A care pathway for the cardiovascular complications of COVID-19: Insights from an institutional response

Abstract

The infection caused by severe acute respiratory syndrome coronavirus-2, or COVID-19, can result in myocardial injury, heart failure, and arrhythmias. In addition to the viral infection itself, investigational therapies for the infection can interact with the cardiovascular system. As cardiologists and cardiovascular service lines will be heavily involved in the care of patients with COVID-19, our division organized an approach to manage these complications, attempting to balance resource utilization and risk to personnel with optimal cardiovascular care. The model presented can provide a framework for other institutions to organize their own approaches and can be adapted to local constraints, resource availability, and emerging knowledge.

Figure 1

A framework for addressing cardiovascular complications associated with COVID-19. Infection with SARS-CoV-2 can result in myocardial injury, HF, and arrhythmias, and putative treatments can have interactions with the cardiovascular system. A framework for approaching these complications is presented. AAD, antiarrhythmic drug; ACLS, advanced cardiac life support; ACEi, angiotensin-converting enzyme inhibitor; ACS, acute coronary syndrome; ADHF, acute decompensated heart failure; AF, atrial fibrillation; AFL, atrial flutter; ALT, alanine aminotransferase; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor-neprilysin inhibitor; AST, aspartate aminotransferase; BP, blood pressure; bpm, beats per minute; CICU, cardiac intensive care unit; CK, creatinine kinase; COVID-19, coronary virus disease 2019; CRP, C-reactive protein; CV, cardiovascular; CYP, cytochrome P450; ECG, electrocardiogram; ER, emergency room; GDMT, guideline-directed medical therapy; HF, heart failure; HR, heart rate; hs-cTnT, high-sensitivity cardiac troponin T; IL-6, interleukin-6; IV, intravenous; JVD, jugular venous distension; K, potassium; LDH, lactate dehydrogenase; LE, lower extremity; LFT, liver function test; MCS, mechanical circulatory support; Mg, magnesium; MI, myocardial infarction; NT-pBNP, N-terminal pro–B-type natriuretic peptide; PPE, personal protective equipment; PAC, pulmonary artery catheter; POCUS, point-of-care ultrasound; QTc, corrected QT interval; RVR, rapid ventricular response; Rx, treatment; STEMI, ST-segment elevation myocardial infarction; TTE, transthoracic echocardiogram; URL, upper reference limit; VF, ventricular fibrillation; VT, ventricular tachycardia.