Int J Med Sci 2020; 17(10):1340-1344. doi:10.7150/ijms.46484

Review

Cardiovascular disease management during the coronavirus disease 2019 pandemic

Wen-Hsien Lee1,2, Ying-Chih Chen1, Szu-Chia Chen1,2, Chang-Jen Chen1, Po-Chao Hsu2,3, Wei-Chung Tsai2,3, Chun-Yuan Chu2,3, Chee-Siong Lee2,3, Tsung-Hsien Lin2,3, Wen-Chol Voon2,3, Chao-Hung Kuo1,2, Ho-Ming Su1,2,4✉

1. Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.
2. Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
3. Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
4. Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.

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Citation:
Lee WH, Chen YC, Chen SC, Chen CJ, Hsu PC, Tsai WC, Chu CY, Lee CS, Lin TH, Voon WC, Kuo CH, Su HM. Cardiovascular disease management during the coronavirus disease 2019 pandemic. Int J Med Sci 2020; 17(10):1340-1344. doi:10.7150/ijms.46484. Available from http://www.medsci.org/v17p1340.htm

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Abstract

Based on clinical presentation, pathophysiology, high infectivity, high cardiovascular involvement, and therapeutic agents with cardiovascular toxicity of coronavirus disease 2019 (COVID-19), regular cardiovascular treatment is being changing greatly. Despite angiotensin-converting enzyme 2 serving as the portal for infection, the continuation of clinically indicated renin-angiotensin-aldosterone blockers is recommended according to the present evidence. Fibrinolytic therapy can be considered a reasonable option for the relatively stable ST segment elevation myocardial infarction (STEMI) patient with suspected or known COVID-19. However, primary percutaneous coronary intervention is still the standard of care in patients with definite STEMI if personal protective equipment is available and cardiac catheterization laboratory has a good infection control. In patients with elevated cardiac enzymes, it is very important to differentiate patients with Type 2 myocardial infarction or myocarditis from those with true acute coronary syndromes because invasive percutaneous intervention management in the former may be unnecessary, especially if they are hemodynamically stable. Finally, patients with baseline QT prolongation or those taking QT prolonging drugs must be cautious when treating with lopinavir/ritonavir and hydroxychloroquine for COVID-19.

Keywords: coronavirus, cardiovascular, pandemic