COVID-19-associated cardiogenic shock: Difference between revisions

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The history of patients presented [[cardiogenic shock]] related to [[COVID-19]], according to a few anecdotal reports were different. Some did not have any [[cardiovascular]] risk factors.
The history of patients presented [[cardiogenic shock]] related to [[COVID-19]], according to a few anecdotal reports were different. Some did not have any [[cardiovascular]] risk factors.


:*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:<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>
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:<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 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
* A 37-year-old woman, obese with a history of [[deep venous thrombosis]], had symptoms of [[dyspnea]] and chest pain


=== Physical Examination ===
=== Physical Examination ===


*Physical examination may be remarkable for [[Covid-19 associated cardiogenic shock]]:<ref>{{cite book | last = Tse | first = FirstName | title = Oxford Desk Reference : Cardiology | publisher = OUP Oxford | location = Oxford | year = 2011 | isbn = 978-0-19-956809-3 }} </ref>
*Physical examination may be remarkable for [[Covid-19 associated cardiogenic shock]]:<ref>{{cite book | last = Tse | first = FirstName | title = Oxford Desk Reference : Cardiology | publisher = OUP Oxford | location = Oxford | year = 2011 | isbn = 978-0-19-956809-3 }} </ref>
:* Assessment of consciousness level
**Assessment of consciousness level
:* Extremities whether they are warm or cool is helpful for evaluation of [[cardiogenic shock]]
**Extremities whether they are warm or cool is helpful for evaluation of [[cardiogenic shock]]
:* Vital signs ([[tachycardia]] and [[hypotension]] and [[tachypnea]])
**Vital signs ([[tachycardia]] and [[hypotension]] and [[tachypnea]])
:* Evaluation of volume status: [[CVP]] (increased [[JVP]]), [[edema]]  
**Evaluation of volume status: [[CVP]] (increased [[JVP]]), [[edema]]
:* Skin pallor
**Skin pallor


=== Laboratory Findings ===
=== Laboratory Findings ===
*In [[COVID-19]] patients, it is essential to differentiate the shock types. Two tests are more valuable to clarify this, which are elevated in [[cardiogenic shock]] related to [[COVID-19]] : <ref name="LalHayward2020">{{cite journal|last1=Lal|first1=Sean|last2=Hayward|first2=Christopher S.|last3=De Pasquale|first3=Carmine|last4=Kaye|first4=David|last5=Javorsky|first5=George|last6=Bergin|first6=Peter|last7=Atherton|first7=John J.|last8=Ilton|first8=Marcus K.|last9=Weintraub|first9=Robert G.|last10=Nair|first10=Priya|last11=Rudas|first11=Mate|last12=Dembo|first12=Lawrence|last13=Doughty|first13=Robert N.|last14=Kumarasinghe|first14=Gayathri|last15=Juergens|first15=Craig|last16=Bannon|first16=Paul G.|last17=Bart|first17=Nicole K.|last18=Chow|first18=Clara K.|last19=Lattimore|first19=Jo-Dee|last20=Kritharides|first20=Leonard|last21=Totaro|first21=Richard|last22=Macdonald|first22=Peter S.|title=COVID-19 and Acute Heart Failure: Screening the Critically Ill – A Position Statement of the Cardiac Society of Australia and New Zealand (CSANZ)|journal=Heart, Lung and Circulation|year=2020|issn=14439506|doi=10.1016/j.hlc.2020.04.005}}</ref>
*In [[COVID-19]] patients, it is essential to differentiate the shock types. Two tests are more valuable to clarify this, which are elevated in [[cardiogenic shock]] related to [[COVID-19]] : <ref name="LalHayward2020">{{cite journal|last1=Lal|first1=Sean|last2=Hayward|first2=Christopher S.|last3=De Pasquale|first3=Carmine|last4=Kaye|first4=David|last5=Javorsky|first5=George|last6=Bergin|first6=Peter|last7=Atherton|first7=John J.|last8=Ilton|first8=Marcus K.|last9=Weintraub|first9=Robert G.|last10=Nair|first10=Priya|last11=Rudas|first11=Mate|last12=Dembo|first12=Lawrence|last13=Doughty|first13=Robert N.|last14=Kumarasinghe|first14=Gayathri|last15=Juergens|first15=Craig|last16=Bannon|first16=Paul G.|last17=Bart|first17=Nicole K.|last18=Chow|first18=Clara K.|last19=Lattimore|first19=Jo-Dee|last20=Kritharides|first20=Leonard|last21=Totaro|first21=Richard|last22=Macdonald|first22=Peter S.|title=COVID-19 and Acute Heart Failure: Screening the Critically Ill – A Position Statement of the Cardiac Society of Australia and New Zealand (CSANZ)|journal=Heart, Lung and Circulation|year=2020|issn=14439506|doi=10.1016/j.hlc.2020.04.005}}</ref>
 
**serum [[brain natriuretic peptide]] ([[BNP]])
:*serum [[brain natriuretic peptide]] ([[BNP]])
**[[Troponin]]
:*[[Troponin]]


*The increase of some biomarkers demonstrates poor prognosis, increased mortality, and more severe symptoms in [[COVID-19]] patients:<ref name="AboughdirKirwin2020">{{cite journal|last1=Aboughdir|first1=Maryam|last2=Kirwin|first2=Thomas|last3=Abdul Khader|first3=Ashiq|last4=Wang|first4=Brian|title=Prognostic Value of Cardiovascular Biomarkers in COVID-19: A Review|journal=Viruses|volume=12|issue=5|year=2020|pages=527|issn=1999-4915|doi=10.3390/v12050527}}</ref>
*The increase of some biomarkers demonstrates poor prognosis, increased mortality, and more severe symptoms in [[COVID-19]] patients:<ref name="AboughdirKirwin2020">{{cite journal|last1=Aboughdir|first1=Maryam|last2=Kirwin|first2=Thomas|last3=Abdul Khader|first3=Ashiq|last4=Wang|first4=Brian|title=Prognostic Value of Cardiovascular Biomarkers in COVID-19: A Review|journal=Viruses|volume=12|issue=5|year=2020|pages=527|issn=1999-4915|doi=10.3390/v12050527}}</ref>
 
**[[cTnT]] and [[cTnI]] levels
:*[[cTnT]] and [[cTnI]] levels
**The association of elevated [[CK-MB]] and [[BNP]]
:*The association of elevated [[CK-MB]] and [[BNP]]


===Electrocardiogram===
===Electrocardiogram===
*There is no specific electrocardiographic finding for [[cardiogenic shock]] in [[COVID-19 patients]].  
*There is no specific electrocardiographic finding for [[cardiogenic shock]] in [[COVID-19 patients]].
**The [[ECG]] can help to find previous cardiac abnormalities and triggering factors, such as [[acute myocardial infarction]], and [[arrhythmias]], which could lead to [[cardiogenic shock]] <ref>{{cite book | last = Tse | first = FirstName | title = Oxford Desk Reference : Cardiology | publisher = OUP Oxford | location = Oxford | year = 2011 | isbn = 978-0-19-956809-3 }} </ref>
*The [[ECG]] can help to find previous cardiac abnormalities and triggering factors, such as [[acute myocardial infarction]], and [[arrhythmias]], which could lead to [[cardiogenic shock]] <ref>{{cite book | last = Tse | first = FirstName | title = Oxford Desk Reference : Cardiology | publisher = OUP Oxford | location = Oxford | year = 2011 | isbn = 978-0-19-956809-3 }} </ref>


=== X-ray ===


===X-ray===
*In a patient with [[COVID-19]]-associated [[cardiogenic shock]], [[CXR]] could manifest coexisting acute respiratory illness and also cardiogenic [[pulmonary edema]]. Observing some findings, such as [[cardiomegaly]] and increased vascular markings, can suggest preexisting [[heart failure]]. <ref name="DrigginMadhavan2020">{{cite journal|last1=Driggin|first1=Elissa|last2=Madhavan|first2=Mahesh V.|last3=Bikdeli|first3=Behnood|last4=Chuich|first4=Taylor|last5=Laracy|first5=Justin|last6=Biondi-Zoccai|first6=Giuseppe|last7=Brown|first7=Tyler S.|last8=Der Nigoghossian|first8=Caroline|last9=Zidar|first9=David A.|last10=Haythe|first10=Jennifer|last11=Brodie|first11=Daniel|last12=Beckman|first12=Joshua A.|last13=Kirtane|first13=Ajay J.|last14=Stone|first14=Gregg W.|last15=Krumholz|first15=Harlan M.|last16=Parikh|first16=Sahil A.|title=Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic|journal=Journal of the American College of Cardiology|volume=75|issue=18|year=2020|pages=2352–2371|issn=07351097|doi=10.1016/j.jacc.2020.03.031}}</ref>
*In a patient with [[COVID-19]]-associated [[cardiogenic shock]], [[CXR]] could manifest coexisting acute respiratory illness and also cardiogenic [[pulmonary edema]]. Observing some findings, such as [[cardiomegaly]] and increased vascular markings, can suggest preexisting [[heart failure]]. <ref name="DrigginMadhavan2020">{{cite journal|last1=Driggin|first1=Elissa|last2=Madhavan|first2=Mahesh V.|last3=Bikdeli|first3=Behnood|last4=Chuich|first4=Taylor|last5=Laracy|first5=Justin|last6=Biondi-Zoccai|first6=Giuseppe|last7=Brown|first7=Tyler S.|last8=Der Nigoghossian|first8=Caroline|last9=Zidar|first9=David A.|last10=Haythe|first10=Jennifer|last11=Brodie|first11=Daniel|last12=Beckman|first12=Joshua A.|last13=Kirtane|first13=Ajay J.|last14=Stone|first14=Gregg W.|last15=Krumholz|first15=Harlan M.|last16=Parikh|first16=Sahil A.|title=Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic|journal=Journal of the American College of Cardiology|volume=75|issue=18|year=2020|pages=2352–2371|issn=07351097|doi=10.1016/j.jacc.2020.03.031}}</ref>


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===CT scan===
===CT scan===
*Generally, the [[CT scan]] is  not suggested being a primary imaging study, for evaluating a case with [[cardiogenic shock]] related to [[COVID-19]]. However, it can be suggestive of a coexisting [[ARDS]] by demonstrating a ground-glass opacity.<ref name="DrigginMadhavan2020">{{cite journal|last1=Driggin|first1=Elissa|last2=Madhavan|first2=Mahesh V.|last3=Bikdeli|first3=Behnood|last4=Chuich|first4=Taylor|last5=Laracy|first5=Justin|last6=Biondi-Zoccai|first6=Giuseppe|last7=Brown|first7=Tyler S.|last8=Der Nigoghossian|first8=Caroline|last9=Zidar|first9=David A.|last10=Haythe|first10=Jennifer|last11=Brodie|first11=Daniel|last12=Beckman|first12=Joshua A.|last13=Kirtane|first13=Ajay J.|last14=Stone|first14=Gregg W.|last15=Krumholz|first15=Harlan M.|last16=Parikh|first16=Sahil A.|title=Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic|journal=Journal of the American College of Cardiology|volume=75|issue=18|year=2020|pages=2352–2371|issn=07351097|doi=10.1016/j.jacc.2020.03.031}}</ref>
*Generally, the [[CT scan]] is  not suggested being a primary imaging study, for evaluating a case with [[cardiogenic shock]] related to [[COVID-19]]. However, it can be suggestive of a coexisting [[ARDS]] by demonstrating a ground-glass opacity.<ref name="DrigginMadhavan2020">{{cite journal|last1=Driggin|first1=Elissa|last2=Madhavan|first2=Mahesh V.|last3=Bikdeli|first3=Behnood|last4=Chuich|first4=Taylor|last5=Laracy|first5=Justin|last6=Biondi-Zoccai|first6=Giuseppe|last7=Brown|first7=Tyler S.|last8=Der Nigoghossian|first8=Caroline|last9=Zidar|first9=David A.|last10=Haythe|first10=Jennifer|last11=Brodie|first11=Daniel|last12=Beckman|first12=Joshua A.|last13=Kirtane|first13=Ajay J.|last14=Stone|first14=Gregg W.|last15=Krumholz|first15=Harlan M.|last16=Parikh|first16=Sahil A.|title=Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic|journal=Journal of the American College of Cardiology|volume=75|issue=18|year=2020|pages=2352–2371|issn=07351097|doi=10.1016/j.jacc.2020.03.031}}</ref>
**To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].
*To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].


===MRI===
===MRI===
*Routinely, in patients with [[COVID-19]]-associated [[cardiogenic shock]], Cardiac [[MRI]] for the assessment of preexisting disorders such as [[myocarditis]] should not be done.<ref name="pmid32601020">{{cite journal| author=Dhakal BP, Sweitzer NK, Indik JH, Acharya D, William P| title=SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart. | journal=Heart Lung Circ | year= 2020 | volume=  | issue=  | pages=  | pmid=32601020 | doi=10.1016/j.hlc.2020.05.101 | pmc=7274628 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32601020  }} </ref>  
*Routinely, in patients with [[COVID-19]]-associated [[cardiogenic shock]], Cardiac [[MRI]] for the assessment of preexisting disorders such as [[myocarditis]] should not be done.<ref name="pmid32601020">{{cite journal| author=Dhakal BP, Sweitzer NK, Indik JH, Acharya D, William P| title=SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart. | journal=Heart Lung Circ | year= 2020 | volume=  | issue=  | pages=  | pmid=32601020 | doi=10.1016/j.hlc.2020.05.101 | pmc=7274628 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32601020  }} </ref>
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]].<br />
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]].<br />


Line 152: Line 151:
== Treatment ==
== Treatment ==


===[[Cardiogenic shock medical therapy]]:===
===Cardiogenic shock medical therapy:===


:*[[Fluid resuscitation]] (crystalloid IV fluids are more efficient than colloid solutions)
* [[Fluid resuscitation]] (crystalloid IV fluids are more efficient than colloid solutions)
:*Administration of [[vasopressors]] and [[inotropes]] to stabilize [[shock]]
* Administration of [[vasopressors]] and [[inotropes]] to stabilize [[shock]]
:*Assess other types of [[shock]] and mixed etiologies of [[shock]] if hemodynamics not refining, specifically, in patients with a previous [[cardiac abnormality]] <ref name="pmid32601020">{{cite journal| author=Dhakal BP, Sweitzer NK, Indik JH, Acharya D, William P| title=SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart. | journal=Heart Lung Circ | year= 2020 | volume=  | issue=  | pages=  | pmid=32601020 | doi=10.1016/j.hlc.2020.05.101 | pmc=7274628 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32601020  }} </ref>
* Assess other types of [[shock]] and mixed etiologies of [[shock]] if hemodynamics not refining, specifically, in patients with a previous [[cardiac abnormality]] <ref name="pmid32601020">{{cite journal| author=Dhakal BP, Sweitzer NK, Indik JH, Acharya D, William P| title=SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart. | journal=Heart Lung Circ | year= 2020 | volume=  | issue=  | pages=  | pmid=32601020 | doi=10.1016/j.hlc.2020.05.101 | pmc=7274628 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32601020  }} </ref>


===Mechanical Support:===
===Mechanical Support:===


*In treating patients with [[cardiogenic shock]] related to [[COVID-19]], the efficacy of [[extracorporeal membrane oxygenation]] ([[ECMO]]) is indistinct. It might be used in most critically ill and highly selective patients. Although specialists utilizing [[ECMO]] and mechanical circulatory support devices, most of the cases have [[cardiogenic shock]] related to [[COVID-19]] die, since it has been reported in a case series from China  that most of these patients had a poor prognosis and did not survive despite implicating [[ECMO]]. <ref name="MacLarenFisher2020">{{cite journal|last1=MacLaren|first1=Graeme|last2=Fisher|first2=Dale|last3=Brodie|first3=Daniel|title=Preparing for the Most Critically Ill Patients With COVID-19|journal=JAMA|volume=323|issue=13|year=2020|pages=1245|issn=0098-7484|doi=10.1001/jama.2020.2342}}</ref> <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>
*In treating patients with [[cardiogenic shock]] related to [[COVID-19]], the efficacy of [[extracorporeal membrane oxygenation]] ([[ECMO]]) is indistinct.  
*It might be used in most critically ill and highly selective patients. Although specialists utilizing [[ECMO]] and mechanical circulatory support devices, most of the cases have [[cardiogenic shock]] related to [[COVID-19]] die, since it has been reported in a case series from China  that most of these patients had a poor prognosis and did not survive despite implicating [[ECMO]]. <ref name="MacLarenFisher2020">{{cite journal|last1=MacLaren|first1=Graeme|last2=Fisher|first2=Dale|last3=Brodie|first3=Daniel|title=Preparing for the Most Critically Ill Patients With COVID-19|journal=JAMA|volume=323|issue=13|year=2020|pages=1245|issn=0098-7484|doi=10.1001/jama.2020.2342}}</ref> <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>


===Surgery===
===Surgery===

Revision as of 23:03, 15 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: : Alieh Behjat, M.D.[2]

Synonyms and keywords:: Novel coronavirus, COVID-19, Wuhan coronavirus, coronavirus disease-19, coronavirus disease 2019, SARS-CoV-2, COVID-19, 2019-nCoV, 2019 novel coronavirus, cardiovascular finding in COVID-19, cardiogenic shock, COVID-19 associated cardiogenic shock

Overview

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. Two mechanisms are more probable to contribute to cardiogenic shock related to Covid-19 that includes direct invasion and cytokine storm. According to a recent study, one-third of critically ill patients with COVID-19 of an ICU in Washington State had clinical signs of cardiogenic shock and cardiomyopathy. According to an observational study in China, COVID-19 associated cardiogenic shock has a poor prognosis.

Historical Perspective

  • In December 2019, a novel coronavirus named SARS-CoV-2 resulted in Coronavirus disease 2019, which caused respiratory disease outbreak identified firstly in Wuhan, China.[1][2]
  • On March 12, 2020, the WHO declared coronavirus disease 2019(COVID-19) outbreak to be a pandemic.[3]
  • 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. [4]
  • To view the historical perspective of COVID-19, click here.

Classification

Pathophysiology

Two mechanisms are more probable to contribute to cardiogenic shock related to Covid-19:[5] [6]

Causes

The causes of cardiogenic shock related to COVID-19 might include: [7] [8]

Differentiating COVID-19 associated cardiogenic shock from other Diseases

Cardiac Output Pulmonary Capillary Wedge Pressure Systemic Vascular Resistance Pulmonary artery diastolic pressure SVO2
Septic shock ↑ ↓ ↓ ↓ ↓
Hypovolemic shock ↓ ↓ ↑ ↓ ↑
Cardiogenic shock ↓ ↑↔ ↑ ↑ ↓

Epidemiology and Demographics

Age

Gender

Race

Risk Factors

There are no established risk factors for COVID-19-associated cardiogenic shock. To view risk factors for the severe form of COVID-19 disease, click here. Moreover, in order to read more on the risk factors of cardiogenic shock, generally, click here.

Screening

There is insufficient evidence to recommend routine screening for COVID-19-associated cardiogenic shock.

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. [14] [15]

Diagnosis

Diagnostic Study of Choice

The diagnosis of cardiogenic shock related to COVID-19 is made when Systolic Blood Pressure is lower than 90 mmHg for more than 15 minutes with impaired organ perfusion while Urine output is less than 30 m/hr in a patient with COVID-19 disease.[15] To view cardiogenic shock diagnostic criteria, click here.

History and Symptoms:

The history of patients presented cardiogenic shock related to COVID-19, according to a few anecdotal reports were different. Some did not have any cardiovascular risk factors.

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. [4]

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:[13]

Physical Examination

Laboratory Findings

  • The increase of some biomarkers demonstrates poor prognosis, increased mortality, and more severe symptoms in COVID-19 patients:[18]

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT scan

  • Generally, the CT scan is not suggested being a primary imaging study, for evaluating a case with cardiogenic shock related to COVID-19. However, it can be suggestive of a coexisting ARDS by demonstrating a ground-glass opacity.[20]
  • To view the CT scan findings on COVID-19, click here.

MRI

Other Imaging Findings

  • To view other imaging findings on COVID-19, click here.

Other Diagnostic Studies

  • To view other diagnostic studies for COVID-19, click here.

Treatment

Cardiogenic shock medical therapy:

Mechanical Support:

Surgery

Primary Prevention

Secondary Prevention

  • There are no established measures for the secondary prevention of COVID-19-associated myocarditis.
  • For secondary preventive measures of [COVID-19], click here.

References

  1. ↑ https://www.cdc.gov/coronavirus/2019-ncov/about/index.html. Missing or empty |title= (help)
  2. ↑ Lu, Jian; Cui, Jie; Qian, Zhaohui; Wang, Yirong; Zhang, Hong; Duan, Yuange; Wu, Xinkai; Yao, Xinmin; Song, Yuhe; Li, Xiang; Wu, Changcheng; Tang, Xiaolu (2020). "On the origin and continuing evolution of SARS-CoV-2". National Science Review. doi:10.1093/nsr/nwaa036. ISSN 2095-5138.
  3. ↑ "Coronavirus (COVID-19) events as they happen".
  4. ↑ 4.0 4.1 4.2 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ Belhadjer, Zahra; Méot, Mathilde; Bajolle, Fanny; Khraiche, Diala; Legendre, Antoine; Abakka, Samya; Auriau, Johanne; Grimaud, Marion; Oualha, Mehdi; Beghetti, Maurice; Wacker, Julie; Ovaert, Caroline; Hascoet, Sebastien; Selegny, Maëlle; Malekzadeh-Milani, Sophie; Maltret, Alice; Bosser, Gilles; Giroux, Nathan; Bonnemains, Laurent; Bordet, Jeanne; Di Filippo, Sylvie; Mauran, Pierre; Falcon-Eicher, Sylvie; Thambo, Jean-Benoît; Lefort, Bruno; Moceri, Pamela; Houyel, Lucile; Renolleau, Sylvain; Bonnet, Damien (2020). "Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic". Circulation. doi:10.1161/CIRCULATIONAHA.120.048360. ISSN 0009-7322.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ Jameson, J (2018). Harrison's principles of internal medicine. New York: McGraw-Hill Education. ISBN 1259644030.
  12. ↑ Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M; et al. (2020). "Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State". JAMA. doi:10.1001/jama.2020.4326. PMC 7082763 Check |pmc= value (help). PMID 32191259 Check |pmid= value (help).
  13. ↑ 13.0 13.1 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.
  14. ↑ 14.0 14.1 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).
  15. ↑ 15.0 15.1 Dhakal, Bishnu P.; Sweitzer, Nancy K.; Indik, Julia H.; Acharya, Deepak; William, Preethi (2020). "SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart". Heart, Lung and Circulation. doi:10.1016/j.hlc.2020.05.101. ISSN 1443-9506.
  16. ↑ Tse, FirstName (2011). Oxford Desk Reference : Cardiology. Oxford: OUP Oxford. ISBN 978-0-19-956809-3.
  17. ↑ 17.0 17.1 Lal, Sean; Hayward, Christopher S.; De Pasquale, Carmine; Kaye, David; Javorsky, George; Bergin, Peter; Atherton, John J.; Ilton, Marcus K.; Weintraub, Robert G.; Nair, Priya; Rudas, Mate; Dembo, Lawrence; Doughty, Robert N.; Kumarasinghe, Gayathri; Juergens, Craig; Bannon, Paul G.; Bart, Nicole K.; Chow, Clara K.; Lattimore, Jo-Dee; Kritharides, Leonard; Totaro, Richard; Macdonald, Peter S. (2020). "COVID-19 and Acute Heart Failure: Screening the Critically Ill – A Position Statement of the Cardiac Society of Australia and New Zealand (CSANZ)". Heart, Lung and Circulation. doi:10.1016/j.hlc.2020.04.005. ISSN 1443-9506.
  18. ↑ Aboughdir, Maryam; Kirwin, Thomas; Abdul Khader, Ashiq; Wang, Brian (2020). "Prognostic Value of Cardiovascular Biomarkers in COVID-19: A Review". Viruses. 12 (5): 527. doi:10.3390/v12050527. ISSN 1999-4915.
  19. ↑ Tse, FirstName (2011). Oxford Desk Reference : Cardiology. Oxford: OUP Oxford. ISBN 978-0-19-956809-3.
  20. ↑ 20.0 20.1 Driggin, Elissa; Madhavan, Mahesh V.; Bikdeli, Behnood; Chuich, Taylor; Laracy, Justin; Biondi-Zoccai, Giuseppe; Brown, Tyler S.; Der Nigoghossian, Caroline; Zidar, David A.; Haythe, Jennifer; Brodie, Daniel; Beckman, Joshua A.; Kirtane, Ajay J.; Stone, Gregg W.; Krumholz, Harlan M.; Parikh, Sahil A. (2020). "Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic". Journal of the American College of Cardiology. 75 (18): 2352–2371. doi:10.1016/j.jacc.2020.03.031. ISSN 0735-1097.
  21. ↑ 21.0 21.1 Dhakal BP, Sweitzer NK, Indik JH, Acharya D, William P (2020). "SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart". Heart Lung Circ. doi:10.1016/j.hlc.2020.05.101. PMC 7274628 Check |pmc= value (help). PMID 32601020 Check |pmid= value (help).
  22. ↑ MacLaren, Graeme; Fisher, Dale; Brodie, Daniel (2020). "Preparing for the Most Critically Ill Patients With COVID-19". JAMA. 323 (13): 1245. doi:10.1001/jama.2020.2342. ISSN 0098-7484.

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