COVID-19 and the Cardiovascular System

From Pathophysiology to Clinical Management

1st Edition - October 11, 2024
Editors: Brian C. Case, Ron Waksman
Language: English
Paperback ISBN:
9 7 8 - 0 - 4 4 3 - 1 4 0 0 1 - 3
eBook ISBN:
9 7 8 - 0 - 4 4 3 - 1 4 0 0 2 - 0

COVID-19 and the Cardiovascular System: From Pathophysiology to Clinical Management comprehensively covers COVID-19’s impact on the cardiovascular system. Coverage includes the… Read more

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COVID-19 and the Cardiovascular System: From Pathophysiology to Clinical Management comprehensively covers COVID-19’s impact on the cardiovascular system. Coverage includes the pathophysiology, clinical manifestations, diagnostic approach, treatment options, and clinical outcomes of patients presenting with COVID-19 with cardiac involvement. In a concise but comprehensive manner, the book's content reviews the epidemiology, risk factors, pathophysiology of COVID-19, cardiovascular clinical manifestations, non-invasive and invasive diagnostic evaluation, therapeutic options, outcomes data, role of the COVID-19 vaccine, and long-term outcomes/management.

This is the perfect reference for basic and clinical researchers in cardiovascular medicine as well as practicing clinical cardiologists who are dealing with COVID-19 patients with cardiac involvement.

Title of Book
Cover image
Title page
Table of Contents
Copyright
Contributors
Preface
Acknowledgment
Chapter 1. Prologue
A once-in-a-century pandemic
Direct effects of SARS-CoV-2 and COVID-19 on the heart
Indirect effects of SARS-CoV-2 and COVID-19 on the heart and cardiac care systems
Effects of underlying heart disease on COVID-19 outcomes
Adverse effects of COVID-19 vaccination on the heart
Conclusions
Chapter 2. Introduction and epidemiology
Introduction
Epidemiology and clinical characteristics
Origins
Transmission
Vulnerable populations
Clinical manifestations: Then and now
Myocarditis and myocardial injury
Heart failure
Arrhythmia
Thromboembolic events
Variants
Alpha
Delta
Omicron
Vaccination
Chapter 3. Pathophysiology of COVID-19
Introduction to COVID-19
The origin of SARS-CoV-2: A subgenus of zoonotic Coronaviruses with bats as the most likely reservoir host
SARS-CoV-2 viral structure and binding to human cells
Immune response in COVID-19
The innate immune response to COVID-19
The adaptive immune response to COVID-19
The effects of SARS-CoV-2 on the cardiovascular system
Imaging and histological evidence of SARS-CoV-2-releated myocardial injury
COVID-19-related myocardial injury: The proposed mechanisms
Direct cellular injury
Direct damage to endothelial cells and endotheliitis
SARS-CoV-2-induced hypercoagulopathy
Multisystem inflammatory syndrome-mediated cardiac injury
SARS-CoV-2-associated autoimmune reaction and post-COVID-19 vaccine myocarditis
The long-term cardiovascular sequelae of COVID-19
The cardiovascular manifestations of long COVID and increased cardiovascular risks
Structural and functional consequences of cardiac injury in long COVID
Proposed pathophysiology of cardiovascular long COVID
Chapter 4. Risk factors and special populations
Special populations: General considerations
Overview
Sex and demographic factors
HIV
Chagas disease
Rheumatologic disease
Chronic kidney disease
Malignancy
Pediatric groups and adolescent patients
Adult congenital heart disease
Mental health conditions
Special populations: Athletes
The profound impact of COVID-19 on the sports landscape
Impact of COVID-19 infection on the athletes' cardiovascular health
Psychosocial impact of COVID-19 pandemic on athletes
Post-COVID symptoms
Lessons learned
Special populations: Pregnancy
Disease severity in pregnancy
Risk factors
Specific cardiovascular complications in pregnancy
Myocardial injury
Arrhythmias
Heart failure
Hypertensive disorders of pregnancy
Thromboembolic complications
Post-COVID-19 sequelae
Prepregnancy counseling and delivery considerations
Summary
Chapter 5. Pathophysiology of COVID-19 and the heart
Introduction
Etiology of myocardial injury after COVID-19 infection
General concept of virus structure and cell entry mechanism
Evidence of SARS-CoV-2 infection in the heart
SARS-CoV-2 infection and myocarditis
Histological diagnosis of myocarditis in COVID-19
6.2 Type of inflammatory cell in myocardium of COVID-19 and non-COVID-19
Mechanism of myocardial ischemia following SARS-CoV-2 infection
Mechanisms of microthrombi formation in the COVID-19 heart
Endothelial activation
Complement, platelet, coagulation cascade, and NETs
Cytokine storm
Long-term cardiovascular complication after SARS-CoV-2 infection
Summary and conclusion
Chapter 6. Cardiac clinical manifestations
Myocardial injury and acute myocarditis
Clinical presentation and workup
Heart failure and stress-induced cardiomyopathy
Clinical presentation and work-up
Acute coronary syndrome
Clinical presentation and work-up
Arrhythmias
Clinical presentation and work-up
Venous thrombo-embolic disease
Clinical presentation and work-up
Pericarditis
Clinical presentation and work-up
Long COVID syndrome
Conclusions
Chapter 7. The impact of COVID-19 on acute myocardial infarction care
Introduction
Direct effects
Indirect effects
Out-of-hospital cardiac arrest
ST-elevation myocardial infarction care
Non-ST-elevation myocardial infarction care
Acute coronary syndrome patients with COVID-19 infection
Future directions and initiatives to improve care
Summary
Chapter 8. Noninvasive diagnostic evaluation
Introduction
Venous thromboembolism
Diagnosis
Assessment of clinical (pretest) probability
D-dimer testing considerations
Chest radiograph
Electrocardiographic findings in PE
Transthoracic echocardiography (TTE)
Extremity venous Doppler ultrasound
Computed tomographic pulmonary angiography
Lung scintigraphy
Imaging, laboratory, and other clinical investigations for risk stratification
Myocarditis
Diagnostic evaluation for COVID-19-related myocarditis
Cardiac biomarker testing in COVID-19-related myocarditis
Electrocardiogram
Cardiovascular imaging
Echocardiography
Cardiac magnetic resonance imaging (CMR)
Multisystem inflammatory syndrome in children (MIS-C)
COVID-19-associated pericardial involvement
Acute coronary syndrome (ACS) and COVID-19
Electrocardiography (ECG)
Cardiac troponin T/I
Noninvasive imaging
Functional evaluation: Echocardiography, CMR, and SPECT
Echocardiography
Coronary computed tomography angiography (CCTA)
Cardiac magnetic resonance (CMR)
Nuclear cardiology
Takotsubo cardiomyopathy (TTC)
Incidence during the COVID-19 pandemic
Investigations
Cardiac arrhythmias
Conclusion
Chapter 9. Invasive diagnostic evaluation: The role of coronary angiography in the evaluation of COVID-19 patients with myocardial injury
Introduction
Myocardial injury
Myocardial injury in COVID-19
Role of coronary angiography in myocardial injury pre-COVID-19 pandemic
Role of coronary angiography in myocardial injury during the COVID-19 pandemic
Role of coronary angiography in myocardial injury post-COVID-19 pandemic
Conclusions
Chapter 10. COVID-19 and the heart: Acute and long-term treatment options
Introduction
Spectrum of disease
Acute coronary syndrome: Diagnosis and management in COVID-19 patients
Other treatment options in an acute infection
Remdesivir
Dexamethasone
Role of ECMO and supportive care
Role of IL-6 inhibitors
Role of Janus kinase inhibitors
Role of anticoagulation
Long-term treatment options and heart transplant
Cardiac and pulmonary rehabilitation
Conclusion
Chapter 11. Acute clinical outcome and prognosis
Introduction
Abnormal laboratory or imaging tests without clinical involvement
Cardiac Biomarkers
Electrocardiogram
Transthoracic Echocardiogram
Left heart catheterization
Computed Tomography
Cardiac Magnetic Resonance Imaging
Endomyocardial biopsy
Acute Clinical Cardiac Manifestations and Prognosis (Fig. 11.1)
Myocarditis
Pericarditis and pericardial effusion
Stress (takotsubo) cardiomyopathy
Myocardial Infarction
Atrial fibrillation
Ventricular arrhythmia and bradycardia
Pulmonary Embolism (PE)
Heart failure
Summary
Chapter 12. Long-term clinical outcomes and prognosis
Introduction
PASC
Symptoms
Classification and mechanisms
PASC-CVD
PASC-CVS
Structural consequences
COVID heart
Myocarditis
Myocarditis following COVID-19 vaccine
Myocardial infarction
Venous thromboembolic disorders
Stroke
Functional consequences
Cardiovascular autonomic dysfunction
Postural orthostatic tachycardia syndrome
Inappropriate sinus tachycardia
Orthostatic hypotension
Reflex syncope
Evaluation and management
Prognostic impact of COVID-19
Future perspectives
Chapter 13. The impact of COVID-19 on patients with heart failure and valvular disease
Introduction
Physiology of SARS-CoV-2 as it relates to heart failure
Impact of COVID-19 on the development of HF and VHD
Arterial and venous thrombosis
Pulmonary hypertension and RV failure
Ischemia
Myocarditis and vasculitis
Arrhythmia
Stress cardiomyopathy
Valvular heart disease
COVID-19 infection among patients with preexisting HF or VHD
Initial diagnosis and management
Guideline-directed medical therapies
Valvular heart disease
Impact of COVID-19 on healthcare delivery for patients with HF and valvular heart disease
Access to valvular interventions
Evaluation for advanced therapies
Shift to telehealth
COVID-19 among LVAD and HT patients
LVAD recipients
Heart transplant recipients
Importance of COVID-19 vaccination for HF and VHD patients
Conclusion
Chapter 14. Emerging therapeutic options
Introduction
COVID-19 treatment options
Antiviral agents
Nirmatrelvir-ritonavir (NMVr)
Remdesivir
Molnupiravir
Monoclonal antibodies
Immunomodulators
Corticosteroids
Interleukin-6 inhibitors
Janus kinase inhibitors
Vilobelimab
Drug-drug interactions of COVID-19 therapies and cardiovascular medications
Nirmatrelvir-ritonavir
Other COVID-19 therapies
Postacute sequelae of COVID-19
Conclusion
Chapter 15. The role of COVID-19 vaccination
Introduction
COVID-19 vaccine platforms and the cardiovascular system
Protein subunit
RNA
Nonreplicating viral vector
Inactivated virus
Effectiveness of SARS-COV-2 vaccine in individuals with cardiac risk factors and established cardiovascular disease
Cardiac risk factors
Established cardiovascular disease
Cardiovascular side effects of COVID-19 vaccines
Myocarditis and pericarditis
Overview and incidence
Mechanism
Clinical presentation and evaluation
Management and prognosis
Vaccine-induced thrombotic thrombocytopenia
Overview and incidence
Mechanism
Clinical presentation and evaluation
Management and prognosis
Other cardiovascular side effects of COVID-19 vaccines
Myocardial infarction
Arrhythmia
Hypertension
Stress cardiomyopathy
Impact of COVID-19 vaccines on cardiovascular outcomes
Cardioprotective effects of vaccination
Myocarditis and pericarditis
Myocardial infarction and cardiac injury
Arrhythmia
Recommendations for COVID-19 vaccination in high-risk individuals
Heart failure
Coronary artery disease
Cardiac transplant
Conclusion
Index

Brian C. Case

Brian Case, MD, FACC, FSACI is an Interventional Cardiologist at MedStar Heart and Vascular Institute, working at MedStar Washington Hospital Center, MedStar Georgetown University Hospital and MedStar Southern Maryland Hospital. He is the Chief of Interventional Cardiology and Director of the Cardiac Cath Lab at MedStar Southern Maryland Hospital. He holds an appointment of Assistant Professor of Medicine, Georgetown University. He is board certified in interventional cardiology, cardiovascular disease and internal medicine with extensive fellowship training. He is also an associate editor of the Cardiovascular Revascularization Medicine Journal.

He has as written over ten first author manuscripts on original data evaluating the impact of the COVID-19 on the cardiovascular system. This includes clinical outcomes, therapeutic options, and the role of the COVID-19 vaccine on outcomes. He has also written several editorials and review papers on the topic. His work has been presented at multiple national cardiology conference. His healthcare center (MedStar) has been a contributing site to the North American COVID-19 Myocardial infarction Registry, which is a national, multi-site registry evaluating patients with COVID-19 presenting with ST-elevation myocardial infarction. The registry has already published multiple manuscripts with plans to continue this work.

Affiliations and expertise

Scientific Lead, MedStar Cardiovascular Research Network, Maryland, USA

Ron Waksman

Ron Waksman, MD, FACC, FESC, MSCAI, is a distinguished Professor of Cardiology at Georgetown University, Associate Director of Cardiology at MedStar Washington Hospital Center, and Director of Cardiovascular Research and Advanced Education at MedStar Health. A globally recognized interventional cardiologist, he has been Principal Investigator for over 230 clinical studies.

He is Editor-in-Chief of the Journal Cardiovascular, Revascularization Medicine, and is founder and chair of the Cardiovascular Research Technology meeting. He is credited on 15 patents in vascular brachytherapy, covered stents, leaflet valve modification, and balloon technology.

His research interests include brachytherapy for restenosis prevention, stent technology, biodegradable scaffolds, HDL therapy, vulnerable plaque, intracoronary imaging, structural heart disease, cardiovascular pharmacotherapy, and chronic total occlusion intervention. Dr. Waksman's scholarly contributions include over 1000 published manuscripts, over 16 edited textbooks, and 47 book chapters. He is also founder and Editor-in-Chief of the CRTonline and the CardioTube websites.

Affiliations and expertise

MedStar Washington Hospital Center

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