Cardiovascular Co-morbidity in COVID-19 Pandemic

  • Rikesh Tamrakar Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal https://orcid.org/0000-0002-7904-8781
  • Kapil Amgain Associate Professor, Karnali Academy of Health Sciences, Jumla, Nepal
  • Ahmad Naeem Sajed Department of Microbiology, Lahore Garrison University, Lahore, Pakistan
Keywords: Coronavirus Disease 2019, Myocardial injury, Myocarditis, Heart failure, Arrhythmia, COVID-19, Comorbidity, Pandemic

Abstract

At present, we are in the middle of a global pandemic due to COVID 19 disease caused by SARS-CoV-2 viral infection. It has now spread virtually to every corner of the globe. Medical professionals are faced with the challenge of managing diverse clinical manifestations and multisystem involvement of this infection. Although respiratory system is mainly involved COVID-19 disease, there have been diverse manifestations within the cardiovascular (CV) system that posing unique therapeutic challenges. Clinically, a patient may have features of myocarditis, heart failure, acute myocardial infarction, arrhythmia, and vascular thrombosis. Of these manifestations, the most common mechanism implicated is direct myocardial injury, whereas systemic inflammation, oxygen supply-demand mismatch, plaque rupture have also been suggested. Furthermore, current available data suggest cardiovascular related manifestations lead to increased morbidity and mortality. Also, patients with underlying cardiac conditions are more prone for severe disease and death. Although there are limited treatment options available for COVID-19 currently, it is imperative that the potential cardiovascular implications of these therapies are to be considered in these patients. There is need to review current available information regarding the implication of cardiovascular co-morbidity in COVID-19 disease so that we have uptodate and better understanding in this global problem. This review highlights the manifestations, pathophysiological mechanisms for cardiovascular manifestations of COVID-19 and address specific concerns of cardiac patients regarding medications and further management.

References

World Health Organization (WHO). Coronavirus disease (COVID-19) Situation report 124. [Link] [Google Scholar]

Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. nature. 2020; 579(7798):270-3. https://doi.org/10.1038/s41586-020-2012-7 [Google Scholar] [Pubmed]

Wu F, Zhao S, Yu B, Chen YM, Wang W, Song ZG, Hu Y, Tao ZW, Tian JH, Pei YY, Yuan ML. A new coronavirus associated with human respiratory disease in China. Nature. 2020; 579(7798):265-9. https://doi.org/10.1038/s41586-020-2008-3 [Google Scholar] [Pubmed]

Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LF. The trinity of COVID-19: immunity, inflammation and intervention. Nature Reviews Immunology. 2020;20(6):363-74. https://doi.org/10.1038/s41577-020-0311-8 [Google Scholar] [Pubmed]

Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. Journal of the American college of cardiology. 2020;75(23):2950-73. https://doi.org/10.1016/j.jacc.2020.04.031 [Google Scholar] [Pubmed]

Vincent JL, Taccone FS. Understanding pathways to death in patients with COVID-19. The Lancet Respiratory Medicine. 2020 ;8(5):430-2. https://doi.org/10.1016/S2213-2600(20)30165-X [Google Scholar] [Pubmed]

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine. 2020 ;382(18):1708-20. https://doi.org/10.1056/NEJMoa2002032 [Google Scholar] [Pubmed]

Nguyen JL, Yang W, Ito K, Matte TD, Shaman J, Kinney PL. Seasonal influenza infections and cardiovascular disease mortality. JAMA cardiology. 2016;1(3):274-81. https://doi.org/10.1001/jamacardio.2016.0433 [Google Scholar] [Pubmed]

Xiong TY, Redwood S, Prendergast B, Chen M. Coronaviruses and the cardiovascular system: acute and long-term implications. European heart journal. 2020. https://doi.org/10.1093/eurheartj/ehaa231 [Google Scholar] [Pubmed]

Li SS, Cheng CW, Fu CL, Chan YH, Lee MP, Chan JW, Yiu SF. Left ventricular performance in patients with severe acute respiratory syndrome: a 30-day echocardiographic follow-up study. Circulation. 2003 108(15):1798-803. https://doi.org/10.1161/01.CIR.0000094737.21775.32 [Google Scholar] [Pubmed]

Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. European heart journal. 2013;34(33):2636-48. https://doi.org/10.1093/eurheartj/eht210 [Google Scholar] [Pubmed]

Tan W, Aboulhosn J. The cardiovascular burden of coronavirus disease 2019 (COVID-19) with a focus on congenital heart disease. International journal of cardiology. 2020; 309:70-7. https://doi.org/10.1016/j.ijcard.2020.03.063 [Google Scholar] [Pubmed]

Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clinical Chemistry and Laboratory Medicine (CCLM). 2020; 58(7):1131-4. https://doi.org/10.1515/cclm-2020-0198 [Google Scholar] [Pubmed]

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Jama. 2020; 323(11): 1061-9. https://doi.org/10.1001/jama.2020.1585 [Google Scholar] [Pubmed]

Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA cardiology. 2020;5(7):802-10. https://doi.org/10.1001/jamacardio.2020.0950 [Google Scholar] [Pubmed]

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet. 2020;395(10229):1054-62. https://doi.org/10.1016/S0140-6736(20)30566-3 [Google Scholar] [Pubmed]

Mehra MR, Ruschitzka, F. COVID-19 illness and heart failure: a missing link? JACC Heart Fail. 8, 512–514 (2020). https://doi.org/10.1016/j.jchf.2020.03.004 [Google Scholar] [Pubmed]

Fried JA, Ramasubbu K, Bhatt R, Topkara VK, Clerkin KJ, Horn E, et al. The variety of cardiovascular presentations of COVID-19. Circulation. 2020; 141(23):1930-6. https://doi.org/10.1161/CIRCULATIONAHA.120.047164 [Google Scholar] [Pubmed]

Prabhu SD. Cytokine-induced modulation of cardiac function. Circulation research. 2004; 95(12):1140-53. https://doi.org/10.1161/01.RES.0000150734.79804.92 [Google Scholar] [Pubmed]

Stefanini GG, Montorfano M, Trabattoni D, Andreini D, Ferrante G, Ancona M, et al. ST-elevation myocardial infarction in patients with COVID-19: clinical and angiographic outcomes. Circulation. 2020; 141(25):2113-6. https://doi.org/10.1161/CIRCULATIONAHA.120.047525 [Google Scholar] [Pubmed]

Pessoa-Amorim G, Camm CF, Gajendragadkar P, De Maria GL, Arsac C, Laroche C, et al. Admission of patients with STEMI since the outbreak of the COVID-19 pandemic: a survey by the European Society of Cardiology. European Heart Journal-Quality of Care and Clinical Outcomes. 2020; 6(3):210-6. https://doi.org/10.1093/ehjqcco/qcaa04 [Google Scholar] [Pubmed]

Liu K, Fang YY, Deng Y, Liu W, Wang MF, Ma JP, et al Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chinese medical journal. 2020. https://doi.org/10.1097/CM9.0000000000000744 [Google Scholar] [Pubmed]

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Jama. 2020;323(11):1061-9. https://doi.org/10.1001/jama.2020.1585 [Google Scholar] [Pubmed]

Goha A, Mezue K, Edwards P, Nunura F, Baugh D, Madu E. COVID‐19 and the heart: an update for clinicians. Clinical cardiology. 2020; 43(11):1216-22. https://doi.org/10.1002/clc.23406 [Google Scholar] [Pubmed]

Li R, Pei S, Chen B, Song Y, Zhang T, Yang W, Shaman J. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2). Science.2020 1;368(6490):489-93. https://doi.org/10.1126/science.abb3221 [Google Scholar] [Pubmed]

Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, Jain SS, et al. COVID-19 and cardiovascular disease. Circulation. 2020; 141(20):1648-55. https://doi.org/10.1161/CIRCULATIONAHA.120.046941 [Google Scholar] [Pubmed]

Klok FA, Kruip MJ, Van der Meer NJ, Arbous MS, Gommers DA, Kant KM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: an updated analysis. Thrombosis research. 2020; 191:148-50. https://doi.org/10.1016/j.thromres.2020.04.041 [Google Scholar] [Pubmed]

Klok FA, Kruip MJ, Van der Meer NJ, Arbous MS, Gommers DA, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis research. 2020; 191:145-7. https://doi.org/10.1016/j.thromres.2020.04.013 [Google Scholar] [Pubmed]

Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive care medicine. 2020 ;46(6):1089-98. https://doi.org/10.1007/s00134-020-06062-x [Google Scholar] [Pubmed]

Singhania N, Bansal S, Nimmatoori DP, Ejaz AA, McCullough PA, Singhania G. Current overview on hypercoagulability in COVID-19. American Journal of Cardiovascular Drugs. 2020 ;20(5):393-403. https://doi.org/10.1007/s40256-020-00431-z [Google Scholar] [Pubmed]

Xiong TY, Redwood S, Prendergast B, Chen M. Coronaviruses and the cardiovascular system: acute and long-term implications. European heart journal. 2020. https://doi.org/10.1093/eurheartj/ehaa231 [Google Scholar] [Pubmed]

Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, Bi Z, Zhao Y. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clinical Research in Cardiology. 2020 ;109(5):531-8. https://doi.org/10.1007/s00392-020-01626-9 [Google Scholar] [Pubmed]

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet. 2020 ;395(10229):1054-62. https://doi.org/10.1016/S0140-6736(20)30566-3 [Google Scholar] [Pubmed]

Bansal M. Cardiovascular disease and COVID-19. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020;14(3):247-50. https://doi.org/10.1016/j.dsx.2020.03.013 [Google Scholar] [Pubmed]

Li X, Hu C, Su F, Dai J. Hypokalemia and clinical implications in patients with coronavirus disease 2019 (COVID-19). MedRxiv. 2020. https://doi.org/10.1101/2020.02.27.20028530 [Google Scholar] [Pubmed]

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Jama. 2020; 323(11):1061-9. https://doi.org/10.1001/jama.2020.1585 [Google Scholar] [Pubmed]

Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, Bi Z, Zhao Y. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clinical Research in Cardiology. 2020;109(5):531-8. https://doi.org/10.1007/s00392-020-01626-9 [Google Scholar] [Pubmed]

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. Jama. 2020; 323(16):1574-81. https://doi.org/10.1001/jama.2020.5394 [Google Scholar] [Pubmed]

Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, et al. Clinical characteristics of Covid-19 in New York city. New England Journal of Medicine. 2020; 382(24):2372-4. https://doi.org/10.1056/NEJMc2010419 [Google Scholar] [Pubmed]

Bandyopadhyay D, Akhtar T, Hajra A, Gupta M, Das A, Chakraborty S, et al. COVID-19 pandemic: cardiovascular complications and future implications. American Journal of Cardiovascular Drugs. 2020:1-4. https://doi.org/10.1007/s40256-020-00420-2 [Google Scholar] [Pubmed]

Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D. Elevated troponin in patients with Coronavirus Disease 2019 (COVID-19): possible mechanisms. Journal of cardiac failure. 2020. https://doi.org/10.1016/j.cardfail.2020.04.009 [Google Scholar] [Pubmed]

Tam CC, Cheung KS, Lam S, Wong A, Yung A, Sze M, et al. Impact of coronavirus disease 2019 (COVID-19) outbreak on ST-segment–elevation myocardial infarction care in Hong Kong, China. Circulation: Cardiovascular Quality and Outcomes. 2020;13(4):e006631. https://doi.org/10.1161/CIRCOUTCOMES.120.00663 [Google Scholar] [Pubmed]

Welt FG, Shah PB, Aronow HD, Bortnick AE, Henry TD, Sherwood MW, et al. Catheterization laboratory considerations during the coronavirus (COVID-19) pandemic: from the ACC’s Interventional Council and SCAI. Journal of the American College of Cardiology. 2020;75(18):2372-5. https://doi.org/10.1016/j.jacc.2020.03.021 [Google Scholar] [Pubmed]

Geleris J, Sun Y, Platt J, Zucker J, Baldwin M, Hripcsak G, et al. Observational study of hydroxychloroquine in hospitalized patients with Covid-19. New England Journal of Medicine. 2020;382(25):2411-8. https://doi.org/10.1056/NEJMoa2012410 [Google Scholar] [Pubmed]

Cardiology ES. ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic. [Google Scholar]

Kollias A, Kyriakoulis KG, Dimakakos E, Poulakou G, Stergiou GS, Syrigos K. Thromboembolic risk and anticoagulant therapy in COVID-19 patients: emerging evidence and call for action. Br J Haematol. 2020. https://doi.org/10.1111/bjh.16727 [Google Scholar] [Pubmed]

Barrett CD, Moore HB, Yaffe MB, Moore EE. ISTH interim guidance on recognition and management of coagulopathy in COVID‐19: A Comment. Journal of Thrombosis and Haemostasis. 2020;18(8):2060-3. https://doi.org/10.1111/jth.14860 [Google Scholar] [Pubmed]

Zhang P, Zhu L, Cai J, Lei F, Qin JJ, Xie J, et al. Association of inpatient use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with mortality among patients with hypertension hospitalized with COVID-19. Circulation research. 2020;126(12):1671-81. https://doi.org/10.1161/CIRCRESAHA.120.317134 [Google Scholar] [Pubmed]

Jarcho JA, Ingelfinger JR, Hamel MB, D’Agostino Sr RB, Harrington DP. Inhibitors of the renin–angiotensin–aldosterone system and Covid-19. https://doi.org/10.1056/NEJMe 20129 24. [Google Scholar] [Pubmed]

Sanchis-Gomar F, Lavie CJ, Perez-Quilis C, Henry BM, Lippi G. Angiotensin-converting enzyme 2 and antihypertensives (angiotensin receptor blockers and angiotensin-converting enzyme inhibitors) in coronavirus disease 2019. In Mayo Clinic Proceedings 2020 (Vol. 95, No. 6, pp. 1222-1230). Elsevier. https://doi.org/10.1016/j.mayocp.2020.03.026 [Google Scholar] [Pubmed]

Published
2020-12-30
How to Cite
1.
Tamrakar R, Amgain K, Sajed AN. Cardiovascular Co-morbidity in COVID-19 Pandemic. Europasian J Med Sci. [Internet]. 2020Dec.30 [cited 2024May13];20:73-0. Available from: https://www.europasianjournals.org/ejms/index.php/ejms/article/view/314
Section
Review Articles