COVID-19-associated heart failure: Difference between revisions

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**[[Palpitations]]  
**[[Palpitations]]  
*Less common symptoms include:
*Less common symptoms include:
**[[Paroxysmal nocturnal dyspnea ]]
**[[Paroxysmal nocturnal dyspnea]]
**Cool extremities  
**Cool extremities  
**[[Cyanosis ]]
**[[Cyanosis ]]
*[[*Dizziness]]
*[[Dizziness]]
**[[Syncope]]
**[[Syncope]]
**Fatigue
**Fatigue

Revision as of 21:52, 29 June 2020

For COVID-19 frequently asked inpatient questions, click here
For COVID-19 frequently asked outpatient questions, click here

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mitra Chitsazan, M.D.[2]Mandana Chitsazan, M.D. [3]

Synonyms and keywords: coronavirus disease-19, coronavirus disease 2019, SARS-CoV-2, COVID-19, 2019-nCoV, 2019 novel coronavirus, acute heart failure, de novo acute heart failure, chronic heart failure, acute decompensated heart failure, HFrEF, HFpEF, heart failure with reduced ejection fraction, heart failure with preserved ejection fraction

Overview

Historical perspective

Classification

  • Acute heart failure has two forms:
    • Newly-arisen (“de novo”) acute heart failure
    • Acutely decompensated chronic heart failure (ADCHF)

Pathophysiology

  • Presumed pathophysiologic mechanisms for the development of new or decompensated heart failure in patients with COVID-19 include:[1] [2] [3] [4] [5]


Causes


Differentiating ((COVID-19 associated heart failure)) from other Diseases

In patients with COVID-19 infection, acute heart failure should be differentiated from other diseases presenting with dyspnea and/or tachypnea. The differentials include the following:


Epidemiology and Demographics

  • Data on incidence on acute heart failure in COVID-19 patients is limited.
  • In one study, acute heart failure was seen in 4.1% of patients with acute cardiac injury.
  • In a retrospective study on 191 COVID-19 patients in Wuhan, China, the incidence of heart failure was 23% (52% in non-survivors vs 12% in survivors).

Risk Factors

Screening

  • There is insufficient evidence to recommend routine screening for heart failure in COVID-19 patients.
  • Routine measurement of natriuretic peptides and/or cardiac troponins have not been recommended in the absence of a high index of suspicion for HF on the clinical grounds.

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

  • Cardiac Troponins:
    • Elevated cardiac troponin levels suggest the presence of myocardial cell injury or death.
    • Cardiac troponin levels may increase in patients with chronic or acute decompensated heart failure.[6]

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

References

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  6. PMID 20863950 (PMID 20863950)
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  10. PMID 18298480 (PMID 18298480)
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  18. PMID 31129923 (PMID 31129923)
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