Cardiovascular Considerations for the Internist and Hospitalist in the COVID-19 Era - 05/11/20

Doi : 10.1016/j.amjmed.2020.06.005

Michael R. Massoomi, MD ^a, R. David Anderson, MD ^a,^⁎ , Mustafa M. Ahmed, MD ^a, Osama Dasa, MD ^b, Philip George, MD ^a, William M. Miles, MD ^a, Juan M. Aranda, MD ^a, Carl J. Pepine, MD ^a
^a Division of Cardiovascular Medicine, UF Health, University of Florida, Gainesville
^b Department of Internal Medicine, UF Health, University of Florida, Gainesville

^⁎Requests for reprints should be addressed to R. David Anderson, MD, University of Florida Division of Cardiovascular Medicine, 1329 SW 16th St, PO Box 100288, Gainesville, FL 32610-0288University of Florida Division of Cardiovascular Medicine1329 SW 16th St PO Box 100288GainesvilleFL32610-0288

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Abstract

It is clear that existing cardiovascular disease is a major risk factor for COVID-19 and related adverse outcomes. In addition to acute respiratory syndrome, a large cohort also develop myocardial or vascular dysfunction, in part from inflammation and renin angiotensin system activation with increased sympathetic outflow, cardiac arrhythmias, ischemia, heart failure, and thromboembolic complications that portend poor outcomes related to COVID-19.

We summarize recent information for hospitalists and internists on the front line of this pandemic regarding its cardiovascular impacts and management and the need for cardiovascular consultation.

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Keywords : Cardiovascular consult, Cardiovascular disease, COVID-19, Multidisciplinary care, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Plan

Introduction

Electrocardiogram and Biomarker Testing

Anticoagulation

Approach to Acute Myocardial Injury in the COVID-19 Era

ST-Segment Elevation Myocardial Injury

Unstable Angina or NSTEMI Myocardial Injury

Cardiogenic Shock or Out-of-Hospital Cardiac Arrest

Heart Failure Considerations in COVID-19 Management

Cardiac Arrhythmia Considerations

Drug-Induced QT Interval Prolongation and Torsades de Pointes

Arrhythmia Management in COVID-19

Cardiac Implantable Electronic Devices

Conclusions

	Funding: None.
	Conflicts of Interest: Authors do not have conflicts or funding specific to this manuscript.
	Authorship: All authors had access to the data and a role in writing this manuscript.