60
Lameijer JRC; van Houte, J; et al.. Severe arterial thromboembolism in patients with Covid-19. J Crit Care ;2020; 60: 106-110.
Corrales‐Medina VF, Madjid M, Musher DM. Role of acute infection in triggering acute coronary syndromes. Lancet Infect Dis. 2010; 10(2): 83‐ 92.
Tedeschi, D, Rizzi, A, Biscaglia, S, Tumscitz, C. Acute myocardial infarction and large coronary thrombosis in a patient with COVID‐19. Catheter Cardiovasc Interv. 2020; 1- 6. https://doi.org/10.1002/ccd.29179
Seif S, Ayuna A, Kumar A, Macdonald J. Massive coronary thrombosis caused primary percutaneous coronary intervention to fail in a COVID-19 patient with ST-elevation myocardial infarction. Catheter Cardiovasc Interv. 2020 May 30:10.1002/ccd.29050. doi: 10.1002/ccd.29050
Shams A, Ata F, Mushtaq K, Munir W, Yousaf Z. Coronary thrombosis in a young male with COVID-19. IDCases. 2020 Jul 25; 21:e00923. doi: 10.1016/j.idcr.2020.e00923. PMID: 32754426; PMCID: PMC7381412.
Al-Sadawi M, Mohiuddin A, Hossain N, et al. Management of ST-Elevation Myocardial Infarction in the COVID-19 Era: The Role of Thrombosis and Anticoagulation Strategy. Am J Med Case Rep. 2020;8(9):262-267. Epub 2020 May 2
Bangalore S, Sharma A, Slotwiner A, et al. ST-Segment Elevation in Patients with Covid-19 - A Case Series. N Engl J Med. 2020;382(25):2478-2480. doi:10.1056/NEJMc2009020
Hajra A, Mathai SV, Ball S,et al. Management of Thrombotic Complications in COVID-19: An Update. Drugs. 2020; 80:1553-1562. https://doi.org/10.1007/s40265-020-01377
Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost 2020; 18: 1023-26.
Oudkerk M, Buller HR, Kuijpers D, et al. Diagnosis, prevention, and treatment of thromboembolic complications in COVID-19: report of the National Institute for public health of the Netherlands. Radiology 2020:201629 https://doi.org/10.1148/radiol.2020201629
Siripanthong B, Nazarian S, Muser D, et al. Recognizing COVID-19-related myocarditis: Te possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm. 2020;17(9):1463-1471.
Gnecchi M, Moretti F, Bassi EM, et al. Myocarditis in a 16-year-old boy positive for SARS-CoV-2. Lancet. 2020;395(10242):e116. doi:10.1016/S0140-6736(20)31307-6
Blagojevic NR, Bosnjakovic D, Vukomanovic V, et al. Acute pericarditis and SARS-CoV-2: case report [published online ahead of print, 2020 Sep 28]. Int J Infect Dis. 2020; doi:10.1016/j.ijid.2020.09.1440
Paul JF, Charles P, Richaud C, Caussin C, Diakov C. Myocarditis revealing COVID-19 infection in a young patient. Eur Heart J Cardiovasc Imaging. 2020;21(7):776. doi: 10.1093/ehjci/jeaa107. PMID: 32338706; PMCID: PMC7197601
Kim IC, Kim JY, Kim HA, Han S. COVID-19-related myocarditis in a 21-year-old female patient. Eur Heart J. 2020;41(19):1859. doi:10.1093/eurheartj/ehaa288
Sala S, Peretto G, Gramegna M, al. Acute myocarditis presenting as a reverse Tako-Tsubo syndrome in a patient with SARS-CoV-2 respiratory infection. Eur Heart J. 2020;41(19):1861-1862. doi: 10.1093/eurheartj/ehaa286. PMID: 32267502; PMCID:
Lala A., Johnson K.W., James L. et al. Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection. J Am Coll Cardiol. 2020 , 76 (5) 533-546.
Shi S., Qin M., Shen B., et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiology. 2020; 5(7):802-810. doi:10.1001/jamacardio.2020.0950
Lindner D, Fitzek A, Bräuninger H, et al. Association of Cardiac Infection With SARS-CoV-2 in Confirmed COVID-19 Autopsy Cases. JAMA Cardiol. Published online July 27, 2020.
Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. Published online July 27, 2020. doi:10.1001/jamacardio.2020.3557
Shauer A, Gotsman I, Keren A, Zwas DR, Hellman Y, Durst R, Admon D. Acute viral myocarditis: current concepts in diagnosis and treatment. Isr Med Assoc J. 2013;15(3):180-185. PMID: 23662385.
Pollack A, Kontorovich AR, Fuster V, Dec GW. Viral myocarditis--diagnosis, treatment options, and current controversies. Nat Rev Cardiol. 2015 Nov;12(11):670-80. doi: 10.1038/nrcardio.2015.108. Epub 2015 Jul 21. PMID: 26194549.
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