How to overcome cardiovascular challenges in COVID-19 patients: a guide for common practice

Main Article Content

Pegah Eslami
Mohammadreza Tabary
Arash Dooghaie-Moghadam
Isa Khaheshi


COVID-19, SARS-CoV-2, Cardiovascular disease, Heart, Severe Acute Respiratory Syndrome


The COVID-19 epidemic initially started in Wuhan, China in December 2019 due to SARS-CoV-2. SARS-CoV-2 is genetically similar to the bat beta-coronavirus genus, but the novel species of this genus has the ability to infect human. The most common clinical features of COVID-19 are fever, cough, myalgia, fatigue, expectoration, and dyspnea. The primary reported mortality rate was about 2-3% in China; however, it reached up to 10% among patients with underlying cardiovascular diseases. The primary epidemiological investigations showed a high prevalence of underlying cardiovascular diseases in more than 40% of the infected patients. A high prevalence of hypertension , ischemic heart disease, and diabetes was reported among deceased patients in Italy. Previous experiments in different pandemic situations showed that the cardiovascular system has been affected in many ways. Previous studies on SARS-CoV and MERS-CoV reported that cardiovascular
co-morbidities had direct correlation with the risk of infection, severity of disease and the mortality rate. Therefore, brief and available protocols for controlling the negative effects of this novel respiratory infection on the cardiovascular system, especially in high-risk population with underlying cardiovascular conditions, is one of the most serious concern among healthcare providers. Herein, we aimed to review the available data on the cardiac manifestation of COVID-19. In addition, we described useful maps for the better treatment of COVID-19 infection in patients with underlying cardiovascular conditions, as a high-risk group of patients.



Download data is not yet available.


Metrics Loading ...
Abstract 17 | PDF Downloads 4


1. Ali SA, Baloch M, Ahmed N, Ali AA, Iqbal A. The outbreak of Coronavirus Disease 2019 (COVID-19)—An emerging global health threat. Journal of Infection and Public Health. 2020.
2. Wang L-s, Wang Y-r, Ye D-w, Liu Q-q. A review of the 2019 Novel Coronavirus (COVID-19) based on current evidence. International Journal of Antimicrobial Agents. 2020:105948.
3. Hsu LY, Chia PY, Lim J. The Novel Coronavirus (SARS-CoV-2) Epidemic. Annals of the Academy of Medicine, Singapore. 2020;49(1):1-3.
4. Li Lq, Huang T, Wang Yq, Wang Zp, Liang Y, Huang Tb, et al. 2019 novel coronavirus patients’ clinical characteristics, discharge rate and fatality rate of meta‐analysis. Journal of Medical Virology. 2020.
5. Di Pasquale G. Coronavirus COVID-19: quali implicazioni per la Cardiologia? Giornale Italiano di Cardiologia. 2020;21(4):243-5.
6. Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, et al. Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease. Circulation. 2020.
7. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020.
8. Welt FG, Shah PB, Aronow HD, Bortnick AE, Henry TD, Sherwood MW, et al. Catheterization Laboratory Considerations During the Coronavirus (COVID-19) Pandemic: From ACC’s Interventional Council and SCAI. Journal of the American College of Cardiology. 2020.
9. Hu H, Ma F, Wei X, Fang Y. Coronavirus fulminant myocarditis saved with glucocorticoid and human immunoglobulin. European Heart Journal. 2020.
10. Touret F, de Lamballerie X. Of chloroquine and COVID-19. Antiviral research. 2020:104762.
11. Zhou D, Dai S-M, Tong Q. COVID-19: a recommendation to examine the effect of hydroxychloroquine in preventing infection and progression. Journal of Antimicrobial Chemotherapy. 2020.
12. Liu J, Cao R, Xu M, Wang X, Zhang H, Hu H, et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discovery. 2020;6(1):1-4.
13. Sahraei Z, Shabani M, Shokouhi S, Saffaei A. Aminoquinolines Against Coronavirus Disease 2019 (COVID-19): Chloroquine or Hydroxychloroquine. International journal of antimicrobial agents. 2020:105945.
14. Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. New England Journal of Medicine. 2020.
15. Li G, De Clercq E. Therapeutic options for the 2019 novel coronavirus (2019-nCoV). Nature Publishing Group; 2020.
16. Dong L, Hu S, Gao J. Discovering drugs to treat coronavirus disease 2019 (COVID-19). Drug Discoveries & Therapeutics. 2020;14(1):58-60.
17. Zeng JH, Liu Y-X, Yuan J, Wang F-X, Wu W-B, Li J-X, et al. First case of COVID-19 infection with fulminant myocarditis complication: case report and insights. 2020.
18. Sakabe M, Yoshioka R, Fujiki A. Sick sinus syndrome induced by interferon and ribavirin therapy in a patient with chronic hepatitis C. Journal of cardiology cases. 2013;8(6):173-5.
19. Cai Q, Yang M, Liu D, Chen J, Shu D, Xia J, et al. Experimental treatment with favipiravir for COVID-19: an open-label control study. Engineering. 2020.
20. Long B, Brady WJ, Koyfman A, Gottlieb M. Cardiovascular complications in COVID-19. The American Journal of Emergency Medicine. 2020.
21. Grein J, Ohmagari N, Shin D, Diaz G, Asperges E, Castagna A, et al. Compassionate use of remdesivir for patients with severe COVID-19. New England Journal of Medicine. 2020.
22. Yang X, Yu Y, Xu J, Shu H, Liu H, Wu Y, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine. 2020.
23. Gurwitz D. Angiotensin receptor blockers as tentative SARS‐CoV‐2 therapeutics. Drug development research. 2020.
24. Qiu Y, Zhao Y-B, Wang Q, Li J-Y, Zhou Z-J, Liao C-H, et al. Predicting the angiotensin converting enzyme 2 (ACE2) utilizing capability as the receptor of SARS-CoV-2. Microbes and Infection. 2020.
25. Diaz JH. Hypothesis: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19. J Travel Med. 2020.
26. Kuster GM, Pfister O, Burkard T, Zhou Q, Twerenbold R, Haaf P, et al. SARS-CoV2: should inhibitors of the renin–angiotensin system be withdrawn in patients with COVID-19? European Heart Journal. 2020.
27. Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Bondi-Zoccai G, et al. Cardiovascular considerations for patients, health care workers, and health systems during the coronavirus disease 2019 (COVID-19) pandemic. Journal of the American College of Cardiology. 2020.
28. Applegate WB, Ouslander JG. COVID‐19 Presents High Risk to Older Persons. Journal of the American Geriatrics Society. 2020.
29. Foy M, Sperati CJ, Lucas GM, Estrella MM. Drug interactions and antiretroviral drug monitoring. Current HIV/AIDS Reports. 2014;11(3):212-22.
30. Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D, et al. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiology. 2020.
31. McNicholl I, Peiperl L. Database of antiretroviral drug interactions. HIV InSite San Francisco: UCSF Center for HIV Information Accessed December. 2013;1.
32. Info A. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents 2016. Available from: aidsinfo nih gov/guidelines/html/1/adult-andadolescent-arv-guidelines/0/(accessed August 27, 2012). 2019.
33. Giguère P, Nhean S, Tseng AL, Hughes CA, Angel JB. Getting to the heart of the matter: a review of drug interactions between HIV antiretrovirals and cardiology medications. Canadian Journal of Cardiology. 2019;35(3):326-40.
34. Tam C-CF, Cheung K-S, Lam S, Wong A, Yung A, Sze M, et al. Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on ST-Segment–Elevation Myocardial Infarction Care in Hong Kong, China. Circulation: Cardiovascular Quality and Outcomes. 2020:CIRCOUTCOMES. 120.006631.
35. Iacobucci G. Covid-19: all non-urgent elective surgery is suspended for at least three months in England. BMJ. 2020;368:m1106.
36. Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, et al. 2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2014;64(24):e139-e228.
37. Ibánez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Revista espanola de cardiologia (English ed). 2017;70(12):1082.
38. Zeng J, Huang J, Pan L. How to balance acute myocardial infarction and COVID-19: the protocols from Sichuan Provincial People’s Hospital. Intensive care medicine. 2020:1-3.
39. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2016;68(10):1082-115.
40. van der Lee M, Sankatsing R, Schippers E, Vogel M, Fätkenheuer G, van der Ven A, et al. Pharmacokinetics and pharmacodynamics of combined use of lopinavir/ritonavir and rosuvastatin in HIV-infected patients. Antiviral therapy. 2007;12(7):1127.
41. Vicente J, Zusterzeel R, Johannesen L, Ochoa-Jimenez R, Mason JW, Sanabria C, et al. Assessment of Multi-Ion Channel Block in a Phase I Randomized Study Design: Results of the CiPA Phase I ECG Biomarker Validation Study. Clinical pharmacology and therapeutics. 2019;105(4):943-53.
42. Qian L, Zheng J, Xu H, Shi L, Li L. Extracorporeal membrane oxygenation treatment of a H7N9-caused respiratory failure patient with mechanical valves replacement history: A case report. Medicine. 2016;95(40):e5052.
43. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2017;70(2):252-89.
44. Moody W, Loudon M, Watkin R, Steeds R, Prendergast B. Infective endocarditis: diagnosis delayed during swine flu pandemic. Postgraduate medical journal. 2011;87(1025):240-.
45. Peterson D, Van Ermen A. Increased warfarin requirements in a patient with chronic hepatitis C infection receiving sofosbuvir and ribavirin. American Journal of Health-System Pharmacy. 2017;74(12):888-92.
46. Puglisi G, Smith S, Jankovich R, Ashby JC, Jodlowski T. Paritaprevir/ritonavir/ombitasvir+ dasabuvir plus ribavirin therapy and inhibition of the anticoagulant effect of warfarin: a case report. Journal of clinical pharmacy and therapeutics. 2017;42(1):115-8.
47. Knoell KR, Young TM, Cousins ES. Potential Interaction Involving Warfarin and Ritonavir. Annals of Pharmacotherapy. 1998;32(12):1299-302.
48. Cortegiani A, Ingoglia G, Ippolito M, Giarratano A, Einav S. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. Journal of Critical Care. 2020.
49. Lip GY. Cardioversion of atrial fibrillation. Postgrad Med J. 1995;71(838):457-65.
50. Zeitlinger M. Pharmacokinetics-pharmacodynamics of antiviral agents used to treat SARS-CoV-2 and their potential interaction with drugs and other supportive measures: A comprehensive review by the PK/PD of Anti-Infectives Study Group of the European Society of Antimicrobial Agents.

DB Error: Unknown column 'Array' in 'where clause'