Myocardial injury in severe COVID-19: Identification and management
Long Li1, Jonathan Hill2, James C Spratt3
1Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Insights
COVID-19 management often overlooks cardiac complications like myocardial injury and myocarditis. Early intervention with mechanical support and anti-inflammatory treatments is crucial for severe cases.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- The COVID-19 pandemic has highlighted significant cardiac involvement, including myocardial injury and acute myocarditis, in severe cases.
- Current COVID-19 management strategies may not adequately address cardiac detection, monitoring, and treatment.
- Elevated myocardial injury markers, arrhythmias, heart failure, and cardiac arrest are observed in severe COVID-19 patients.
Discussion:
- This paper emphasizes the critical need to consider cardiac complications in COVID-19 patient management.
- It suggests that rapid progression of pneumonia, decreased ejection fraction, or heart failure warrants earlier consideration of mechanical circulatory support.
- Blood purification techniques like continuous kidney replacement therapy (CRRT) are recommended to mitigate the cytokine storm.
Key Insights:
- Severe COVID-19 patients frequently exhibit signs of myocardial injury and acute myocarditis.
- Prompt initiation of advanced therapies such as intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO) may be necessary.
- Early administration of glucocorticoids and human immunoglobulin is beneficial for patients with acute myocarditis and hemodynamic instability.
Outlook:
- Further research is needed to elucidate the precise mechanisms of COVID-19-related cardiac injury.
- Developing standardized protocols for cardiac monitoring and management in COVID-19 patients is essential.
- Investigating the long-term cardiovascular sequelae of COVID-19 will be critical for patient recovery and public health.
Abstract:
The World Health Organization declared the 2019 coronavirus (COVID-19) a global pandemic on March 12, 2020. However, inadequate attention seems to have been paid to the heart when managing COVID-19 in terms of detection, monitoring and treatment. We are of the opinion that these severe patients may have had myocardial injury or acute myocarditis. Signs that supports this opinion is the extremely high myocardial injury markers in severe patients, cardiac arrhythmia and suffer progressive heart failure or unexpected cardiac arrest in recent studies. Some suggestions involved of treatment need to be made. The use of an intra-aortic balloon pump (IABP) plus extracorporeal membrane oxygenation (ECMO) should be placed earlier if the pneumonia progresses rapidly, the ejection fraction decreases or there is heart failure. Besides, blood purification treatment including continuous kidney substitution treatment (CRRT) is recommended to clear inflammatory factors and block cytokine storm. In addition, the early usage of glucocorticoid and human immunoglobulin has been found to be preferable when acute myocarditis is accompanied by unstable hemodynamics.
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