Table I.

Summary of key takeaways for COVID-19 and CVD

Topic	Key takeaways
Role of established CVD and comorbidities	• The overall SARS-CoV-2–infected population is young with low rates of comorbidities compared to the general population. • Those patients with a severe clinical course from COVID-19 are often older and have diabetes, hypertension, underlying lung disease, or baseline CVD. • In-hospital outcomes appear worse as the number of comorbid conditions increases.
Elevation of cardiac injury biomarkers	• Evidence of myocardial injury in the form of troponin elevation is common in patients hospitalized with COVID-19. • The prevalence of troponin elevation appears to increase with disease severity. • Biomarker elevation may be present without underlying obstructive CAD. • The presence of troponin elevation is an independent predictor of mortality for inpatients.
Ventricular dysfunction and myocarditis	• Frank ventricular dysfunction and myocarditis appear to be infrequent when compared to troponin elevation. • The true incidence of ventricular dysfunction appears unclear. • In cases of shock with ventricular failure and/or in refractory pulmonary failure, VA and VV ECMO, respectively, may play a role.
Thrombotic events	• Elevation of D-dimer levels is common in patients with COVID-19. • Both macro- and microvascular coagulopathies have been described. • Macrovascular thrombosis in arterial and venous beds is a concern in these patients, and the use of anticoagulation has been associated with improved outcomes in one observational study.
Electrophysiologic manifestations	• Diffuse or focal ST-segment elevation can be seen in COVID-19 patients. • The ST-segment elevation can be present even without obstructive CAD. • New-onset supraventricular arrhythmias including atrial fibrillation and flutter are described. • Early interest in the combination therapy of azithromycin and hydroxychloroquine has been tempered by negative observational data. This combination of drugs has been associated with QT interval prolongation and TdP. • Given that fever is central symptom of COVID-19, unmasking or manifestation of Brugada syndrome is a concern in relevant patients.
Controversy regarding ACEi and ARB use	• There are theoretical paradigms which propose harm or benefit for the use of RAS blockade in the context of COVID-19. • The data to date suggest no increase in SARS-CoV-2 viral positivity in patients based on baseline RAS blockade use. • Most retrospective analyses suggest no deleterious impact of RAS blockade on outcomes in patients with COVID-19.
Protection of HCWs	• The shortages of PPE during the initial period of the pandemic have been well documented and contributed to the deaths of many HCWs. • Although cardiac catheterization is typically not an aerosol-generating procedure, the potential need for CPR or intubation exists—especially in acutely ill patients. The use of PPE for the staff including covering for the head, eyes/face, and body and N95 masks appears as a common recommendation in societal consensus documents for patients with documented and those at risk of SARS-CoV-2. • Treatment delays for ACS (particularly STEMI) on the part of patients fearing exposure and on the health care system related to need for more thorough patient evaluation have been noted. Time delays related to staff donning of PPE and room preparation may be present. • Consensus recommendations still emphasize a goal of minimizing total ischemic time in patients with STEMI. Primary PCI when performed safely (for the staff and patients) remains the reperfusion therapy of choice. • Transesophageal echocardiography risks the performing team to exposure, and PPE along with risk/benefit of the study should be considered. CT imaging may provide an alternative imaging modality for specific anatomical and clinical subsets. • CPR is a high-risk procedure in patients with COVID-19. Emphasis on aggressive PPE protection and early defibrillation (prior to chest compressions) has been recommended.

Abbreviations: VA (veno‐arterial), VV (veno‐venous), ECMO Extracorporeal membrane oxygenation, CVD Cardiovascular disease, RAS Renin angiotensin system, PPE personal protective equipment, ACS Acute coronary syndrome, STEMI ST segment elevation myocardial infarction.