Quick Links

Contact Us

Cardiovascular Health and Disease in the Context of COVID-19.

Authors: Sidhant Umbrajkar|||Rachel V Stankowski|||Shereif Rezkalla|||Robert A Kloner

Journal: Cardiology research

Publication Type: Journal Article

Date: 2021

DOI: PMC7935632

ID: 33738009

Affiliations:

Affiliations

    University of California, Los Angeles (UCLA), 10833 Le Conte Ave., Los Angeles, CA 90095, USA.|||Family Health Center of Marshfield, Inc., Marshfield Clinic Health System, 1000 N Oak Ave., Marshfield, WI 54449, USA.|||Department of Cardiology, Marshfield Medical Center, 1000 N Oak Ave., Marshfield, WI 54449, USA.|||Huntington Medical Research Institutes, 686 South Fair Oaks Ave., Pasadena, CA 91105, USA.

Abstract

First documented in China in early December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread rapidly and continues to test the strength of healthcare systems and public health programs all over the world. Underlying cardiovascular disease has been recognized as a risk factor for coronavirus disease 2019 (COVID-19)-related morbidity and mortality since the early days of the pandemic. In addition, evidence demonstrates cardiac and endothelial damage in somewhere between one-third and three-quarters of individuals with COVID-19, regardless of symptom severity. This damage is thought to be mediated by direct viral infection, immunopathology and hypoxemia with the additional possibility of exacerbation via medication-induced cardiotoxicity. Clinically, the cardiovascular consequences of COVID-19 may present as myocarditis with or without arrhythmia, endothelial dysfunction and thrombosis, acute coronary syndromes and heart failure. Presentation can vary widely and may or may not be typical of the condition in an individual without COVID-19. There is evidence to support the prognostic utility of cardiac biomarkers (e.g., cardiac troponin) and imaging studies (e.g., echocardiography, cardiac magnetic resonance imaging) in the context of COVID-19 and building evidence suggests that cardiovascular screening may be warranted even among those with asymptomatic or mild infection and those without traditional cardiovascular risk factors. In addition, evidence suggests the potential for long-term cardiovascular consequences for those who recover from COVID-19 with implications for the field of cardiology long into the future. Even among those without COVID-19, disruption of infrastructure and changes in human behavior as a result of the pandemic also have an upstream role in cardiovascular outcomes, which have already been documented in multiple locations. This review summarizes what is currently known regarding the pathogenic mechanisms of COVID-19-related cardiovascular injury and describes clinical cardiovascular presentations, prognostic indicators, recommendations for screening and treatment, and long-term cardiovascular consequences of infection. Ultimately, medical personnel must be vigilant in their attention to possible cardiovascular symptoms, take appropriate steps for clinical diagnosis and be prepared for long-term ramifications of myocardial injury sustained as a result of COVID-19.

Reference List

    Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), US Department of Health and Human Services. Scientific Brief: SARS-CoV-2 and Potential Airborne Transmission. https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-sars-cov-2.html. Updated 5 October 2020. Accessed 11 October 2020.|||Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, Bi Z. et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020;109(5):531–538. doi: 10.1007/s00392-020-01626-9.|||Barber C. COVID-19 can wreck your heart, even if you haven't had any symptoms. Scientific American. Aug 31, 2020.|||Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020;17(5):259–260. doi: 10.1038/s41569-020-0360-5.|||Szekely Y, Lichter Y, Taieb P, Banai A, Hochstadt A, Merdler I, Gal Oz A. et al. Spectrum of cardiac manifestations in COVID-19: a systematic echocardiographic study. Circulation. 2020;142(4):342–353. doi: 10.1161/CIRCULATIONAHA.120.047971.|||Arcari L, Luciani M, Cacciotti L, Musumeci MB, Spuntarelli V, Pistella E. et al. Incidence and determinants of high-sensitivity troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients. Internal and Emergency Medicine. 2020;28:1–10. doi: 10.1007/s11739-020-02498-7.|||Shah P, Doshi R, Chenna A, Owens R, Cobb A, Ivey H, Newton S. et al. Prognostic value of elevated cardiac troponin I in hospitalized COVID-19 patients. Am J Cardiol. 2020;135:150–153. doi: 10.1016/j.amjcard.2020.08.041.|||Rajpal S, Tong MS, Borchers J, Zareba KM, Obarski TP, Simonetti OP, Daniels CJ. Cardiovascular magnetic resonance findings in competitive athletes recovering from COVID-19 infection. JAMA Cardiol. 2021;6(1):116–118. doi: 10.1001/jamacardio.2020.4916.|||Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, Shchendrygina A. et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19) JAMA Cardiol. 2020;5(11):1265–1273. doi: 10.1001/jamacardio.2020.3557.|||Alger HM, Rutan C, Williams JHt, Walchok JG, Bolles M, Hall JL, Bradley SM. et al. American Heart Association COVID-19 CVD registry powered by get with the guidelines. Circ Cardiovasc Qual Outcomes. 2020;13(8):e006967. doi: 10.1161/CIRCOUTCOMES.120.006967.|||Hoffmann M, Kleine-Weber H, Schroeder S, Kruger N, Herrler T, Erichsen S, Schiergens TS. et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271–280. doi: 10.1016/j.cell.2020.02.052. e278.|||Liu PP, Blet A, Smyth D, Li H. The science underlying COVID-19: implications for the cardiovascular system. Circulation. 2020;142(1):68–78. doi: 10.1161/CIRCULATIONAHA.120.047549.|||Lindner D, Fitzek A, Brauninger H, Aleshcheva G, Edler C, Meissner K, Scherschel K. et al. Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 autopsy cases. JAMA Cardiol. 2020;5(11):1281–1285. doi: 10.1001/jamacardio.2020.3551.|||Dolhnikoff M, Ferreira Ferranti J, de Almeida Monteiro RA, Duarte-Neto AN, Soares Gomes-Gouvea M, Viu Degaspare N, Figueiredo Delgado A. et al. SARS-CoV-2 in cardiac tissue of a child with COVID-19-related multisystem inflammatory syndrome. Lancet Child Adolesc Health. 2020;4(10):790–794. doi: 10.1016/S2352-4642(20)30257-1.|||Fox SE, Li G, Akmatbekov A, Harbert JL, Lameira FS, Brown JQ, Vander Heide RS. Unexpected features of cardiac pathology in COVID-19 infection. Circulation. 2020;142(11):1123–1125. doi: 10.1161/CIRCULATIONAHA.120.049465.|||Tavazzi G, Pellegrini C, Maurelli M, Belliato M, Sciutti F, Bottazzi A, Sepe PA. et al. Myocardial localization of coronavirus in COVID-19 cardiogenic shock. Eur J Heart Fail. 2020;22(5):911–915. doi: 10.1002/ejhf.1828.|||Chen L, Li X, Chen M, Feng Y, Xiong C. The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2. Cardiovasc Res. 2020;116(6):1097–1100. doi: 10.1093/cvr/cvaa078.|||Tucker NR, Chaffin M, Bedi KC Jr, Papangeli I, Akkad AD, Arduini A, Hayat S. et al. Myocyte-specific upregulation of ACE2 in cardiovascular disease: implications for SARS-CoV-2-mediated myocarditis. Circulation. 2020;142(7):708–710. doi: 10.1161/CIRCULATIONAHA.120.047911.|||Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, Mehra MR. et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417–1418. doi: 10.1016/S0140-6736(20)30937-5.|||Menter T, Haslbauer JD, Nienhold R, Savic S, Hopfer H, Deigendesch N, Frank S. et al. Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction. Histopathology. 2020;77(2):198–209. doi: 10.1111/his.14134.|||Wang J, Saguner AM, An J, Ning Y, Yan Y, Li G. Dysfunctional coagulation in COVID-19: from cell to bedside. Adv Ther. 2020;37(7):3033–3039. doi: 10.1007/s12325-020-01399-7.|||Freaney PM, Shah SJ, Khan SS. COVID-19 and heart failure with preserved ejection fraction. JAMA. 2020;324(15):1499–1500. doi: 10.1001/jama.2020.17445.|||Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, Hlh Across Speciality Collaboration UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033–1034. doi: 10.1016/S0140-6736(20)30628-0.|||Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46(5):846–848. doi: 10.1007/s00134-020-05991-x.|||Mahmudpour M, Roozbeh J, Keshavarz M, Farrokhi S, Nabipour I. COVID-19 cytokine storm: The anger of inflammation. Cytokine. 2020;133:155151. doi: 10.1016/j.cyto.2020.155151.|||Coperchini F, Chiovato L, Croce L, Magri F, Rotondi M. The cytokine storm in COVID-19: An overview of the involvement of the chemokine/chemokine-receptor system. Cytokine Growth Factor Rev. 2020;53:25–32. doi: 10.1016/j.cytogfr.2020.05.003.|||Akhmerov A, Marban E. COVID-19 and the Heart. Circ Res. 2020;126(10):1443–1455. doi: 10.1161/CIRCRESAHA.120.317055.|||Libby P, Luscher T. COVID-19 is, in the end, an endothelial disease. Eur Heart J. 2020;41(32):3038–3044. doi: 10.1093/eurheartj/ehaa623.|||Unudurthi SD, Luthra P, Bose RJC, McCarthy JR, Kontaridis MI. Cardiac inflammation in COVID-19: Lessons from heart failure. Life Sci. 2020;260:118482. doi: 10.1016/j.lfs.2020.118482.|||Li G, Saguner AM, An J, Ning Y, Day JD, Ding L, Waintraub X. et al. Cardiovascular disease during the COVID-19 pandemic: Think ahead, protect hearts, reduce mortality. Cardiol J. 2020;27(5):616–624. doi: 10.5603/CJ.a2020.0101.|||Masi P, Hekimian G, Lejeune M, Chommeloux J, Desnos C, Pineton De Chambrun M, Martin-Toutain I. et al. Systemic inflammatory response syndrome is a major contributor to COVID-19-associated coagulopathy: insights from a prospective, single-center cohort study. Circulation. 2020;142(6):611–614. doi: 10.1161/CIRCULATIONAHA.120.048925.|||Marchetti M. COVID-19-driven endothelial damage: complement, HIF-1, and ABL2 are potential pathways of damage and targets for cure. Ann Hematol. 2020;99(8):1701–1707. doi: 10.1007/s00277-020-04138-8.|||Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo C. Cardiac and arrhythmic complications in patients with COVID-19. J Cardiovasc Electrophysiol. 2020;31(5):1003–1008. doi: 10.1111/jce.14479.|||Chorin E, Dai M, Shulman E, Wadhwani L, Bar-Cohen R, Barbhaiya C, Aizer A. et al. The QT interval in patients with COVID-19 treated with hydroxychloroquine and azithromycin. Nat Med. 2020;26(6):808–809. doi: 10.1038/s41591-020-0888-2.|||Rosenberg ES, Dufort EM, Udo T, Wilberschied LA, Kumar J, Tesoriero J, Weinberg P. et al. Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State. JAMA. 2020;323(24):2493–2502. doi: 10.1001/jama.2020.8630.|||Million M, Lagier JC, Gautret P, Colson P, Fournier PE, Amrane S, Hocquart M. et al. Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France. Travel Med Infect Dis. 2020;35:101738. doi: 10.1016/j.tmaid.2020.101738.|||Singh H, Chauhan P, Kakkar AK. Hydroxychloroquine for the treatment and prophylaxis of COVID-19: The journey so far and the road ahead. Eur J Pharmacol. 2021;890:173717. doi: 10.1016/j.ejphar.2020.173717.|||Campbell CM, Guha A, Haque T, Neilan TG, Addison D. Repurposing immunomodulatory therapies against coronavirus disease 2019 (COVID-19) in the era of cardiac vigilance: a systematic review. J Clin Med. 2020;9(9):2935. doi: 10.3390/jcm9092935.|||Siddamreddy S, Thotakura R, Dandu V, Kanuru S, Meegada S. Corona Virus Disease 2019 (COVID-19) Presenting as Acute ST Elevation Myocardial Infarction. Cureus. 2020;12(4):e7782. doi: 10.7759/cureus.7782.|||Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, Brown TS. et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol. 2020;75(18):2352–2371. doi: 10.1016/j.jacc.2020.03.031.||| European Society of Cardiology. The collateral damage of COVID-19: cardiovascular disease, the next pandemic wave. June 3, 2020. https://www.escardio.org/The-ESC/Advocacy/Shaping-policy-and-regulation/ESC-positions/the-collateral-damage-of-covid-19-cardiovascular-disease-the-next-pandemic-wav. Updated 3 June 2020. Accessed November 11, 2020.|||Bollmann A, Hohenstein S, Konig S, Meier-Hellmann A, Kuhlen R, Hindricks G. In-hospital mortality in heart failure in Germany during the Covid-19 pandemic. ESC Heart Fail. 2020;7(6):4416–4419. doi: 10.1002/ehf2.13011.|||De Filippo O, D'Ascenzo F, Angelini F, Bocchino PP, Conrotto F, Saglietto A, Secco GG. et al. Reduced rate of hospital admissions for ACS during COVID-19 Outbreak in Northern Italy. N Engl J Med. 2020;383(1):88–89. doi: 10.1056/NEJMc2009166.|||Solomon MD, McNulty EJ, Rana JS, Leong TK, Lee C, Sung SH, Ambrosy AP. et al. The COVID-19 pandemic and the incidence of acute myocardial infarction. N Engl J Med. 2020;383(7):691–693. doi: 10.1056/NEJMc2015630.|||Gori T, Lelieveld J, Munzel T. Perspective: cardiovascular disease and the Covid-19 pandemic. Basic Res Cardiol. 2020;115(3):32. doi: 10.1007/s00395-020-0792-4.|||Fox SE, Akmatbekov A, Harbert JL, Li G, Quincy Brown J, Vander Heide RS. Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans. Lancet Respir Med. 2020;8(7):681–686. doi: 10.1016/S2213-2600(20)30243-5.|||Kim D, Quinn J, Pinsky B, Shah NH, Brown I. Rates of co-infection between SARS-CoV-2 and other respiratory pathogens. JAMA. 2020;323(20):2085–2086. doi: 10.1001/jama.2020.6266.|||Kim IC, Kim JY, Kim HA, Han S. COVID-19-related myocarditis in a 21-year-old female patient. Eur Heart J. 2020;41(19):1859. doi: 10.1093/eurheartj/ehaa288.|||Zeng JH, Liu YX, Yuan J, Wang FX, Wu WB, Li JX, Wang LF. et al. First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection. 2020;48(5):773–777. doi: 10.1007/s15010-020-01424-5.|||Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–1069. doi: 10.1001/jama.2020.1585.|||Siripanthong B, Nazarian S, Muser D, Deo R, Santangeli P, Khanji MY, Cooper LT Jr. et al. Recognizing COVID-19-related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm. 2020;17(9):1463–1471. doi: 10.1016/j.hrthm.2020.05.001.|||Babapoor-Farrokhran S, Rasekhi RT, Gill D, Babapoor S, Amanullah A. Arrhythmia in COVID-19. SN Compr Clin Med. 2020;2:1430–1435. doi: 10.1007/s42399-020-00454-2.|||Gopinathannair R, Merchant FM, Lakkireddy DR, Etheridge SP, Feigofsky S, Han JK, Kabra R. et al. COVID-19 and cardiac arrhythmias: a global perspective on arrhythmia characteristics and management strategies. J Interv Card Electrophysiol. 2020;59(2):329–336. doi: 10.1007/s10840-020-00789-9.|||Kir D, Mohan C, Sancassani R. Heart Brake: an unusual cardiac manifestation of COVID-19. JACC Case Rep. 2020;2(9):1252–1255. doi: 10.1016/j.jaccas.2020.04.026.|||Peigh G, Leya MV, Baman JR, Cantey EP, Knight BP, Flaherty JD. Novel coronavirus 19 (COVID-19) associated sinus node dysfunction: a case series. Eur Heart J Case Rep. 2020;4(FI1):1–6. doi: 10.1093/ehjcr/ytaa132.|||Chorin E, Wadhwani L, Magnani S, Dai M, Shulman E, Nadeau-Routhier C, Knotts R. et al. QT interval prolongation and torsade de pointes in patients with COVID-19 treated with hydroxychloroquine/azithromycin. Heart Rhythm. 2020;17(9):1425–1433. doi: 10.1016/j.hrthm.2020.05.014.|||Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, Wang H. et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19) JAMA Cardiol. 2020;5(7):811–818. doi: 10.1001/jamacardio.2020.1017.|||Mercuro NJ, Yen CF, Shim DJ, Maher TR, McCoy CM, Zimetbaum PJ, Gold HS. Risk of QT interval prolongation associated with use of hydroxychloroquine with or without concomitant azithromycin among hospitalized patients testing positive for coronavirus disease 2019 (COVID-19) JAMA Cardiol. 2020;5(9):1036–1041. doi: 10.1001/jamacardio.2020.1834.|||Saleh M, Gabriels J, Chang D, Soo Kim B, Mansoor A, Mahmood E, Makker P. et al. Effect of chloroquine, hydroxychloroquine, and azithromycin on the corrected QT interval in patients with SARS-CoV-2 infection. Circ Arrhythm Electrophysiol. 2020;13(6):e008662. doi: 10.1161/CIRCEP.120.008662.|||Hadi HA, Carr CS, Al Suwaidi J. Endothelial dysfunction: cardiovascular risk factors, therapy, and outcome. Vasc Health Risk Manag. 2005;1(3):183–198.|||Zhang J, Tecson KM, McCullough PA. Endothelial dysfunction contributes to COVID-19-associated vascular inflammation and coagulopathy. Rev Cardiovasc Med. 2020;21(3):315–319. doi: 10.31083/j.rcm.2020.03.126.|||Wichmann D, Sperhake JP, Lutgehetmann M, Steurer S, Edler C, Heinemann A, Heinrich F. et al. Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study. Ann Intern Med. 2020;173(4):268–277. doi: 10.7326/M20-2003.|||Klok FA, Kruip M, van der Meer NJM, Arbous MS, Gommers D, Kant KM, Kaptein FHJ. et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145–147. doi: 10.1016/j.thromres.2020.04.013.|||Bilaloglu S, Aphinyanaphongs Y, Jones S, Iturrate E, Hochman J, Berger JS. Thrombosis in hospitalized patients with COVID-19 in a New York City Health System. JAMA. 2020;324(8):799–801. doi: 10.1001/jama.2020.13372.|||Mosleh W, Chen K, Pfau SE, Vashist A. Endotheliitis and endothelial dysfunction in patients with COVID-19: its role in thrombosis and adverse outcomes. J Clin Med. 2020;9(6):1862. doi: 10.3390/jcm9061862.|||Teuwen LA, Geldhof V, Pasut A, Carmeliet P. COVID-19: the vasculature unleashed. Nat Rev Immunol. 2020;20(7):389–391. doi: 10.1038/s41577-020-0343-0.|||Huertas A, Montani D, Savale L, Pichon J, Tu L, Parent F, Guignabert C. et al. Endothelial cell dysfunction: a major player in SARS-CoV-2 infection (COVID-19)? Eur Respir J. 2020;56(1):2001634. doi: 10.1183/13993003.01634-2020.|||Froldi G, Dorigo P. Endothelial dysfunction in Coronavirus disease 2019 (COVID-19): Gender and age influences. Med Hypotheses. 2020;144:110015. doi: 10.1016/j.mehy.2020.110015.|||Zhang J, McCullough PA, Tecson KM. Vitamin D deficiency in association with endothelial dysfunction: Implications for patients with COVID-19. Rev Cardiovasc Med. 2020;21(3):339–344. doi: 10.31083/j.rcm.2020.03.131.|||Schiavone M, Gobbi C, Biondi-Zoccai G, D'Ascenzo F, Palazzuoli A, Gasperetti A, Mitacchione G. et al. Acute Coronary Syndromes and Covid-19: Exploring the Uncertainties. J Clin Med. 2020;9(6):1683. doi: 10.3390/jcm9061683.|||Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, Gong W. et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802–810. doi: 10.1001/jamacardio.2020.0950.|||Stefanini GG, Montorfano M, Trabattoni D, Andreini D, Ferrante G, Ancona M, Metra M. et al. ST-elevation myocardial infarction in patients with COVID-19: clinical and angiographic outcomes. Circulation. 2020;141(25):2113–2116. doi: 10.1161/CIRCULATIONAHA.120.047525.|||Knight DS, Kotecha T, Razvi Y, Chacko L, Brown JT, Jeetley PS, Goldring J. et al. COVID-19: myocardial injury in survivors. Circulation. 2020;142(11):1120–1122. doi: 10.1161/CIRCULATIONAHA.120.049252.|||Guagliumi G, Sonzogni A, Pescetelli I, Pellegrini D, Finn AV. Microthrombi and ST-segment-elevation myocardial infarction in COVID-19. Circulation. 2020;142(8):804–809. doi: 10.1161/CIRCULATIONAHA.120.049294.|||Shirazi S, Mami S, Mohtadi N, Ghaysouri A, Tavan H, Nazari A, Kokhazadeh T. et al. Sudden cardiac death in COVID-19 patients, a report of three cases. Future Cardiol. 2021;17(1):113–118. doi: 10.2217/fca-2020-0082.|||Mazzanti A, Briani M, Kukavica D, Bulian F, Marelli S, Trancuccio A, Monteforte N. et al. Association of Hydroxychloroquine With QTc Interval in Patients With COVID-19. Circulation. 2020;142(5):513–515. doi: 10.1161/CIRCULATIONAHA.120.048476.|||Long B, Brady WJ, Koyfman A, Gottlieb M. Cardiovascular complications in COVID-19. Am J Emerg Med. 2020;38(7):1504–1507. doi: 10.1016/j.ajem.2020.04.048.|||Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, Ma K. et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091. doi: 10.1136/bmj.m1091.|||Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062. doi: 10.1016/S0140-6736(20)30566-3.|||Argulian E, Sud K, Vogel B, Bohra C, Garg VP, Talebi S, Lerakis S. et al. Right ventricular dilation in hospitalized patients with COVID-19 infection. JACC Cardiovasc Imaging. 2020;13(11):2459–2461. doi: 10.1016/j.jcmg.2020.05.010.|||Bader F, Manla Y, Atallah B, Starling RC. Heart failure and COVID-19. Heart Fail Rev. 2021;26(1):1–10. doi: 10.1007/s10741-020-10008-2.|||Salvatici M, Barbara B, Cioffi SMG, Morenghi E, Leone FP, Maura F. et al. Association between cardiac troponin I and mortality in patients with COVID-19. Biomarkers. 2020;25(8):634–640. doi: 10.1080/1354750X.2020.1831609.|||Goshua G, Pine AB, Meizlish ML, Chang CH, Zhang H, Bahel P, Baluha A. et al. Endotheliopathy in COVID-19-associated coagulopathy: evidence from a single-centre, cross-sectional study. Lancet Haematol. 2020;7(8):e575–e582. doi: 10.1016/S2352-3026(20)30216-7.|||Schott JP, Mertens AN, Bloomingdale R, O'Connell TF, Gallagher MJ, Dixon S, Abbas AE. Transthoracic echocardiographic findings in patients admitted with SARS-CoV-2 infection. Echocardiography. 2020;37(10):1551–1556. doi: 10.1111/echo.14835.|||Kirkpatrick JN, Mitchell C, Taub C, Kort S, Hung J, Swaminathan M. ASE statement on protection of patients and echocardiography service providers during the 2019 novel coronavirus outbreak: endorsed by the American College of Cardiology. J Am Coll Cardiol. 2020;75(24):3078–3084. doi: 10.1016/j.jacc.2020.04.002.|||Cau R, Bassareo P, Saba L. Cardiac Involvement in COVID-19-Assessment with Echocardiography and Cardiac Magnetic Resonance Imaging. SN Compr Clin Med. 2020;2:845–851. doi: 10.1007/s42399-020-00344-7.|||Kociol RD, Cooper LT, Fang JC, Moslehi JJ, Pang PS, Sabe MA, Shah RV. et al. Recognition and Initial Management of Fulminant Myocarditis: A Scientific Statement From the American Heart Association. Circulation. 2020;141(6):e69–e92. doi: 10.1161/CIR.0000000000000745.|||Mahmud E, Dauerman HL, Welt FGP, Messenger JC, Rao SV, Grines C, Mattu A. et al. Management of acute myocardial infarction during the COVID-19 pandemic: a position statement from the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP) J Am Coll Cardiol. 2020;76(11):1375–1384. doi: 10.1016/j.jacc.2020.04.039.|||Hamadeh A, Aldujeli A, Briedis K, Tecson KM, Sanz-Sanchez J, Al Dujeili M, Al-Obeidi A. et al. Characteristics and outcomes in patients presenting with COVID-19 and ST-segment elevation myocardial infarction. Am J Cardiol. 2020;131:1–6. doi: 10.1016/j.amjcard.2020.06.063.|||Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, Hohmann E. et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020;383(19):1813–1826. doi: 10.1056/NEJMoa2007764.||| Food and Drug Administration, US Department of Health and Human Services. FDA News Release. Coronavirus (COVID-19) update: FDA authorizes monoclonal antibodies for treatment of COVID-19. November 21, 2020. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-monoclonal-antibodies-treatment-covid-19.|||DiNicolantonio JJ, Barroso J, McCarty M. Ivermectin may be a clinically useful anti-inflammatory agent for late-stage COVID-19. Open Heart. 2020;7(2):e001350. doi: 10.1136/openhrt-2020-001350.|||Padhy BM, Mohanty RR, Das S, Meher BR. Therapeutic potential of ivermectin as add on treatment in COVID 19: A systematic review and meta-analysis. J Pharm Pharm Sci. 2020;23:462–469. doi: 10.18433/jpps31457.|||Zhao M. Cytokine storm and immunomodulatory therapy in COVID-19: Role of chloroquine and anti-IL-6 monoclonal antibodies. Int J Antimicrob Agents. 2020;55(6):105982. doi: 10.1016/j.ijantimicag.2020.105982.|||RECOVERY Collaborative Group. Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L. et al. Dexamethasone in hospitalized patients with COVID-19 - preliminary report. N Engl J Med. 2020|||Chow JH, Khanna AK, Kethireddy S, Yamane D, Levine A, Jackson AM, McCurdy MT. et al. Aspirin use is associated with decreased mechanical ventilation, ICU admission, and in-hospital mortality in hospitalized patients with COVID-19. Anesth Analg. 2020|||Wu Q, Zhou L, Sun X, Yan Z, Hu C, Wu J, Xu L. et al. Altered Lipid Metabolism in Recovered SARS Patients Twelve Years after Infection. Sci Rep. 2017;7(1):9110. doi: 10.1038/s41598-017-09536-z.|||Ledford H, Cyranoski D, Van Noorden R. The UK has approved a COVID vaccine - here's what scientists now want to know. Nature. 2020;588(7837):205–206. doi: 10.1038/d41586-020-03441-8.||| Food and Drug Administration, US Department of Health and Human Services. Pfizer-BioNTech COVID-19 vaccine. December 11, 2020. https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/pfizer-biontech-covid-19-vaccine.|||Callaway E. COVID vaccine excitement builds as Moderna reports third positive result. Nature. 2020;587(7834):337–338. doi: 10.1038/d41586-020-03248-7.