The American College of Cardiology released a bulletin on the cardiac implications of the coronavirus emphasizing the importance of advising patients with CVD on their potential increased risk for the virus.
“In geographies with active 2019-nCoV transmission (mainly China), it is reasonable to advise patients with underlying cardiovascular disease of the potential increased risk and to encourage additional, reasonable precautions,” Mohammad Madjid, MD, MS, FACC, FSCAI, assistant professor of cardiovascular medicine at McGovern Medical School at The University of Texas Health Science Center at Houston and an expert advisor of the ACC clinical bulletin, and colleagues wrote.
The coronavirus was first reported in late December 2019 and originated in Wuhan, China. Across 28 countries, there have been 45,204 confirmed cases with 1,117 confirmed deaths since Feb. 12, 2020, according to the bulletin. This virus may have a greater infectivity compared with SARS and MERS, in addition to a lower case fatality rate.
Several cardiac implications have been determined from case reports, including elevated risk for mortality or complications from the coronavirus in patients with underlying conditions, as up to 50% of patients who have been hospitalized have a chronic illness, according to the bulletin. CVD or cerebrovascular disease have been observed in 40% of patients hospitalized with a confirmed diagnosis of the coronavirus.
Nearly 20% of patients developed acute respiratory distress syndrome, according to a case report of 138 hospitalized patients. In addition, 7.2% developed acute cardiac injury, 8.7% developed shock, 3.6% developed acute kidney injury and 16.7% developed arrhythmias. Several unpublished first-hand reports also suggested that some patients who were diagnosed with the coronavirus developed myocarditis.
The bulletin also addresses the use of guideline-directed medical therapies to potentially provide additional protection.
“Some experts have suggested that the rigorous use of guideline-directed plaque stabilizing agents could offer additional protection to CVD patients during a widespread outbreak (statins, beta-blockers, ACE inhibitors, aspirin); however, such therapies should be tailored to individual patients,” Madjid and colleagues wrote.
Keeping up to date with vaccinations is also important for patients with CVD, including pneumococcal and influenza vaccines, according to the bulletin. Patients who develop the coronavirus should be triaged based on the presence of underlying chronic diseases including CVD, respiratory and renal diseases so they receive prioritized treatment.
As health care providers focus in on the coronavirus, there is a possibility that classic symptoms and presentation of acute MI may be missed and result in underdiagnosis, according to the bulletin.
“2019-nCoV is a fast-moving epidemic with an uncertain clinical profile,” Madjid and colleagues wrote. “Providers should be prepared for guidance to shift as more information becomes available.” – by Darlene Dobkowski
Madjid M, et al. ACC Clinical Bulletin: Cardiac Implications of Novel Wuhan Coronavirus (2019-nCoV). Accessed Feb. 13, 2020.
Disclosure: Madjid reports he consulted for Sanofi Pasteur.