COVID-19-associated cardiogenic shock: Difference between revisions
Jump to navigation
Jump to search
(Created page with "__NOTOC__ '''For COVID-19 frequently asked inpatient questions, click here'''<br> '''For COVID-19 frequently asked outpatient...") |
No edit summary |
||
| Line 9: | Line 9: | ||
==Historical Perspective== | ==Historical Perspective== | ||
*In Italy, for the first time in a 69-year-old patient, who was presented with cardiogenic shock due to COVID-19 infection, myocardial involvement by viral particles was pathologically proved through biopsy. <ref name="TavazziPellegrini2020">{{cite journal|last1=Tavazzi|first1=Guido|last2=Pellegrini|first2=Carlo|last3=Maurelli|first3=Marco|last4=Belliato|first4=Mirko|last5=Sciutti|first5=Fabio|last6=Bottazzi|first6=Andrea|last7=Sepe|first7=Paola Alessandra|last8=Resasco|first8=Tullia|last9=Camporotondo|first9=Rita|last10=Bruno|first10=Raffaele|last11=Baldanti|first11=Fausto|last12=Paolucci|first12=Stefania|last13=Pelenghi|first13=Stefano|last14=Iotti|first14=Giorgio Antonio|last15=Mojoli|first15=Francesco|last16=Arbustini|first16=Eloisa|title=Myocardial localization of coronavirus in COVID‐19 cardiogenic shock|journal=European Journal of Heart Failure|volume=22|issue=5|year=2020|pages=911–915|issn=1388-9842|doi=10.1002/ejhf.1828}}</ref> | *In Italy, for the first time in a 69-year-old patient, who was presented with [[cardiogenic shock]] due to [[COVID-19]] infection, [[myocardial]] involvement by viral particles was pathologically proved through [[biopsy]]. <ref name="TavazziPellegrini2020">{{cite journal|last1=Tavazzi|first1=Guido|last2=Pellegrini|first2=Carlo|last3=Maurelli|first3=Marco|last4=Belliato|first4=Mirko|last5=Sciutti|first5=Fabio|last6=Bottazzi|first6=Andrea|last7=Sepe|first7=Paola Alessandra|last8=Resasco|first8=Tullia|last9=Camporotondo|first9=Rita|last10=Bruno|first10=Raffaele|last11=Baldanti|first11=Fausto|last12=Paolucci|first12=Stefania|last13=Pelenghi|first13=Stefano|last14=Iotti|first14=Giorgio Antonio|last15=Mojoli|first15=Francesco|last16=Arbustini|first16=Eloisa|title=Myocardial localization of coronavirus in COVID‐19 cardiogenic shock|journal=European Journal of Heart Failure|volume=22|issue=5|year=2020|pages=911–915|issn=1388-9842|doi=10.1002/ejhf.1828}}</ref> | ||
==Classification== | ==Classification== | ||
There is no specific classification for COVID-19 associated cardiogenic shock. | There is no specific classification for [[COVID-19]] associated [[cardiogenic shock]]. | ||
For more information regarding general classification, see the [[cardiogenic shock classification]]. | For more information regarding general classification, see the [[cardiogenic shock classification]]. | ||
==Pathophysiology== | ==Pathophysiology== | ||
Two mechanisms are more probable to contribute to cardiogenic shock related to Covid-19: | Two mechanisms are more probable to contribute to [[cardiogenic shock]] related to [[Covid-19]]: | ||
* Direct invasion of the virus into the cardiomyocytes | * Direct invasion of the virus into the [[cardiomyocytes]] | ||
* Cytokine storm activated by T helper cells (Th1 and Th2) and trigger a systemic hyperinflammatory response.<ref name="SiddiqiMehra2020">{{cite journal|last1=Siddiqi|first1=Hasan K.|last2=Mehra|first2=Mandeep R.|title=COVID-19 illness in native and immunosuppressed states: A clinical–therapeutic staging proposal|journal=The Journal of Heart and Lung Transplantation|volume=39|issue=5|year=2020|pages=405–407|issn=10532498|doi=10.1016/j.healun.2020.03.012}}</ref> <ref name="YeWang2020">{{cite journal|last1=Ye|first1=Qing|last2=Wang|first2=Bili|last3=Mao|first3=Jianhua|title=The pathogenesis and treatment of the `Cytokine Storm' in COVID-19|journal=Journal of Infection|volume=80|issue=6|year=2020|pages=607–613|issn=01634453|doi=10.1016/j.jinf.2020.03.037}}</ref> | * [[Cytokine storm]] activated by [[T helper cells]] ([[Th1]] and [[Th2]]) and trigger a systemic hyperinflammatory response.<ref name="SiddiqiMehra2020">{{cite journal|last1=Siddiqi|first1=Hasan K.|last2=Mehra|first2=Mandeep R.|title=COVID-19 illness in native and immunosuppressed states: A clinical–therapeutic staging proposal|journal=The Journal of Heart and Lung Transplantation|volume=39|issue=5|year=2020|pages=405–407|issn=10532498|doi=10.1016/j.healun.2020.03.012}}</ref> <ref name="YeWang2020">{{cite journal|last1=Ye|first1=Qing|last2=Wang|first2=Bili|last3=Mao|first3=Jianhua|title=The pathogenesis and treatment of the `Cytokine Storm' in COVID-19|journal=Journal of Infection|volume=80|issue=6|year=2020|pages=607–613|issn=01634453|doi=10.1016/j.jinf.2020.03.037}}</ref> | ||
==Differentiating COVID-19 associated cardiogenic shock from other Diseases== | ==Differentiating [[COVID-19]] associated [[cardiogenic shock]] from other Diseases== | ||
*[[Cardiogenic shock]] related to COVID-19 must be differentiated from other diseases when hemodynamics not changing, such as: | *[[Cardiogenic shock]] related to [[COVID-19]] must be differentiated from other diseases when hemodynamics not changing, such as: | ||
:* COVID-19 associated distributive shock | :* COVID-19 associated [[distributive shock]] | ||
:* COVID-19 associated hypovolemic shock | :* COVID-19 associated [[hypovolemic shock]] | ||
:* COVID-19 associated mixed (distributive and cardiogenic shock) <ref name="BoukhrisHillani2020">{{cite journal|last1=Boukhris|first1=Marouane|last2=Hillani|first2=Ali|last3=Moroni|first3=Francesco|last4=Annabi|first4=Mohamed Salah|last5=Addad|first5=Faouzi|last6=Ribeiro|first6=Marcelo Harada|last7=Mansour|first7=Samer|last8=Zhao|first8=Xiaohui|last9=Ybarra|first9=Luiz Fernando|last10=Abbate|first10=Antonio|last11=Vilca|first11=Luz Maria|last12=Azzalini|first12=Lorenzo|title=Cardiovascular Implications of the COVID-19 Pandemic: A Global Perspective|journal=Canadian Journal of Cardiology|year=2020|issn=0828282X|doi=10.1016/j.cjca.2020.05.018}}</ref> <ref name="RajagopalKeller2020">{{cite journal|last1=Rajagopal|first1=Keshava|last2=Keller|first2=Steven P.|last3=Akkanti|first3=Bindu|last4=Bime|first4=Christian|last5=Loyalka|first5=Pranav|last6=Cheema|first6=Faisal H.|last7=Zwischenberger|first7=Joseph B.|last8=El Banayosy|first8=Aly|last9=Pappalardo|first9=Federico|last10=Slaughter|first10=Mark S.|last11=Slepian|first11=Marvin J.|title=Advanced Pulmonary and Cardiac Support of COVID-19 Patients|journal=Circulation: Heart Failure|volume=13|issue=5|year=2020|issn=1941-3289|doi=10.1161/CIRCHEARTFAILURE.120.007175}}</ref> | :* COVID-19 associated mixed ([[distributive]] and [[cardiogenic shock]]) <ref name="BoukhrisHillani2020">{{cite journal|last1=Boukhris|first1=Marouane|last2=Hillani|first2=Ali|last3=Moroni|first3=Francesco|last4=Annabi|first4=Mohamed Salah|last5=Addad|first5=Faouzi|last6=Ribeiro|first6=Marcelo Harada|last7=Mansour|first7=Samer|last8=Zhao|first8=Xiaohui|last9=Ybarra|first9=Luiz Fernando|last10=Abbate|first10=Antonio|last11=Vilca|first11=Luz Maria|last12=Azzalini|first12=Lorenzo|title=Cardiovascular Implications of the COVID-19 Pandemic: A Global Perspective|journal=Canadian Journal of Cardiology|year=2020|issn=0828282X|doi=10.1016/j.cjca.2020.05.018}}</ref> <ref name="RajagopalKeller2020">{{cite journal|last1=Rajagopal|first1=Keshava|last2=Keller|first2=Steven P.|last3=Akkanti|first3=Bindu|last4=Bime|first4=Christian|last5=Loyalka|first5=Pranav|last6=Cheema|first6=Faisal H.|last7=Zwischenberger|first7=Joseph B.|last8=El Banayosy|first8=Aly|last9=Pappalardo|first9=Federico|last10=Slaughter|first10=Mark S.|last11=Slepian|first11=Marvin J.|title=Advanced Pulmonary and Cardiac Support of COVID-19 Patients|journal=Circulation: Heart Failure|volume=13|issue=5|year=2020|issn=1941-3289|doi=10.1161/CIRCHEARTFAILURE.120.007175}}</ref> | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
* The prevalence of cardiogenic shock-associated COVID-19 has not yet been reported.There are several anecdotal reports of cardiogenic shock related to COVID-19: | * The prevalence of [[cardiogenic shock-associated COVID-19]] has not yet been reported.There are several anecdotal reports of [[cardiogenic shock]] related to [[COVID-19]]: | ||
* A 69-year-old patient from Italy has been reported by Tavazzi et al., as a cardiogenic shock-associated COVID-19 case. The patient had flu-like symptoms when he was hospitalized and quickly deteriorated into respiratory distress and cardiogenic shock. <ref name="TavazziPellegrini2020">{{cite journal|last1=Tavazzi|first1=Guido|last2=Pellegrini|first2=Carlo|last3=Maurelli|first3=Marco|last4=Belliato|first4=Mirko|last5=Sciutti|first5=Fabio|last6=Bottazzi|first6=Andrea|last7=Sepe|first7=Paola Alessandra|last8=Resasco|first8=Tullia|last9=Camporotondo|first9=Rita|last10=Bruno|first10=Raffaele|last11=Baldanti|first11=Fausto|last12=Paolucci|first12=Stefania|last13=Pelenghi|first13=Stefano|last14=Iotti|first14=Giorgio Antonio|last15=Mojoli|first15=Francesco|last16=Arbustini|first16=Eloisa|title=Myocardial localization of coronavirus in COVID‐19 cardiogenic shock|journal=European Journal of Heart Failure|volume=22|issue=5|year=2020|pages=911–915|issn=1388-9842|doi=10.1002/ejhf.1828}}</ref> | * A 69-year-old patient from Italy has been reported by Tavazzi et al., as a cardiogenic shock-associated COVID-19 case. The patient had flu-like symptoms when he was hospitalized and quickly deteriorated into [[respiratory distress]] and [[cardiogenic shock]]. <ref name="TavazziPellegrini2020">{{cite journal|last1=Tavazzi|first1=Guido|last2=Pellegrini|first2=Carlo|last3=Maurelli|first3=Marco|last4=Belliato|first4=Mirko|last5=Sciutti|first5=Fabio|last6=Bottazzi|first6=Andrea|last7=Sepe|first7=Paola Alessandra|last8=Resasco|first8=Tullia|last9=Camporotondo|first9=Rita|last10=Bruno|first10=Raffaele|last11=Baldanti|first11=Fausto|last12=Paolucci|first12=Stefania|last13=Pelenghi|first13=Stefano|last14=Iotti|first14=Giorgio Antonio|last15=Mojoli|first15=Francesco|last16=Arbustini|first16=Eloisa|title=Myocardial localization of coronavirus in COVID‐19 cardiogenic shock|journal=European Journal of Heart Failure|volume=22|issue=5|year=2020|pages=911–915|issn=1388-9842|doi=10.1002/ejhf.1828}}</ref> | ||
* Four patients with cardiogenic shock complication related to COVID-19 were reported by Sanchez-Recalde, et al. They were hospitalized between 1 March and 15 April 2020 including: | * Four patients with [[cardiogenic shock]] complication related to [[COVID-19]] were reported by Sanchez-Recalde, et al. They were hospitalized between 1 March and 15 April 2020 including: | ||
** A 42-year-old woman, who had dyslipidemia as a cardiovascular risk factor | ** A 42-year-old woman, who had [[dyslipidemia]] as a [[cardiovascular]] risk factor | ||
** A 50-year-old man, without any cardiovascular risk factors, admitted by severe bilateral pneumonia related to COVID-19. After a few hours, he developed cardiogenic shock. | ** A 50-year-old man, without any [[cardiovascular]] risk factors, admitted by severe bilateral [[pneumonia]] related to [[COVID-19]]. After a few hours, he developed [[cardiogenic shock]]. | ||
** A 75-year-old man did not have any cardiovascular risk factors and was admitted due to dyspnea, chest pain, and bilateral SARS-CoV-2 pneumonia. | ** A 75-year-old man did not have any [[cardiovascular]] risk factors and was admitted due to [[dyspnea]], [[chest pain]], and bilateral SARS-CoV-2 [[pneumonia]]. | ||
** A 37-year-old woman, obese with a history of deep venous thrombosis, had symptoms of dyspnea and chest pain <ref name="Sánchez-RecaldeSolano-López2020">{{cite journal|last1=Sánchez-Recalde|first1=Ángel|last2=Solano-López|first2=Jorge|last3=Miguelena-Hycka|first3=Javier|last4=Martín-Pinacho|first4=Jesús Javier|last5=Sanmartín|first5=Marcelo|last6=Zamorano|first6=José L.|title=COVID-19 and cardiogenic shock. Different cardiovascular presentations with high mortality|journal=Revista Española de Cardiología (English Edition)|year=2020|issn=18855857|doi=10.1016/j.rec.2020.04.012}}</ref> | ** A 37-year-old woman, obese with a history of [[deep venous thrombosis]], had symptoms of [[dyspnea]] and [[chest pain]] <ref name="Sánchez-RecaldeSolano-López2020">{{cite journal|last1=Sánchez-Recalde|first1=Ángel|last2=Solano-López|first2=Jorge|last3=Miguelena-Hycka|first3=Javier|last4=Martín-Pinacho|first4=Jesús Javier|last5=Sanmartín|first5=Marcelo|last6=Zamorano|first6=José L.|title=COVID-19 and cardiogenic shock. Different cardiovascular presentations with high mortality|journal=Revista Española de Cardiología (English Edition)|year=2020|issn=18855857|doi=10.1016/j.rec.2020.04.012}}</ref> | ||
==Causes== | ==Causes== | ||
The causes of cardiogenic shock related to COVID-19 might include: | The causes of [[cardiogenic shock]] related to [[COVID-19]] might include: | ||
* Newly emerging COVID-19 associated myocarditis, cardiac arrhythmias, cardiomyopathy, or an acute coronary syndrome deteriorated into cardiogenic shock | * Newly emerging COVID-19 associated [[myocarditis]], [[cardiac arrhythmias]], [[cardiomyopathy]], or an [[acute coronary syndrome]] deteriorated into [[cardiogenic shock]] | ||
* Worsening of previous left ventricular failure due to COVID-19 <ref name="MahajanChandra2020">{{cite journal|last1=Mahajan|first1=Kunal|last2=Chandra|first2=K.Sarat|title=Cardiovascular comorbidities and complications associated with coronavirus disease 2019|journal=Medical Journal Armed Forces India|year=2020|issn=03771237|doi=10.1016/j.mjafi.2020.05.004}}</ref> | * Worsening of previous [[left ventricular failure]] due to [[COVID-19]] <ref name="MahajanChandra2020">{{cite journal|last1=Mahajan|first1=Kunal|last2=Chandra|first2=K.Sarat|title=Cardiovascular comorbidities and complications associated with coronavirus disease 2019|journal=Medical Journal Armed Forces India|year=2020|issn=03771237|doi=10.1016/j.mjafi.2020.05.004}}</ref> | ||
== Complications and Prognosis== | == Complications and Prognosis== | ||
According to an observational study in China, COVID-19 associated cardiogenic shock has a poor prognosis. In spite of using Extracorporeal membrane oxygenation (ECMO), 83% of patients died. <ref name="pmid32105632">{{cite journal| author=Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H | display-authors=etal| title=Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. | journal=Lancet Respir Med | year= 2020 | volume= 8 | issue= 5 | pages= 475-481 | pmid=32105632 | doi=10.1016/S2213-2600(20)30079-5 | pmc=7102538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32105632 }} </ref> <ref name="pmid7274628">{{cite journal| author=Takahashi M, Arai H, Kokubo T, Furukawa F, Kurata Y, Ito N| title=An ultrastructural study of precancerous and cancerous lesions of the pancreas in Syrian golden hamsters induced by N-nitrosobis(2-oxopropyl)amine. | journal=Gan | year= 1980 | volume= 71 | issue= 6 | pages= 825-31 | pmid=7274628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7274628 }} </ref> | According to an observational study in China, [[COVID-19]] associated [[cardiogenic shock]] has a poor prognosis. In spite of using [[Extracorporeal membrane oxygenation]] ([[ECMO]]), 83% of patients died. <ref name="pmid32105632">{{cite journal| author=Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H | display-authors=etal| title=Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. | journal=Lancet Respir Med | year= 2020 | volume= 8 | issue= 5 | pages= 475-481 | pmid=32105632 | doi=10.1016/S2213-2600(20)30079-5 | pmc=7102538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32105632 }} </ref> <ref name="pmid7274628">{{cite journal| author=Takahashi M, Arai H, Kokubo T, Furukawa F, Kurata Y, Ito N| title=An ultrastructural study of precancerous and cancerous lesions of the pancreas in Syrian golden hamsters induced by N-nitrosobis(2-oxopropyl)amine. | journal=Gan | year= 1980 | volume= 71 | issue= 6 | pages= 825-31 | pmid=7274628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7274628 }} </ref> | ||
== Diagnosis == | == Diagnosis == | ||
Revision as of 22:28, 29 June 2020
For COVID-19 frequently asked inpatient questions, click here
For COVID-19 frequently asked outpatient questions, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alieh Behjat, M.D.
Overview
Historical Perspective
- In Italy, for the first time in a 69-year-old patient, who was presented with cardiogenic shock due to COVID-19 infection, myocardial involvement by viral particles was pathologically proved through biopsy. [1]
Classification
There is no specific classification for COVID-19 associated cardiogenic shock. For more information regarding general classification, see the cardiogenic shock classification.
Pathophysiology
Two mechanisms are more probable to contribute to cardiogenic shock related to Covid-19:
- Direct invasion of the virus into the cardiomyocytes
- Cytokine storm activated by T helper cells (Th1 and Th2) and trigger a systemic hyperinflammatory response.[2] [3]
Differentiating COVID-19 associated cardiogenic shock from other Diseases
- Cardiogenic shock related to COVID-19 must be differentiated from other diseases when hemodynamics not changing, such as:
- COVID-19 associated distributive shock
- COVID-19 associated hypovolemic shock
- COVID-19 associated mixed (distributive and cardiogenic shock) [4] [5]
Epidemiology and Demographics
- The prevalence of cardiogenic shock-associated COVID-19 has not yet been reported.There are several anecdotal reports of cardiogenic shock related to COVID-19:
- A 69-year-old patient from Italy has been reported by Tavazzi et al., as a cardiogenic shock-associated COVID-19 case. The patient had flu-like symptoms when he was hospitalized and quickly deteriorated into respiratory distress and cardiogenic shock. [1]
- Four patients with cardiogenic shock complication related to COVID-19 were reported by Sanchez-Recalde, et al. They were hospitalized between 1 March and 15 April 2020 including:
- A 42-year-old woman, who had dyslipidemia as a cardiovascular risk factor
- A 50-year-old man, without any cardiovascular risk factors, admitted by severe bilateral pneumonia related to COVID-19. After a few hours, he developed cardiogenic shock.
- A 75-year-old man did not have any cardiovascular risk factors and was admitted due to dyspnea, chest pain, and bilateral SARS-CoV-2 pneumonia.
- A 37-year-old woman, obese with a history of deep venous thrombosis, had symptoms of dyspnea and chest pain [6]
Causes
The causes of cardiogenic shock related to COVID-19 might include:
- Newly emerging COVID-19 associated myocarditis, cardiac arrhythmias, cardiomyopathy, or an acute coronary syndrome deteriorated into cardiogenic shock
- Worsening of previous left ventricular failure due to COVID-19 [7]
Complications and Prognosis
According to an observational study in China, COVID-19 associated cardiogenic shock has a poor prognosis. In spite of using Extracorporeal membrane oxygenation (ECMO), 83% of patients died. [8] [9]
Diagnosis
Treatment
References
- ↑ 1.0 1.1 Tavazzi, Guido; Pellegrini, Carlo; Maurelli, Marco; Belliato, Mirko; Sciutti, Fabio; Bottazzi, Andrea; Sepe, Paola Alessandra; Resasco, Tullia; Camporotondo, Rita; Bruno, Raffaele; Baldanti, Fausto; Paolucci, Stefania; Pelenghi, Stefano; Iotti, Giorgio Antonio; Mojoli, Francesco; Arbustini, Eloisa (2020). "Myocardial localization of coronavirus in COVID‐19 cardiogenic shock". European Journal of Heart Failure. 22 (5): 911–915. doi:10.1002/ejhf.1828. ISSN 1388-9842.
- ↑ Siddiqi, Hasan K.; Mehra, Mandeep R. (2020). "COVID-19 illness in native and immunosuppressed states: A clinical–therapeutic staging proposal". The Journal of Heart and Lung Transplantation. 39 (5): 405–407. doi:10.1016/j.healun.2020.03.012. ISSN 1053-2498.
- ↑ Ye, Qing; Wang, Bili; Mao, Jianhua (2020). "The pathogenesis and treatment of the `Cytokine Storm' in COVID-19". Journal of Infection. 80 (6): 607–613. doi:10.1016/j.jinf.2020.03.037. ISSN 0163-4453.
- ↑ Boukhris, Marouane; Hillani, Ali; Moroni, Francesco; Annabi, Mohamed Salah; Addad, Faouzi; Ribeiro, Marcelo Harada; Mansour, Samer; Zhao, Xiaohui; Ybarra, Luiz Fernando; Abbate, Antonio; Vilca, Luz Maria; Azzalini, Lorenzo (2020). "Cardiovascular Implications of the COVID-19 Pandemic: A Global Perspective". Canadian Journal of Cardiology. doi:10.1016/j.cjca.2020.05.018. ISSN 0828-282X.
- ↑ Rajagopal, Keshava; Keller, Steven P.; Akkanti, Bindu; Bime, Christian; Loyalka, Pranav; Cheema, Faisal H.; Zwischenberger, Joseph B.; El Banayosy, Aly; Pappalardo, Federico; Slaughter, Mark S.; Slepian, Marvin J. (2020). "Advanced Pulmonary and Cardiac Support of COVID-19 Patients". Circulation: Heart Failure. 13 (5). doi:10.1161/CIRCHEARTFAILURE.120.007175. ISSN 1941-3289.
- ↑ Sánchez-Recalde, Ángel; Solano-López, Jorge; Miguelena-Hycka, Javier; Martín-Pinacho, Jesús Javier; Sanmartín, Marcelo; Zamorano, José L. (2020). "COVID-19 and cardiogenic shock. Different cardiovascular presentations with high mortality". Revista Española de Cardiología (English Edition). doi:10.1016/j.rec.2020.04.012. ISSN 1885-5857.
- ↑ Mahajan, Kunal; Chandra, K.Sarat (2020). "Cardiovascular comorbidities and complications associated with coronavirus disease 2019". Medical Journal Armed Forces India. doi:10.1016/j.mjafi.2020.05.004. ISSN 0377-1237.
- ↑ Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H; et al. (2020). "Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study". Lancet Respir Med. 8 (5): 475–481. doi:10.1016/S2213-2600(20)30079-5. PMC 7102538 Check
|pmc=value (help). PMID 32105632 Check|pmid=value (help). - ↑ Takahashi M, Arai H, Kokubo T, Furukawa F, Kurata Y, Ito N (1980). "An ultrastructural study of precancerous and cancerous lesions of the pancreas in Syrian golden hamsters induced by N-nitrosobis(2-oxopropyl)amine". Gan. 71 (6): 825–31. PMID 7274628.