Myocardial injury in severe COVID-19: Identification and management

Abstract

The World Health Organization declared the 2019 coronavirus (COVID-19) a global pandemic on March 12, 2020. However, inadequate attention seems to have been paid to the heart when managing COVID-19 in terms of detection, monitoring and treatment. We are of the opinion that these severe patients may have had myocardial injury or acute myocarditis. Signs that supports this opinion is the extremely high myocardial injury markers in severe patients, cardiac arrhythmia and suffer progressive heart failure or unexpected cardiac arrest in recent studies. Some suggestions involved of treatment need to be made. The use of an intra-aortic balloon pump (IABP) plus extracorporeal membrane oxygenation (ECMO) should be placed earlier if the pneumonia progresses rapidly, the ejection fraction decreases or there is heart failure. Besides, blood purification treatment including continuous kidney substitution treatment (CRRT) is recommended to clear inflammatory factors and block cytokine storm. In addition, the early usage of glucocorticoid and human immunoglobulin has been found to be preferable when acute myocarditis is accompanied by unstable hemodynamics.

Keywords: COVID-19; Cytokine storm; Myocardial injury.

Fig. 1

The Mechanism, manifestation and treatment underlying myocardial injury in COVID-19. RAS, renin–angiotensin system; TNF-α, tumor necrosis factor-α; LDH, lactic dehydrogenase; ECMO, extracorporeal membrane oxygenation; CRRT, continuous renal replacement therapy; ARDS, acute respiratory distress syndrome; SIRS, systemic inflammatory response syndrome; NT-proBNP, N-terminal pro-brain natriuretic peptide.