Narrative Review of New Insight into the Influence of the COVID-19 Pandemic on Cardiovascular Care
Abstract
:1. Introduction
2. Materials and Methods
3. Context
4. The Impact of COVID-19 Infection on the Cardiovascular System
4.1. Thromboembolic Condition
4.2. Mechanisms of Coagulopathy Linked with COVID-19
4.3. COVID-19 and Peripheral Venous Diseases
4.4. Cardiovascular Implications of ACE2 Being the SARS-CoV-2 Receptor
4.5. Thromboprophylaxis for the COVID-19
5. COVID-19 Cardiovascular Symptoms
5.1. Ischemia and Non-Ischemia-Related Cardiac Injury
5.2. Cardiomyopathies and Myocarditis
5.3. Arrhythmia and Abrupt Cardiac Death
5.4. Heart Failure
6. Solutions
6.1. Management of Cardiovascular Disease in COVID-19-Exposed Patients
6.2. The Possibility of Using Renin–Angiotensin System Antagonists as a Treatment in COVID-19 Pneumonia
6.3. Additional COVID-19 Therapy Suggestions
6.4. Transplantation of the Heart with Mechanical Circulatory Support
7. Vascular Surgeons and Ethics-Related Factors
8. Transition of Cardiovascular Surgery
Effects Worldwide
9. Residency and COVID-19
10. Short-Term and Long-Term Consequences of the COVID-19 Pandemic Affecting Surgical Care Provision
10.1. The Pandemic’s Effect on Surgical Services
10.2. Reconstructing Surgical Capability following Pandemic
10.3. Getting Ready for the Future
11. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Cardiovascular Condition Associated with COVID-19 | Mechanisms Implicated | Therapy/Management | References |
---|---|---|---|
Coagulopathy/thrombosis linked with COVID-19 | Reactivity of platelets, with viral-mediated endothelial inflammation and hypercoagulability, higher levels of coagulation factors, accumulated antiphospholipid antibodies, and lowered levels of intrinsic anticoagulant proteins | Antiaggregant/anticoagulant therapy | [42,43,44,45,46,47,48] |
Peripheral venous diseases | Cytokine storm, systemic immune reaction, hypercoagulable condition, excessive inflammation, platelet activation, endothelial dysfunction, and stasis | Antiaggregant/anticoagulant therapy, venous ablation | [49,50,51,52] |
Thromboembolism | Disease’s overall severity and its consequences | Low-molecular-weight heparin or fondaparinux instead of straight oral anticoagulants or fractionated heparin | [81] |
Virus-induced myocarditis and myocardial impairment | Hypoxia or cytokine-mediated systemic inflammation | Depending on the symptomatology | [88] |
Myocardial infarction | Elevated concentrations of circulating pro-inflammatory cytokines, macrophage involvement inside atherosclerotic plaques, plaque rupture, and thrombosis | Antiaggregant/anticoagulant therapy | [93] |
Cardiomyopathies and myocarditis | Lymphocytic or eosinophilic infiltration of the heart, cytokine-induced inflammatory myocarditis | Depending on the symptomatology | [97] |
Takotsubo cardiomyopathy | Direct myocardial damage, inflammation, and stress | Depending on the symptomatology | [104,105] |
Arrhythmia and abrupt cardiac death | Systemic illness, systemic infection, inflammation, QTc-prolonging drugs, i.e., quinolone antibiotics or hydroxychloroquine | Pharmacological management, i.e., amiodarone and diltiazem | [107,108] |
Heart failure | Invasion of inflammatory cells, proinflammatory cytokines, endothelial damage, microthrombosis, and hypoxia due to respiratory failure | Pharmacological management | [110,111,112,113,114] |
Preoperative | Intraoperative | Postoperative |
---|---|---|
Constant COVID-19 infection screening prior to 24 to 48 h | Non-COVID surgical suites | Clean recuperation area |
History of travel and possible exposure | Adaptation of negative-pressure ORs | Considering COVID-19 infection in the event of persistent respiratory distress |
Accurate CXR evaluation | Airborne measures and PPE must be used by all suppliers | Reduce the risk of renal failure and persistent respiratory distress |
Avoid unnecessary testing wherever feasible | Non-essential personnel to be absent from room | Protocol for accelerated recuperation, if applicable: Extubation, mobility, and disconnection of chest tubes and pacing wires as quickly is possible |
Consider using previous test results wherever feasible | Just attending-level medical personnel | Shortly following extubation, patients receive surgical masks |
Presurgical care delivered through telehealth | Video laryngoscopy to facilitate intubation | Timely collaboration with the family for postoperative recuperation at residence |
Patients wear surgical masks before arriving at the hospital | Reduce worker turnover inside the room | Early release when clinically stable |
Prompt intubation before surgery for patients with COVID-19 and respiratory dysfunction | Whenever possible, avoid TEE to prevent pleural invasion and lung harm | Following discharge, frequent and regular digital follow-up |
Putting off a case if COVID-19 positive | Limit operations that involve CO2 insufflation | Test for COVID-19 if clinical signs are seen |
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Axelerad, A.; Stuparu, A.Z.; Muja, L.F.; Docu Axelerad, S.; Petrov, S.G.; Gogu, A.E.; Jianu, D.C. Narrative Review of New Insight into the Influence of the COVID-19 Pandemic on Cardiovascular Care. Medicina 2022, 58, 1554. https://doi.org/10.3390/medicina58111554
Axelerad A, Stuparu AZ, Muja LF, Docu Axelerad S, Petrov SG, Gogu AE, Jianu DC. Narrative Review of New Insight into the Influence of the COVID-19 Pandemic on Cardiovascular Care. Medicina. 2022; 58(11):1554. https://doi.org/10.3390/medicina58111554
Chicago/Turabian StyleAxelerad, Any, Alina Zorina Stuparu, Lavinia Florenta Muja, Silviu Docu Axelerad, Silvia Georgeta Petrov, Anca Elena Gogu, and Dragos Catalin Jianu. 2022. "Narrative Review of New Insight into the Influence of the COVID-19 Pandemic on Cardiovascular Care" Medicina 58, no. 11: 1554. https://doi.org/10.3390/medicina58111554