COVID-19 and Acute Heart Failure: Screening the Critically Ill - A Position Statement of the Cardiac Society of Australia and New Zealand (CSANZ)

Abstract

Up to one-third of COVID-19 patients admitted to intensive care develop an acute cardiomyopathy, which may represent myocarditis or stress cardiomyopathy. Further, while mortality in older patients with COVID-19 appears related to multi-organ failure complicating acute respiratory distress syndrome (ARDS), the cause of death in younger patients may be related to acute heart failure. Cardiac involvement needs to be considered early on in critically ill COVID-19 patients, and even after the acute respiratory phase is passing. This Statement presents a screening algorithm to better identify COVID-19 patients at risk for severe heart failure and circulatory collapse, while balancing the need to protect health care workers and preserve personal protective equipment (PPE). The significance of serum troponin levels and the role of telemetry and targeted transthoracic echocardiography (TTE) in patient investigation and management are addressed, as are fundamental considerations in the management of acute heart failure in COVID-19 patients.

Keywords: Acute cardiomyopathy; COVID-19; High sensitivity troponin; Myocarditis; Screening algorithm; Targeted transthoracic echocardiogram.

Figure 1

Adult pathway to screen for acute heart failure in COVID-19 patients admitted to hospital. Abbreviations: ED, emergency department; EUC, electrolytes, urea and creatine; LFT, liver function test; CRP, C-reactive protein; LDH, lactate dehydrogenase; CXR, chest X-ray; ECG, electrocardiograph; HDU, high dependency unit; ICU, intensive care unit; TTE, transthoracic echocardiogram; LV, left ventricular.