COVID-19: Considerations for Cardiac Care

In a daily situation report I just received, I note that across 13 hospitals there are 986 patients under investigation for coronavirus disease 19 (COVID-19) and 77 confirmed with sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Of these, 43 are inpatients and 14 are ventilated. Wow… four months ago no one saw this coming, and now we are in the midst of a global pandemic. COVID-19 has changed everything and catapulted cardiologists into the forefront of hospital-based response. Two recent articles are of acute interest to all cardiologists and any other clinicians caring for patients with cardiac conditions.

A quick review, provided by Xiong and colleagues [1], outlines the very basics of epidemiology, underlying cardiovascular disease (CVD) risk factors for worsened COVID-19 outcomes, the cardiovascular complications of infection, and long-term sequelae. For a much deeper and well-referenced dive (but one that I would suggest as essential), invest a few minutes in the comprehensive review by Driggen et al.[2] The epidemiology, pathogenesis, and clinical features of SARS-CoV-2 are succinctly presented. The presence of risk factors for CVD and existing CVD are associated with increased COVID-19 morbidity and mortality. Moreover, significant cardiovascular sequelae are commonly reported with SARS-CoV-2 infection and include myocardial ischemia and myocarditis, risk for plaque rupture, arrhythmia, cardiac arrest, cardiomyopathy, heart failure, cardiogenic and mixed shock, venous thromboembolic disease, and confusing symptomology (e.g., chest pain and electrocardiographic changes with normal coronary arteries on catheterization).

The cardiac considerations and complications of the pharmaceutical interventions currently under evaluation or in compassionate use are summarized and their potential interactions with common cardiovascular agents are discussed. For additional and up-to-date information on medications that may be in use for COVID-19 patients, however, I suggest an excellent resource, “Assessment of Evidence for COVID-19-Related Treatments,” provided by the American Society of Health-System Pharmacists at: https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/Coronavirus/docs/ASHP-COVID-19-Evidence-Table.ashx.

Finally, the authors provide an extensive overview regarding self-protection during aerosol producing interventions, such as cardiopulmonary resuscitation, and approaches to lowering risk of transmission to healthcare workers and patients. It’s a new world out there and COVID-19 is likely to be with us for at least several months. As CVD risk factors contribute to COVID-19 hospitalizations and COVID-19 results in cardiovascular complications, cardiologists will increasingly feel the press of this pandemic. Accordingly, thoughtful preparation is a key component of navigating this threat.