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editorial
. 2020 Apr 10;8(6):512–514. doi: 10.1016/j.jchf.2020.03.004

Table 1.

Clinical Cardiovascular Concerns in COVID-19 Illness

COVID-19 Infection Concern Interpretation
Asymptomatic or early mild disease with constitutional symptoms (fever, dry cough, diarrhea, and headache) Should background cardiovascular medications be modified?
  • •

    There is no clear evidence that ACEi or ARBs should be discontinued

  • •

    NSAIDs should be used with caution or, ideally, avoided
Moderate disease with pulmonary complications and shortness of breath (including hypoxia) Is there a cardiovascular contribution to the lung complications?
  • •

    Check troponin (evidence of myocardial injury and prognosis)

  • •

    Check natriuretic peptides

  • •

    Consider cardiac echocardiography to evaluate for evidence of underlying structural heart disease, high filling pressures

  • •

    Avoid overuse of intravenous fluids, which may worsen underlying pulmonary edema
Advanced-stage disease with hypoxia, vasoplegia, and shock Is there evidence of cardiogenic contribution to shock, and what therapy may be potentially curative?
  • •

    Check for evidence of hyperinflammation or a cytokine release storm (elevated troponin, natriuretic peptides, CRP, and serum ferritin of >1,000 ng/ml (measure IL-6 levels if available)

  • •

    If cardiac function is reduced (LVEF <0.50%), consider supportive care with inotropic therapy but move to consider anticytokine therapy with drugs such as tocilizumab and corticosteroids

Note that therapy in COVID-19 remains experimental.

ACEi = angiotensin-converting enzyme inhibitors; ARB = angiotensin receptor blockers; CRP = C-reactive protein; IL = interleukin; LVEF = left ventricular ejection fraction.