From the Guidelines
COVID-19 associated cardiomyopathy is a serious cardiac complication that requires prompt management with standard heart failure therapy, including ACE inhibitors, beta-blockers, and diuretics, to improve morbidity, mortality, and quality of life outcomes. The condition is characterized by heart muscle dysfunction leading to impaired pumping ability, and it typically presents with symptoms of heart failure, including shortness of breath, fatigue, chest pain, and decreased exercise tolerance 1. The pathophysiology involves direct viral invasion of cardiac myocytes, systemic inflammatory response, microvascular dysfunction, and hypoxemia, which can lead to long-term cardiovascular sequelae, including cardiomyopathy, thromboembolism, and arrhythmias 1.
Clinical Presentation and Diagnosis
The clinical presentation of COVID-19 associated cardiomyopathy can vary, but it often includes symptoms of heart failure, such as shortness of breath, fatigue, and chest pain. Echocardiography is essential for diagnosing and monitoring cardiac function, and it can show abnormalities such as left ventricular systolic dysfunction, right ventricular dysfunction, and pericardial effusion 1. Cardiac magnetic resonance (CMR) imaging can also be used to identify myocardial involvement and detect nonischemic late gadolinium enhancement (LGE) and mapping abnormalities.
Management and Treatment
Management of COVID-19 associated cardiomyopathy includes standard heart failure therapy with:
- ACE inhibitors (like lisinopril 10-40 mg daily) to reduce afterload and improve cardiac function
- Beta-blockers (such as metoprolol succinate 25-200 mg daily) to reduce heart rate and improve cardiac function
- Diuretics (furosemide 20-80 mg daily) to relieve symptoms of congestion and edema Severe cases may require advanced therapies, including inotropic support, mechanical circulatory assistance, or in rare cases, heart transplantation 1. Regular cardiac monitoring with echocardiography is essential during recovery, and patients should be advised to limit strenuous activity until cardiac function normalizes.
Prevention and Vaccination
COVID-19 vaccination is recommended to prevent infection and potential cardiac complications in those who haven't yet contracted the virus 1. Vaccination can help reduce the risk of developing COVID-19 associated cardiomyopathy and other cardiovascular complications.
Key Takeaways
- COVID-19 associated cardiomyopathy is a serious cardiac complication that requires prompt management with standard heart failure therapy.
- Echocardiography and CMR imaging are essential for diagnosing and monitoring cardiac function.
- Regular cardiac monitoring and limitation of strenuous activity are crucial during recovery.
- COVID-19 vaccination is recommended to prevent infection and potential cardiac complications.
From the Research
Covid Associated Cardiomyopathy
- Covid-19 has been associated with various cardiac complications, including cardiomyopathy, myocarditis, and heart failure 2, 3, 4, 5.
- The pathophysiology of Covid-19-related cardiomyopathy is thought to be a combination of direct viral injury and cardiac damage due to the host's immune response 4.
- Common comorbidities among patients with Covid-19 and cardiomyopathy include hypertension, diabetes, obesity, hyperlipidemia, and ischemic heart disease 2.
- Laboratory findings may include increased levels of troponin and D-dimer, as well as echocardiographic evidence of left ventricular dysfunction 2, 3.
Clinical Presentation and Diagnosis
- Covid-19-associated myocarditis can present with dyspnea, evidence of cardiac injury, and early shock state 3.
- The diagnosis of Covid-19-related cardiomyopathy should be guided by insights from previous coronavirus and other myocarditis experience, including changes in electrocardiogram and cardiac biomarkers, and impaired cardiac function 4.
- Cardiac magnetic resonance imaging and cardiac computed tomographic angiography may be useful in diagnosing Covid-19-related cardiomyopathy, while endomyocardial biopsy may help identify active cardiac infection 4, 5.
Management and Treatment
- Steroids may be a beneficial treatment for Covid-19-associated myocarditis, similar to other critically ill Covid-19 patients 3.
- Management of post-acute sequelae of SARS-CoV-2 infection, including fatigue, palpitations, and dysautonomia, primarily centers on education, exercise, and salt and fluid repletion 5.
- ACE inhibitors and angiotensin receptor blockers should not be discontinued during the Covid-19 pandemic, as they do not increase the risk of acute kidney injury, macrovascular thrombosis, or in-hospital mortality 6.