A Comprehensive Review of Manifestations of Novel Coronaviruses in the Context of Deadly COVID-19 Global Pandemic

doi:10.1016/j.amjms.2020.05.006

PMC full text:

Am J Med Sci. 2020 Jul; 360(1): 5–34.

Published online 2020 May 11. doi: 10.1016/j.amjms.2020.05.006

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Table 2

Cardiovascular manifestations of SARS-CoV, MERS-CoV and COVID-19.

SARS (only studies with large study population included)
Study	Booth et al (2003) N = 144, confirmed cases Retrospective study	Li et al (2003) N = 46, confirmed cases Prospective study	Pan et al (2003) N = 15, confirmed cases Retrospective study	Ding et al (2004) N = 8 (4 confirmed cases, 4 control) Clinicopathologic study	Yu et al (2006) N = 121, confirmed cases Retrospective study
Clinical features	• Chest pain (10%) • ↑HR (46%)	• No chest pain or overt CHF on admission • ↓HR (non-ICU) ↑HR (ICU) •CHF exacerbation	• Sudden cardiac arrest (100%) • MI and arrhythmia (33%)	• Chest pain	• ↑HR (71.9%) (62.8%, 45.4%, 35.5%) • ↓BP (50.4%) (28.1%, 21.5%, 14.8% during the first, second, third week)↓HR, transient (14.9%) • Reversible cardiomegaly (10.7%), no clinical heart failure • Chest discomfort (7%) • Palpitations (4%)
Key findings on investigations	• ↓Ca++ (60%) • ↓K+ (26%) • ↓Mg++ (18%) • ↓P+ (27%) • ↑ LDH (87%)	• ↑ CK • ↑ LDH • ↓Hb • EKG: RBBB • Echo: ↓LVEF	• Abnormal cardiac enzymes (66%)	N/A	• ↑ CK • ↑CK (26%) without TnI or CKMB • ↑ LDH • CXR or CT abnormality: 100%
Histopathology	N/A	N/A	N/A	• Myocardial stromal edema • Infiltration of vessels by lymphocytes • Focal hyaline degeneration • Muscle fiber lysis	N/A
Key study findings and message	• 20% ICU admission • 6.5% Case fatality rate (21 days) • Diabetes and other comorbidities independently associated with poor prognosis	Possibly reversible subclinical diastolic impairment seen in SARS patients	Proposed causes of SCD: • Hypoxemia leading to myocardial strain • Direct viral myocardial injury • Stress aggravates pre-existing disease • Sympathetic response causing electrical myocardial instability	ACE2 expressed in heart, but virus not detected	• ↑CK likely due to myositis as cardiac enzymes normal • 15% ICU admission • 18 (5) days mean duration of hospital stay • Tachycardia persists during follow up • Cardiac arrhythmia is uncommon

MERS
Study	Alhogbani (2016) N = 1 confirmed case Case report	Almekhlafi et al (2016) N = 31, confirmed cases Retrospective study	Garout et al (2018) N = 52, confirmed cases Retrospective study
Clinical features	CHF	↑HR (67.7%)	Pericarditis
Key findings on investigations	• ↑ TnI • ↑ BNP • ↑ Creatinine • Echo: Severe global LV dysfunction • Cardiac MRI: Myocarditis	N/A	N/A
Key study findings and message	MERS-CoV may cause myocarditis and acute heart failure	• Vasopressor need is a risk factor for death (P = 0.04) • 80.6% vasopressor support rate	No association of ECMO need with outcomes

COVID-19
Study	Huang et al (2020) N = 41, confirmed cases Retrospective study	Wang et al (2020) N = 138, confirmed cases Retrospective study	Zheng et al (2020) Review	Bhatraju et al (2020) N = 24, confirmed cases Retrospective study	Fried et al (2020) N = 4, confirmed cases Case reports
Clinical features	• ↑BP • Acute cardiac injury (12%) more in ICU patients than non-ICU patients (31% vs. 4%)	• Pre-existing HTN (31.2%) (58.3% in ICU, significant) • Pre-existing CVD (14.5%) (25% in ICU, significant) • Acute cardiac injury (7.2%) (22.2% in ICU, significant) • Arrhythmia (16.7%) (44.4% in ICU patients)	• Palpitations • Chest tightness	• ↑HR (48%) • Vasopressor need (71%)	• Myopericarditis • Decompensated heart failure • Cardiogenic Shock
Key findings on investigations	• ↑ TnI (12%) (31% in ICU patients, 4% in non-ICU patients)	• ↑ TnI • ↑ CK-MB	N/A	• ↑ TnI (15%)	• Diffuse ST segment elevations • Elevated cardiac enzymes • LVEF on echo
Key Study findings and message	↑BP more common in ICU patients (P = 0.018)	ICU patients more likely to have pre-existing hypertension, develop arrhythmias, acute cardiac injury (P < 0.001)	Proposed mechanism of cardiac injury: • ACE 2 related • Cytokine storm • Hypoxemia	• ICU admission most commonly due to hypoxemic respiratory failure, vasopressor requirement or both • 50% mortality	• Similar symptoms in heart transplant patients as nontransplant patients

BNP, B-type natriuretic peptide; BP, blood pressure; HR, heart rate; CHF, congestive heart failure; CK, creatine kinase; CKMB, creatine kinase myocardial band; CXR; chest x-ray; ECMO, extracorporeal membrane oxygenation; Hb, hemoglobin; ICU, intensive care unit; LDH, lactate dehydrogenase; LVEF, left ventricular ejection fraction; MI, myocardial infarction; MERS-CoV, middle east respiratory syndrome coronavirus; RBBB, right bundle branch block; SARS-COV, severe acute respiratory syndrome coronavirus; TnI, troponin-I.