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Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome.
Circulation. 2020 06 09; 141(23):1903-1914.Circ

Abstract

Coronavirus disease 2019 (COVID-19) is a rapidly expanding global pandemic caused by severe acute respiratory syndrome coronavirus 2, resulting in significant morbidity and mortality. A substantial minority of patients hospitalized develop an acute COVID-19 cardiovascular syndrome, which can manifest with a variety of clinical presentations but often presents as an acute cardiac injury with cardiomyopathy, ventricular arrhythmias, and hemodynamic instability in the absence of obstructive coronary artery disease. The cause of this injury is uncertain but is suspected to be related to myocarditis, microvascular injury, systemic cytokine-mediated injury, or stress-related cardiomyopathy. Although histologically unproven, severe acute respiratory syndrome coronavirus 2 has the potential to directly replicate within cardiomyocytes and pericytes, leading to viral myocarditis. Systemically elevated cytokines are also known to be cardiotoxic and have the potential to result in profound myocardial injury. Prior experience with severe acute respiratory syndrome coronavirus 1 has helped expedite the evaluation of several promising therapies, including antiviral agents, interleukin-6 inhibitors, and convalescent serum. Management of acute COVID-19 cardiovascular syndrome should involve a multidisciplinary team including intensive care specialists, infectious disease specialists, and cardiologists. Priorities for managing acute COVID-19 cardiovascular syndrome include balancing the goals of minimizing healthcare staff exposure for testing that will not change clinical management with early recognition of the syndrome at a time point at which intervention may be most effective. This article aims to review the best available data on acute COVID-19 cardiovascular syndrome epidemiology, pathogenesis, diagnosis, and treatment. From these data, we propose a surveillance, diagnostic, and management strategy that balances potential patient risks and healthcare staff exposure with improvement in meaningful clinical outcomes.

Authors+Show Affiliations

Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., M.H.D.).Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., M.H.D.).Winters Center for Heart Failure Research, Cardiovascular Research Institute, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX (B.B.).Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (L.T.C.).

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32297796

Citation

Hendren, Nicholas S., et al. "Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome." Circulation, vol. 141, no. 23, 2020, pp. 1903-1914.
Hendren NS, Drazner MH, Bozkurt B, et al. Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome. Circulation. 2020;141(23):1903-1914.
Hendren, N. S., Drazner, M. H., Bozkurt, B., & Cooper, L. T. (2020). Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome. Circulation, 141(23), 1903-1914. https://doi.org/10.1161/CIRCULATIONAHA.120.047349
Hendren NS, et al. Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome. Circulation. 2020 06 9;141(23):1903-1914. PubMed PMID: 32297796.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome. AU - Hendren,Nicholas S, AU - Drazner,Mark H, AU - Bozkurt,Biykem, AU - Cooper,Leslie T,Jr Y1 - 2020/04/16/ PY - 2020/4/17/pubmed PY - 2020/6/20/medline PY - 2020/4/17/entrez KW - COVID-19 KW - SARS-CoV-2 KW - cardiomyopathies KW - heart failure KW - myocarditis SP - 1903 EP - 1914 JF - Circulation JO - Circulation VL - 141 IS - 23 N2 - Coronavirus disease 2019 (COVID-19) is a rapidly expanding global pandemic caused by severe acute respiratory syndrome coronavirus 2, resulting in significant morbidity and mortality. A substantial minority of patients hospitalized develop an acute COVID-19 cardiovascular syndrome, which can manifest with a variety of clinical presentations but often presents as an acute cardiac injury with cardiomyopathy, ventricular arrhythmias, and hemodynamic instability in the absence of obstructive coronary artery disease. The cause of this injury is uncertain but is suspected to be related to myocarditis, microvascular injury, systemic cytokine-mediated injury, or stress-related cardiomyopathy. Although histologically unproven, severe acute respiratory syndrome coronavirus 2 has the potential to directly replicate within cardiomyocytes and pericytes, leading to viral myocarditis. Systemically elevated cytokines are also known to be cardiotoxic and have the potential to result in profound myocardial injury. Prior experience with severe acute respiratory syndrome coronavirus 1 has helped expedite the evaluation of several promising therapies, including antiviral agents, interleukin-6 inhibitors, and convalescent serum. Management of acute COVID-19 cardiovascular syndrome should involve a multidisciplinary team including intensive care specialists, infectious disease specialists, and cardiologists. Priorities for managing acute COVID-19 cardiovascular syndrome include balancing the goals of minimizing healthcare staff exposure for testing that will not change clinical management with early recognition of the syndrome at a time point at which intervention may be most effective. This article aims to review the best available data on acute COVID-19 cardiovascular syndrome epidemiology, pathogenesis, diagnosis, and treatment. From these data, we propose a surveillance, diagnostic, and management strategy that balances potential patient risks and healthcare staff exposure with improvement in meaningful clinical outcomes. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/32297796/full_citation L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.120.047349?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -