Copyright 2009-. New evidence suggests the coronavirus has lasting impacts on the heart, raising alarm for cardiologists who have been concerned about potential long-term heart injury from COVID-19. The presence of reduced LV function and/or myocardial edema could influence the use of inotropic agents, mechanical support or help risk stratify patients for more aggressive anti-inflammatory therapies.At present, there is minimal role for transesophageal echocardiography and MRI, both of which pose significant risk of aerosolization to the imaging team.Pulmonary artery catheters (PAC) provide information about hemodynamic status and cardiac filling pressures. The cytokines released during this phase have the potential to trigger cardiomyocyte dysfunction and cardiac depression.This phenomenon has been well described in other inflammatory conditions such as sepsis, where TNFα and IL-1β/β directly suppress cardiomyocyte contractility.Second, SARS-CoV-2 can directly infect the heart leading to immune cell recruitment and myocarditis. Those with underlying cardiovascular disease are particularly vulnerable to the cardiac effects of COVID-19-induced inflammation (see below).To date, the amount of granular data about cardiomyopathy in COVID-19 is limited. All rights reserved. Cardiomyopathy (kahr-dee-o-my-OP-uh-thee) is a disease of the heart muscle that makes it harder for your heart to pump blood to the rest of your body. Additional data regarding patient outcomes following ECMO support will be necessary to shape recommendations for this approach.Cardiomyopathy in COVID-19 generally appears during the hyper-inflammatory phase of the illness and may be driven, directly or indirectly, by the host immune response to the virus.Treatment strategies including hydroxychloroquine and azithromycin, anti-inflammatory therapies such as intravenous immune globulin (IVIG), tocilizumab, anakinra, IV steroids and antiviral treatment strategies such as remdesivir, lopinavir and ritonavir have been used or considered in patients with COVID-19.Given the high mortality in those with cardiomyopathy it is reasonable to consider these options in patients who require ICU care or who decline despite supportive care.Further research into the cardiovascular and clinical outcomes with these treatments will be necessary to guide recommendations.

COVID-19 is a non-segmented, positive sense RNA virus. Takotsubo cardiomyopathy is known to have regional myocardial oedema on CMR, 4 and injury to myocytes and infiltration of lymphocytes and macrophages in the autopsied specimens. >80%) ~10-20% of patients are admitted to ICU (note – as the pandemic progresses and fewer patients present to hospital, this percentage is growing). However, it is important to minimize sonographer time with COVID-19 positive patients to reduce the risk of spread.To this end, the decision to obtain an echocardiogram should be made on the basis of patient characteristics, blood test abnormalities, and hemodynamic stability and whether echocardiography information will make a difference in management.In most cases, a limited study can provide the necessary information for medical decision-making.Discussing the details of what views are needed with the sonographer before they enter a patient room is important to reduce scan time.Moreover, the use of point-of-care ultrasound (POCUS) can provide useful information about cardiac function while limiting the number of people that are exposed to an infected patient.Echocardiography, beyond POCUS, may need to be largely reserved for the subset of patients who require further information beyond what can be provided by POCUS. Viral infection with SARS-CoV-2, the causative agent of COVID-19, has been proposed to impact cardiac function via at least three distinct mechanisms.First, the later phase of COVID-19 disease is associated with a profound systemic inflammatory response. It is reasonable to consider ECG in patients with elevated troponin, chest pain, arrhythmia, ST-segment abnormality on telemetry or challenging hemodynamics.Echocardiography can be useful to assess LV/right ventricular (RV) structure and function, wall motion abnormalities, and to estimate cardiac hemodynamics. This contains: (i) Four coronaviruses which are widely distributed and usually cause the common cold (but can cause viral pneumonia in patients with comorbidities).


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