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Cardiovascular disease management during the coronavirus disease 2019 pandemic

Wen-Hsien Lee1,2, Ying-Chih Chen1, Szu-Chia Chen1,2

  • 1Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.

International Journal of Medical Sciences
|July 7, 2020
PubMed

Insights

Coronavirus disease 2019 (COVID-19) significantly impacts cardiovascular care, altering standard treatments. Recommendations include continuing renin-angiotensin-aldosterone blockers and considering fibrinolysis for ST-elevation myocardial infarction (STEMI) in COVID-19 patients.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Coronavirus disease 2019 (COVID-19) presents unique challenges in cardiovascular medicine due to its high infectivity and significant cardiac involvement.
  • Therapeutic agents used for COVID-19 may possess cardiovascular toxicity, necessitating careful treatment adjustments.
  • The interaction of COVID-19 with the renin-angiotensin-aldosterone system (RAAS) requires specific considerations for cardiovascular pharmacotherapy.

Purpose of the Study:

  • To outline the evolving landscape of cardiovascular treatment in the context of the COVID-19 pandemic.
  • To provide evidence-based recommendations for managing cardiovascular conditions in patients with COVID-19.
  • To highlight critical considerations for specific cardiovascular therapies and patient populations during the COVID-19 outbreak.

Main Methods:

  • Review of current clinical evidence and pathophysiological understanding of COVID-19's cardiovascular effects.
  • Analysis of therapeutic strategies for acute coronary syndromes (ACS) in COVID-19 patients.
  • Evaluation of drug interactions and contraindications for cardiovascular medications in COVID-19 treatment.

Main Results:

  • Continuation of renin-angiotensin-aldosterone blockers is recommended despite angiotensin-converting enzyme 2 being the viral entry point.
  • Fibrinolytic therapy is a viable option for stable ST-segment elevation myocardial infarction (STEMI) patients with COVID-19, while primary percutaneous coronary intervention remains the standard if feasible.
  • Differentiating Type 2 myocardial infarction or myocarditis from true ACS is crucial to avoid unnecessary invasive procedures in stable patients.

Conclusions:

  • Cardiovascular treatment protocols require significant adaptation for COVID-19 patients.
  • Careful patient selection and management are essential for optimal outcomes in cardiovascular emergencies during the pandemic.
  • Awareness of drug-induced QT prolongation is critical when using specific COVID-19 treatments like lopinavir/ritonavir and hydroxychloroquine.

Keywords:
cardiovascularcoronaviruspandemic

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