Myocardial involvement in coronavirus disease 19
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Introduction In late 2019, a cohort of patients presenting with pneumonia of varying acuity and unclear etiology in Wuhan, China, heralded the outbreak of coronavirus disease 19 (COVID-19). Coronaviruses are known to cause respiratory or intestinal infections in humans and animals [1]. Previous severe acute respiratory syndrome (SARS) beta-coronavirus infections have been associated with tachyarrhythmias and signs and symptoms of heart failure [2]. Other acute respiratory infections, including influenza, respiratory syncytial virus, and bacterial pneumonias, are well-known triggers for cardiovascular diseases (CVD) [3, 4]. According to data from previous coronavirus epidemics (SARS and Middle East respiratory syndrome, MERS), these viral infections led mainly to pulmonary complications such as pneumonia and acute respiratory distress syndrome [5, 6]. Nevertheless, these viruses were reported to cause direct myocardial injury with subsequent myocarditis [7–9]. The emergence of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), which causes COVID-19, rapidly developed into a pandemic, and a large number of infected patients have been reported to have underlying CVD [10, 11]. Although COVID-19 appears to have greater infectivity and lower mortality than SARS and MERS, many uncertainties remain regarding, e.g., its viral evolution, appropriate anti-viral treatment, and strategies for disease control.
Ahmed Saleh1 · Akira Matsumori2 · Sherif Abdelrazek3 · Sara Eltaweel3 · Amjad Salous1 · Franz-Josef Neumann3 · Matthias Antz1 1
Klinikum Braunschweig, Academic Hospital of Hannover Medical School, Braunschweig, Germany Clinical Research Center, Kyoto Medical Center, Kyoto, Japan 3 University heart center Bad Krozingen, Bad Krozingen, Germany 2
Myocardial involvement in coronavirus disease 19 There are only scant published data regarding cardiovascular burden in the wake of viral epidemics. This study aimed to evaluate cardiac involvement in COVID-19.
Methods Study design and participants This prospective cohort study included 40 adult inpatients (≥18 years old) at the Braunschweig Municipal Hospital (21 patients) and the Bad Krozingen Heart Center (19 patients) in Germany. Adult patients diagnosed with COVID19 in accordance with World Health Organization (WHO) interim guidance were included in the study. The suspicion of COVID-19 infection was based on clinical presentation, contact to an active case with current infection, or having visited one of the known risk areas in China or Italy. Throat-swab specimens were obtained for detection of SARS-CoV-2 polymerase chain reaction (PCR) examination at the emergency department. Asymptomatic positive patients were sent home to self-quarantine. Clinically stable positive patients with mild to moderate symptoms were admitted to isolation wards adapted for COVID-19 patients. Admission to an intensive care unit (ICU; arranged for infected patients) for initially unstable COVID-19 patients or upon clinical deterioration was available for further management. The criteria fo
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