StressCovidV1, 2020, Analysis, bibRecord, 000561

Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome.

Identifieur interne : 000561 ( 2020/Analysis ); précédent : 000560; suivant : 000562

Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome.

Auteurs : Nicholas S. Hendren [États-Unis] ; Mark H. Drazner [États-Unis] ; Biykem Bozkurt [États-Unis] ; Leslie T. Cooper [États-Unis]

Source :

Circulation [ 1524-4539 ] ; 2020.

RBID : pubmed:32297796

Abstract

Coronavirus Disease 2019 (COVID-19) is a rapidly expanding global pandemic due to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) resulting in significant morbidity and mortality. A substantial minority of patients hospitalized develop an Acute COVID-19 Cardiovascular Syndrome (ACovCS) that 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 etiology 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, SARS-CoV-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 (SARS-CoV-1) has helped expedite the evaluation of several promising therapies including anti-viral agents, interleukin-6 inhibitors, and convalescent serum. Management of ACovCS should involve a multidisciplinary team including intensive care specialists, infectious disease specialists and cardiologists. Priorities for managing ACovCS 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 where intervention may be most effective. The aim of this paper is to review the best available data on ACovCS 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.

DOI: 10.1161/CIRCULATIONAHA.120.047349
PubMed: 32297796

Affiliations:

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pubmed:32297796

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<front><div type="abstract" xml:lang="en">Coronavirus Disease 2019 (COVID-19) is a rapidly expanding global pandemic due to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) resulting in significant morbidity and mortality. A substantial minority of patients hospitalized develop an Acute COVID-19 Cardiovascular Syndrome (ACovCS) that 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 etiology 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, SARS-CoV-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 (SARS-CoV-1) has helped expedite the evaluation of several promising therapies including anti-viral agents, interleukin-6 inhibitors, and convalescent serum. Management of ACovCS should involve a multidisciplinary team including intensive care specialists, infectious disease specialists and cardiologists. Priorities for managing ACovCS 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 where intervention may be most effective. The aim of this paper is to review the best available data on ACovCS 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.</div>
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Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome.

Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome.

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