Management of Cardiovascular Disease During Coronavirus Disease (COVID-19) Pandemic

Abstract

Patients with pre-existing cardiovascular disease and risk factors are more likely to experience adverse outcomes associated with the novel coronavirus disease-2019 (COVID-19). Additionally, consistent reports of cardiac injury and de novo cardiac complications, including possible myocarditis, arrhythmia, and heart failure in patients without prior cardiovascular disease or significant risk factors, are emerging, possibly due to an accentuated host immune response and cytokine release syndrome. As the spread of the virus increases exponentially, many patients will require medical care either for COVID-19 related or traditional cardiovascular issues. While the COVID-19 pandemic is dominating the attention of the healthcare system, there is an unmet need for a standardized approach to deal with COVID-19 associated and other traditional cardiovascular issues during this period. We provide consensus guidance for the management of various cardiovascular conditions during the ongoing COVID-19 pandemic with the goal of providing the best care to all patients and minimizing the risk of exposure to frontline healthcare workers.

Keywords: COVID-19, Cardiovascular disease; Coronavirus; SARS-CoV-2.

Fig. 1

General approach for patient care during COVID-19 pandemic

Fig. 2

Approach to troponin elevation in patients with suspected or confirmed COVID-19

Fig. 3

Proposed management pathway for COVID-19-associated myocardial injury

Fig. 4

Management of acute coronary syndrome in patients with suspected or confirmed COVID-19

Fig. 5

Management of cardiogenic shock in patients with suspected or confirmed COVID-19. Abbreviations: BiV: biventricular, CI: cardiac index, CVP: central venous pressure, SCvO2: central venous oxygen saturation, tPA: tissue plasminogen activator.