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Contextualizing cardiac dysfunction in critically ill patients with COVID-19.

Guido Tavazzi1,2, Francesco Corradi3,4, Francesco Mojoli1,2

  • 1Unit of Anesthesia and Intensive Care, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.

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COVID-19 patients, especially those in the Intensive Care Unit (ICU), face a significantly higher risk of acute cardiac injury. Cardiovascular comorbidities increase susceptibility, necessitating prompt cardiac monitoring and management strategies.

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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.