Diagnosis and Management of Cardiovascular Disease during the COVID-19 Pandemic

Dear Colleagues,

Cardiac involvement has been reported in COVID-19 across all waves and all viral strains, attributed to the pandemic at all its stages. Earlier reports explained mechanisms of cardiac involvement to include coronary thromboembolism, myocardial inflammation, stress-induced cardiomyopathy, pericardial injury, and RV dysfunction. Echocardiographic studies from earlier time points in the pandemic showed that, specifically, RV dysfunction is a common finding in patients with COVID-19 and is associated with poor prognosis. 

This led to the belief that RV dysfunction can be considered the hallmark of cardiac involvement in hospitalized COVID-19 patients with high mortality risk. Trials to explain this specific association concluded that the RV may be more susceptible to lung injury than the LV considering that COVID-19 has initial pulmonary tropism, causing a special affinity towards an increase in pulmonary vascular resistance and RV dysfunction and consequent results. The suggested pulmonary-RV-related pathological situations were believed to be occurring as a result of virus-induced endothelial injury, vascular inflammation, and hypercoagulable states, causing COVID-19-associated acute respiratory distress syndrome (ARDS) and pulmonary embolism. However, viral-related and cytokine storm-related myocardial injury as well as hypoxia-induced vasoconstriction and myocarditis can also partly account for RV dysfunction in later stages.

The interest in cardiac involvement was only accentuated after the development of the vaccines when it was found that the frequent complications of the vaccines were also via cardiac involvement, more notably COVID-19 vaccine-associated myocarditis. 

Despite the taming of the pandemic at this point in time, there are no guarantees that other strains of this virus may not be generated such that the pandemic may resurface again with significant healthcare impacts. To that extent, clinicians and healthcare facilities, despite the great level of experience in dealing with the pandemic, still have no streamlined guidelines or roadmaps for therapeutics and management options specific to and directed toward patients with COVID-19 myocardial involvement. 

Dr. Jonathan N. Bella
Dr. Alaa Omar
Guest Editors

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