PMC:7212949 / 22050-26537 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7212949","sourcedb":"PMC","sourceid":"7212949","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7212949","text":"Table 2 Cardiovascular manifestations of SARS-CoV, MERS-CoV and COVID-19.\nSARS (only studies with large study population included)\nStudy Booth et al (2003)N = 144, confirmed casesRetrospective study Li et al (2003)N = 46, confirmed casesProspective study Pan et al (2003)N = 15, confirmed casesRetrospective study Ding et al (2004)N = 8 (4 confirmed cases, 4 control)Clinicopathologic study Yu et al (2006)N = 121, confirmed casesRetrospective study\nClinical features • Chest pain (10%)• ↑HR (46%) • No chest pain or overt CHF on admission• ↓HR (non-ICU) ↑HR (ICU)•CHF exacerbation • Sudden cardiac arrest (100%)• MI and arrhythmia (33%) • Chest pain • ↑HR (71.9%) (62.8%, 45.4%, 35.5%)\n• ↓BP (50.4%) (28.1%, 21.5%, 14.8% during the first, second, third week)↓HR, transient (14.9%)\n• Reversible cardiomegaly (10.7%), no clinical heart failure\n• Chest discomfort (7%)\n• Palpitations (4%)\nKey findings on investigations • ↓Ca++ (60%)\n• ↓K+ (26%)\n• ↓Mg++ (18%)\n• ↓P+ (27%)\n• ↑ LDH (87%) • ↑ CK\n• ↑ LDH\n• ↓Hb\n• EKG: RBBB\n• Echo: ↓LVEF • Abnormal cardiac enzymes (66%) N/A • ↑ CK\n• ↑CK (26%) without TnI or CKMB\n• ↑ LDH\n• CXR or CT abnormality: 100%\nHistopathology N/A N/A N/A • Myocardial stromal edema\n• Infiltration of vessels by lymphocytes\n• Focal hyaline degeneration\n• Muscle fiber lysis N/A\nKey study findings and message • 20% ICU admission\n• 6.5% Case fatality rate (21 days)\n• Diabetes and other comorbidities independently associated with poor prognosis Possibly reversible subclinical diastolic impairment seen in SARS patients Proposed causes of SCD:• Hypoxemia leading to myocardial strain\n• Direct viral myocardial injury\n• Stress aggravates pre-existing disease\n• Sympathetic response causing electrical myocardial instability ACE2 expressed in heart, but virus not detected • ↑CK likely due to myositis as cardiac enzymes normal\n• 15% ICU admission\n• 18 (5) days mean duration of hospital stay\n• Tachycardia persists during follow up\n• Cardiac arrhythmia is uncommon\nMERS\nStudy Alhogbani (2016)N = 1 confirmed caseCase report Almekhlafi et al (2016)N = 31, confirmed casesRetrospective study Garout et al (2018)N = 52, confirmed casesRetrospective study\nClinical features CHF ↑HR (67.7%) Pericarditis\nKey findings on investigations • ↑ TnI\n• ↑ BNP\n• ↑ Creatinine\n• Echo: Severe global LV dysfunction\n• Cardiac MRI: Myocarditis N/A N/A\nKey study findings and message MERS-CoV may cause myocarditis and acute heart failure • Vasopressor need is a risk factor for death (P = 0.04)\n• 80.6% vasopressor support rate No association of ECMO need with outcomes\nCOVID-19\nStudy Huang et al (2020)N = 41, confirmed casesRetrospective study Wang et al (2020)N = 138, confirmed casesRetrospective study Zheng et al (2020)Review Bhatraju et al (2020)N = 24, confirmed casesRetrospective study Fried et al (2020)N = 4, confirmed casesCase reports\nClinical features • ↑BP\n• Acute cardiac injury (12%) more in ICU patients than non-ICU patients (31% vs. 4%) • Pre-existing HTN (31.2%) (58.3% in ICU, significant)\n• Pre-existing CVD (14.5%) (25% in ICU, significant)\n• Acute cardiac injury (7.2%) (22.2% in ICU, significant)\n• Arrhythmia (16.7%) (44.4% in ICU patients) • Palpitations\n• Chest tightness • ↑HR (48%)\n• Vasopressor need (71%) • Myopericarditis\n• Decompensated heart failure\n• Cardiogenic Shock\nKey findings on investigations • ↑ TnI (12%) (31% in ICU patients, 4% in non-ICU patients) • ↑ TnI\n• ↑ CK-MB N/A • ↑ TnI (15%) • Diffuse ST segment elevations\n• Elevated cardiac enzymes\n• LVEF on echo\nKey Study findings and message ↑BP more common in ICU patients (P = 0.018) ICU patients more likely to have pre-existing hypertension, develop arrhythmias, acute cardiac injury (P \u003c 0.001) Proposed mechanism of cardiac injury:• ACE 2 related\n• Cytokine storm\n• Hypoxemia • ICU admission most commonly due to hypoxemic respiratory failure, vasopressor requirement or both\n• 50% mortality • Similar symptoms in heart transplant patients as nontransplant patients\nBNP, B-type natriuretic peptide; BP, blood pressure; HR, heart rate; CHF, congestive heart failure; CK, creatine kinase; CKMB, creatine kinase myocardial band; CXR; chest x-ray; ECMO, extracorporeal membrane oxygenation; Hb, hemoglobin; ICU, intensive care unit; LDH, lactate dehydrogenase; LVEF, left ventricular ejection fraction; MI, myocardial infarction; MERS-CoV, middle east respiratory syndrome coronavirus; RBBB, right bundle branch block; SARS-COV, severe acute respiratory syndrome coronavirus; TnI, 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