Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic, being caused by an easily and rapidly spreading novel betacoronavirus, has created a state of emergency for people, the scientific community, healthcare systems and states, while the global financial consequences are still unfolding. Cardiovascular complications have been reported for COVID-19-infected patients and are associated with a worse prognosis. ECG and biomarkers may raise suspicion of cardiac involvement. However, transthoracic echocardiography is a fast and reliable bedside method to establish the diagnosis of cardiac complications, including acute coronary syndromes, pericarditis, myocarditis, and pulmonary embolism. Early detection of cardiac dysfunction by speckle tracking echocardiography during off-line analysis may be used to identify a high-risk population for development of heart failure in the acute setting. Precautionary measures are mandatory for operators and equipment to avoid viral dispersion. No specific treatment is yet available for severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2), and a variety of antiviral, immune-modifying, and antioxidant agents are therefore under intense investigation. Echocardiography, including assessment of myocardial deformation, may provide a useful tool to monitor the effects of the various treatment regimens on cardiac function both acutely and in the midterm.
Highlights
A novel enveloped, single-stranded, positive-sense RNA betacoronavirus belonging to the family of coronaviruses has been identified as the causative agent of the novel viral pneumonia that started in the city of Wuhan, Hubei Province, China, on December 12, 2019, [1] and has turned into a global health emergency
Patients presenting with ST elevation myocardial infarction (STEMI) either as an initial manifestation of the disease or during the course of hospitalization for COVID-19 disease [20] were treated with primary percutaneous intervention (PCI)
Localized wall motion abnormalities may be suggestive of a culprit coronary artery lesion leading to an ACS, whereas a diffuse pattern of abnormal segmental longitudinal myocardial strain by echocardiography may support the diagnosis of myocarditis over this of an acute coronary syndrome
Summary
A novel enveloped, single-stranded, positive-sense RNA betacoronavirus belonging to the family of coronaviruses has been identified as the causative agent of the novel viral pneumonia that started in the city of Wuhan, Hubei Province, China, on December 12, 2019, [1] and has turned into a global health emergency. Myocardial injury is associated with a 37% in-hospital mortality even in patients without prior cardiovascular disease [9, 15]. Patients presenting with ST elevation myocardial infarction (STEMI) either as an initial manifestation of the disease or during the course of hospitalization for COVID-19 disease [20] were treated with primary percutaneous intervention (PCI). Myocardial injury [11, 14] may be attributed to myocardial supply/demand mismatch precipitated by hypoxemia, hypotension, tachycardia, and an uncontrolled inflammatory response, leading to cytokine release syndrome [10]. Localized wall motion abnormalities may be suggestive of a culprit coronary artery lesion leading to an ACS, whereas a diffuse pattern of abnormal segmental longitudinal myocardial strain by echocardiography may support the diagnosis of myocarditis over this of an acute coronary syndrome.
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