Contextualizing cardiac dysfunction in critically ill patients with COVID-19

Area of Science:

• Cardiology
• Infectious Diseases
• Critical Care Medicine

Background:

• COVID-19 infection is associated with a substantially elevated incidence of acute cardiac injury, particularly in critically ill patients.
• Patients with pre-existing cardiovascular comorbidities are more vulnerable to severe COVID-19 and myocardial injury.
• Distinguishing cardiac symptoms from COVID-19 symptoms like dyspnea and chest discomfort can be clinically challenging.

Purpose of the Study:

• To summarize current knowledge on cardiovascular involvement in COVID-19 patients.
• To highlight the mechanisms leading to acute cardiac injury in the context of COVID-19.
• To discuss diagnostic and management strategies for cardiac complications in COVID-19.

Main Methods:

• Review of current literature on cardiovascular manifestations of COVID-19.
• Analysis of reported incidence rates of myocardial injury in different patient populations.
• Discussion of pathophysiological mechanisms including cytokine release, endothelial dysfunction, and thrombosis.

Main Results:

• Acute cardiac injury is approximately 13 times more frequent in Intensive Care Unit (ICU) patients compared to less critical cases.
• Myocardial injury affects up to 15% of hospitalized COVID-19 patients and 30% of ICU patients, especially those with cardiovascular comorbidities.
• Mechanisms include sepsis-related cardiomyopathy, hyper-inflammation, endothelial dysfunction, and thrombotic events like pulmonary embolism.

Conclusions:

• Cardiovascular involvement is a significant concern in COVID-19, with higher risks in severe cases and those with comorbidities.
• Prompt monitoring (ECG, biomarkers, echocardiography) and interventions to improve myocardial oxygen delivery are crucial.
• Close monitoring of coagulation (D-dimer) and appropriate anticoagulation are recommended to manage thrombotic risks and prevent complications like right ventricular failure.