The Exchange

Commentary and Observations from
the Medical Front Lines

The Cardiovascular Impact of COVID-19

The Cardiovascular Impact of COVID-19

On Wednesday, March 18th, the American College of Cardiology held a webinar with the Chinese Cardiovascular Association to hear from physicians on the front lines in Wuhan, China and other cities that have been seriously afflicted by COVID-19. While the physicians did not disclose the number of patients who lost their lives during the peak of their viral season, they did highlight some interesting observations that we should be on the lookout for in the US, particularly in our seriously ill populations.

Two things emerged in the webinar that were particularly interesting. Not only do the patients who test positive for COVID-19 present with respiratory symptoms and fever, but their symptoms dramatically worsen within hours. Respiratory distress seemed to be the overarching problem, and the cardiologists mentioned that almost all the patients had an impressively rapid, severe decline in their respiratory status. Most of these patients had several, multi-lobar consolidations on chest CT that were difficult to treat and lost their lives. In addition, post-mortem examinations revealed that many of the more severely ill patients who became septic also had evidence of microthrombosis, especially in the heart, which caused significant mortality due to cardiogenic shock. Based on this observation, the Chinese hospitals had been empirically treating patients with a sepsis-like presentation, high troponin, and high C-reactive protein levels with heparin to possibly mitigate any further cardiovascular damage. While doing so has its risks, treating by intuition is what makes novel illnesses like COVID-19 unique.

If you are working in an inpatient facility where the risk of COVID-19 with a sepsis-like presentation is becoming prominent, consider researching this topic and making a concerted effort to prepare for the unknown in this rapidly evolving disease.

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Filed under: Cardiometabolic, Infectious Diseases

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