Cardiology in the Time of COVID-19

Jaya Mallidi, MD, MHS

We are in the midst of a pandemic. Yet cardiologists outside the hot geographical zones probably have not yet had direct encounters with hospitalized patients with confirmed coronavirus disease of 2019 (COVID-19). However, the surge is coming, and we will soon see many of them.

Most of our current knowledge is limited to the experience from China. The cardiovascular (CV)  manifestations directly related to COVID-19 include myocarditis, myocardial injury, acute coronary syndrome, cardiomyopathy, congestive heart failure, cardiogenic shock, fatal arrhythmias, and thromboembolic disease. Based on the limited data so far, approximately 10% of hospitalized patients with COVID-19 have underlying CV disease. The number of patients who develop CV sequelae from COVID-19 varies. As cardiology physicians on the frontline, we will be called on to help emergency department physicians, hospitalists, and intensivists in the coming weeks and months.

Below is a summary of the guidance so far from literature review and the CV professional societies:

Troponin: Mild elevation of troponinespecially regarding high-sensitivity troponin in hospitalized patients with COVID-19, is common and nonspecific. Unless symptoms, electrocardiogram (ECG), or echocardiogram findings corroborate clinical suspicion of acute myocardial infarction or myocarditis, ordering "routine troponins for all patients" or testing based on mild, nonspecific elevation (MI)