Cardiovascular involvement in COVID-19: not to be missed

Abstract

In December 2019, a striking appearance of new cases of viral pneumonia in Wuhan led to the detection of a novel coronavirus (SARS-CoV2). By analyzing patients with severe manifestations, it became apparent that 20 to 35% of patients who died had preexisting cardiovascular disease. This finding warrants the important need to discuss the influence of SARS-CoV2 infection on the cardiovascular system and hemodynamics in the context of clinical management, particularly during mechanical ventilation. The SARS-CoV2 enters human cells through the spike protein binding to angiotensin-converting enzyme 2 (ACE2), which is important to cardiovascular modulation and endothelial signaling. As ACE2 is highly expressed in lung tissue, patients have been progressing to acute respiratory injury at an alarming frequency during the Coronavirus Disease (COVID-19) pandemic. Moreover, COVID-19 leads to high D-dimer levels and prothrombin time, which indicates a substantial coagulation disorder. It seems that an overwhelming inflammatory and thrombogenic condition is responsible for a mismatching of ventilation and perfusion, with a somewhat near-normal static lung compliance, which describes two types of pulmonary conditions. As such, positive pressure during invasive mechanical ventilation (IMV) must be applied with caution. The authors of this review appeal to the necessity of paying closer attention to assess microhemodynamic repercussion, by monitoring central venous oxygen saturation during strategies of IMV. It is well known that a severe respiratory infection and a scattered inflammatory process can cause non-ischemic myocardial injury, including progression to myocarditis. Early strategies that guide clinical decisions can be lifesaving and prevent extended myocardial damage. Moreover, cardiopulmonary failure refractory to standard treatment may necessitate the use of extreme therapeutic strategies, such as extracorporeal membrane oxygenation.

Comorbidades E Covid-19

“…O estado inflamatório que a doença propicia torna o ambiente mais propenso a fenômenos trombóticos. Sendo assim, a recomendação tem sido de que as medicações de uso crônico dos pacientes cardiopatas sejam mantidas e a sua retirada/substituição avaliada em nível individual e de acordo com as diretrizes vigentes (ROCCO et al, 2020) Seguindo como uma das comorbidades que apresentou grande incidência nos pacientes diagnosticados com COVID-19, analisados pela literatura, e presente no agravamento dos casos da COVID-19 no mundo estão os problemas respiratórios. (SILVA, MOREIRA, MARTINS, 2020);…”

Healthcare Deprived Centers Attempting Congenital Heart Surgery: what is Desirable versus what is Attainable in this Covid Era?

“…The pandemic and its effects have produced, has killed, spared, and provoked a range of symptomatology afflicting adults and children. Advanced international centers are formulating relevant protocols for diagnosis, triage, isolation, and management of COVID-19 patients with cardiovascular complications: many of these are common sense precautions, but other management features have unconfirmed clinical value [ 1 ] .…”

“…These cardiovascular teams fear an imminent deathblow to their programs as diversion of precious resources and funds from their programs takes place. For many, livelihoods have been upended and elective procedures suspended indefinitely; some are experiencing a reduction in pay to keep support staff and practices afloat while others have no revenue at all [ 1 , 2 ] .…”

“…Healthcare workers with adequate gloves, gowns and face masks may still have 3.4 times the risk of contracting the coronavirus compared to the general population, and support staff have an even greater risk of testing positive. Although nosocomial spread is relevant, person-toperson contact is more important type of transmission [ 1 ] .…”

“…Mother-fetus Covid transmission has been shown to occur without symptoms but this may have future clinical relevance to the performance and outcome of neonatal congenital surgery. More patients with COVID-19 infection on ventilators developed barotrauma than patients who required intubation for other reasons [ 1 ] .…”