Advances in Cardiology and Heart Surgery

The arrival of COVID-19 worldwide has hurled physicians into uncharted territories, not least of whom are cardiovascular and pulmonary specialists trying to stay abreast of the myriad cardiac and respiratory presentations of the virus.

In a paper published online in Circulation on April 4, physicians from NewYork-Presbyterian in New York City analyze four COVID-19 cases to help grasp and address unparalleled patient care challenges.

• Case 1: 64-year-old woman with predominant cardiac symptoms; diagnosed with myopericarditis and subsequently tests positive for SARS-CoV-2
• Case 2: 38-year-old man presents with cardiogenic shock and respiratory failure associated with COVID-19; managed successfully with VAV ECMO
• Case 3: 64-year-old woman with history of cardiomyopathy and diabetes; develops profound decompensated heart failure in the context of COVID-19 infection
• Case 4: 51-year-old man – a heart and kidney transplant recipient – presents with COVID-19; immunosuppressive therapy was adjusted for duration of illness

In their article, the physicians detail the clinical pathophysiology of each of these cases and the elements of their clinical decision-making within the current environment of COVID-19, including discussions on the following questions:

• How does COVID-19 infection result in cardiovascular presentations?
• What are treatment considerations for patients with preexisting cardiovascular diseases?
• What treatments should be used for patients with cardiovascular manifestations of COVID-19 infection?
• What are the issues for heart and other solid organ transplant recipients?

The thorough case studies provide instructional insight into the variable presentation of COVID-19 involvement of the cardiovascular system and highlight evolving considerations for treatment pathways across the spectrum of patients with preexisting cardiovascular diseases.

You can read the full article at https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.047164