Cardiovascular manifestations in severe and critical patients with COVID-19

Clin Cardiol. 2020 Jul;43(7):796-802. doi: 10.1002/clc.23384. Epub 2020 Jun 20.

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could cause virulent infection leading to Corona Virus Disease 2019 (COVID-19)-related pneumonia as well as multiple organ injuries.

Hypothesis: COVID-19 infection may result in cardiovascular manifestations leading to worse clinical outcome.

Methods: Fifty four severe and critical patients with confirmed COVID-19 were enrolled. Risk factors predicting the severity of COVID-19 were analyzed.

Results: Of the 54 patients (56.1 ± 13.5 years old, 66.7% male) with COVID-19, 39 were diagnosed as severe and 15 as critical cases. The occurrence of diabetes, the level of D-dimer, inflammatory and cardiac markers in critical cases were significantly higher. Troponin I (TnI) elevation occurred in 42.6% of all the severe and critical patients. Three patients experienced hypotension at admission and were all diagnosed as critical cases consequently. Hypotension was found in one severe case and seven critical cases during hospitalization. Sinus tachycardia is the most common type of arrythmia and was observed in 23 severe patients and all the critical patients. Atrioventricular block and ventricular tachycardia were observed in critical patients at end stage while bradycardia and atrial fibrillation were less common. Mild pericardial effusion was observed in one severe case and five critical cases. Three critical cases suffered new onset of heart failure. Hypotension during treatment, severe myocardial injury and pericardial effusion were independent risk factors predicting the critical status of COVID-19 infection.

Conclusion: This study has systemically observed the impact of COVID-19 on cardiovascular system, including myocardial injury, blood pressure, arrythmia and cardiac function in severe and critical cases. Monitoring of vital signs and cardiac function of COVID-19 patients and applying potential interventions especially for those with hypotension during treatment, severe myocardial injury or pericardial effusion, is of vital importance.

Keywords: COVID-19; cardiac injury; cardiovascular manifestations; critical status; hypotension.

MeSH terms

  • Adult
  • Aged
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / therapy
  • Cause of Death*
  • China / epidemiology
  • Cohort Studies
  • Comorbidity
  • Coronavirus Infections / diagnosis*
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / therapy
  • Critical Illness / mortality
  • Critical Illness / therapy
  • Female
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Middle Aged
  • Monitoring, Physiologic
  • Multivariate Analysis
  • Pandemics
  • Pneumonia, Viral / diagnosis*
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / therapy
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Survival Analysis

Supplementary concepts

  • COVID-19