By Kevin A Courville, MD, FACC, FHFSA, Advanced Heart Failure Specialist
As the consequences of the global pandemic associated with the outbreak of COVID-19 continue to be realized at an alarming rate, more data related to the effects of the cardiovascular system are becoming available.
Previous outbreaks of the most recent past provide a look into the destructive path of a large- scale virus spread. The SARS outbreak from 2002 and the H1N1 pandemic of 2009 (in addition to MERS 2012) yielded a large number of deaths due to respiratory infection worldwide.
However, cardiovascular complications when they exist are usually severe and must be addressed. Often as the disease progresses, the cardiovascular complications escalate the patients’ status to critical and frequently require treatment within intensive care units and require extensive healthcare utilization.
Common findings of COVID-19 are arrhythmia, shock and acute cardiac injury occurring at a rate of 16.7%, 8.7% and7.2%, respectively. Potential findings that may be seen clinically include EKG changes, elevated troponin and abnormal findings on echocardiography (to include both diastolic and systolic dysfunction).
Heart failure exacerbations were commonly seen during previous pandemics with significant morbidity and mortality associated with exacerbation. Similarly, systemic inflammation induced by the SARS CoV-2 virus binding to cells expressing viral receptors such as angiotensin-converting enzyme 2 (ACE2) can have the consequence of plaque disruption and acute coronary syndromes (ACS). Anti-platelet agents, beta-blockers, ACE inhibitors, and statins have been suggested as possible therapeutic strategies for ACS.
The pro-coagulant effect of the systemic inflammatory state caused by the virus should be identified in all hospitalized patients and preventive measures deployed.
Patients with pre-existing cardiovascular disease should be carefully monitored and aggressive supportive care given upon the immediate diagnosis of COVID-19. For patients without pre-existing cardiovascular disease, a heightened suspicion for cardiovascular complications is required for all patients with a progressive course of COVID-19.
Telemetric monitoring is offered here as a way to detect myocardial virus attacks.
And lastly, for any patient surviving COVID-19 with a cardiovascular insult, prolonged disease monitoring is suggested such as the monitoring offered from the cloud-based PULSARIO remote heart management system. Although the current pandemic is in evolution, the above considerations are offered based on previous data sets and will most certainly continue to evolve.
(Note: This is an article published about COVID-19 on March 21 by Dr. Courville. He is the sole physician in Wyoming that is Board Certified in Interventional Cardiology and Advanced Heart Failure.)