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Revision as of 19:36, 23 July 2020

For COVID-19 frequently asked inpatient questions, click here
For COVID-19 frequently asked outpatient questions, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: : Alieh Behjat, M.D.[2]

Synonyms and keywords:: Novel coronavirus, COVID-19, Wuhan coronavirus, coronavirus disease-19, coronavirus disease 2019, SARS-CoV-2, COVID-19, 2019-nCoV, 2019 novel coronavirus, cardiovascular finding in COVID-19, cardiogenic shock, COVID-19 associated cardiogenic shock

Overview

The first confirmed instance of cardiogenic shock due to COVID-19 infection through myocardial infection by viral particles was in a 69-year-old patient from Italy. This was confirmed via biopsy. Since then, the two most probable mechanisms of cardiogenic shock related to COVID-19 are direct invasion and cytokine storm. According to a recent study out of an ICU in Washington state, one-third of critically ill patients with COVID-19 had clinical signs of cardiogenic shock and cardiomyopathy. According to another observational study in China, COVID-19 associated cardiogenic shock has a poor prognosis.

Historical Perspective

The novel coronavirus, SARS-CoV-2, is identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China in late December 2019. It was named SARS-CoV-2 for its similarity severe acute respiratory syndrome related coronaviruses such as SARS-CoV, which caused acute respiratory distress syndrome (ARDS) in 2002–2003. ^[1]^[2]
On March 12, 2020, the WHO declared the Coronavirus disease 2019 (COVID-19) outbreak to be a pandemic.^[3]
The first confirmed instance of cardiogenic shock due to COVID-19 infection through myocardial infection by viral particles was in a 69-year-old patient from Italy. This was confirmed via biopsy. ^[4]

To view the historical perspective of COVID-19, click here.

Classification

There is no specific classification for COVID-19 associated cardiogenic shock. To view cardiogenic shock classification, click here.

Pathophysiology

The two most likely mechanisms that contribute to COVID-19 cardiogenic shock are: ^[5] ^[6]

Direct invasion of the virus into the cardiomyocytes
Cytokine storm activated by T helper cells (Th1 and Th2) that triggers a systemic hyperinflammatory response

Causes

The causes of cardiogenic shock related to COVID-19 may include: ^[7] ^[8]

Newly emerging COVID-19 associated myocarditis, cardiac arrhythmias, cardiomyopathy, or an acute coronary syndrome deteriorated into cardiogenic shock
Worsening of previous left ventricular failure due to COVID-19
COVID-19-associated multisystem inflammatory syndromein children (MIS-C)

Differentiating COVID-19 associated cardiogenic shock from other Diseases

Cardiogenic shock related to COVID-19 must be differentiated from other diseases which include: ^[9] ^[10]

distributive shock
hypovolemic shock
mixed (distributive and cardiogenic shock).

Some hemodynamic parameters would help differentiate significant types of shock: ^[11]


	Cardiac Output	Pulmonary Capillary Wedge Pressure	Systemic Vascular Resistance	Pulmonary artery diastolic pressure	SVO2
COVID-19-associated cardiogenic shock	↓	↑↔	↑	↑	↓
Septic shock	↑	↓	↓	↓	↓
Hypovolemic shock	↓	↓	↑	↓	↑

Epidemiology and Demographics

According to a recent study out of an ICU in Washington state, one-third of critically ill patients with COVID-19 had clinical signs of cardiogenic shock and cardiomyopathy.^[12] There are few anecdotal reports of cardiogenic shock related to COVID-19. ^[4] ^[13]

Age

There is no data on age predilection to cardiogenic shock in COVID-19.

Gender

There is no data on gender predilection to cardiogenic shock in COVID-19.

Race

There is no data on racial predilection to cardiogenic shock in COVID-19.

Risk Factors

There are no established risk factors for COVID-19-associated cardiogenic shock.
To view risk factors for the severe form of COVID-19 disease, click here.
Moreover, in order to read more on the risk factors of cardiogenic shock, generally, click here.

Screening

There is insufficient evidence to recommend routine screening for COVID-19-associated cardiogenic shock.

Natural History, Complications and Prognosis

According to an observational study in China, COVID-19 associated cardiogenic shock has a poor prognosis.
In spite of using Extracorporeal membrane oxygenation (ECMO), 83% of patients died. ^[14] ^[15]

Diagnosis

Diagnostic Study of Choice

A diagnosis of cardiogenic shock related to COVID-19 can be made when Systolic Blood Pressure is lower than 90 mmHg for more than 15 minutes with impaired organ perfusion while Urine output is less than 30 m/hr in a patient with COVID-19 disease.^[15]

To view cardiogenic shock diagnostic criteria, click here.

History and Symptoms:

According to anecdotal reports, some patients that have presented with COVID-19 related cardiogenic shock did not have any cardiovascular risk factors.

A 69-year-old patient from Italy has been reported by Tavazzi et al., as a COVID-19-associated cardiogenic shock case.
- This patient had flu-like symptoms when hospitalized and quickly deteriorated into respiratory distress and cardiogenic shock. ^[4]

Four patients with cardiogenic shock complication related to COVID-19 were reported by Sanchez-Recalde, et al.
- These patients were hospitalized between March 1, 2020 and April 15, 2020 and included:^[13]
  - A 42-year-old woman, who had dyslipidemia as a cardiovascular risk factor
  - A 50-year-old man, without any cardiovascular risk factors, admitted with severe bilateral pneumonia related to COVID-19. After a few hours, he developed cardiogenic shock
  - A 75-year-old man who did not have any cardiovascular risk factors and was admitted due to dyspnea, chest pain, and bilateral COVID-19 pneumonia
  - A 37-year-old woman, with a history of obesity and deep venous thrombosis, and had symptoms of dyspnea and chest pain

Physical Examination

Physical examination findings that may be of note for the diagnosis of Covid-19 associated cardiogenic shock include:^[16]

Assessment of consciousness level
Extremities, whether they are warm or cool, is helpful for evaluation of cardiogenic shock
Vital signs (tachycardia and hypotension and tachypnea)
Evaluation of volume status: CVP (increased JVP), edema
Skin pallor

Laboratory Findings

In COVID-19 patients, it is essential to differentiate the type of shock. Two tests are best able to clarify this, and result in higher levels in patients with cardiogenic shock related to COVID-19. These tests are: ^[17]
- serum brain natriuretic peptide (BNP)
- Troponin

In addition, the increase of some biomarkers demonstrates poor prognosis, increased mortality, and more severe symptoms in COVID-19 patients:^[18]
- cTnT and cTnI levels
- The association of elevated CK-MB and BNP

Electrocardiogram

There is no specific electrocardiographic finding for cardiogenic shock in COVID-19 patients.
The ECG can help to find previous cardiac abnormalities and triggering factors, such as acute myocardial infarction, and arrhythmias, which could lead to cardiogenic shock ^[19]

X-ray

In a patient with COVID-19-associated cardiogenic shock, CXR could manifest coexisting acute respiratory illness and also cardiogenic pulmonary edema. Some findings, such as cardiomegaly and increased vascular markings, can suggest preexisting heart failure. ^[20]

Echocardiography or Ultrasound

Echocardiography is an appropriate way to identify the extent of cardiac involvement in COVID-19-associated cardiogenic shock cases.^[17]

CT scan

Generally, aCT scan is not suggested as a primary imaging study for evaluating a case of cardiogenic shock related to COVID-19. However, it can useful for observing coexisting ARDS by demonstrating a ground-glass opacity.^[20]

To view the CT scan findings on COVID-19, click here.

MRI

Generally, in patients with COVID-19-associated cardiogenic shock, Cardiac MRI for the assessment of preexisting disorders such as myocarditis should not be done.^[21]

To view the MRI findings on COVID-19, click here.

Other Imaging Findings

To view other imaging findings on COVID-19, click here.

Other Diagnostic Studies

To view other diagnostic studies for COVID-19, click here.

Treatment

Cardiogenic shock medical therapy:

Fluid resuscitation (crystalloid IV fluids are more efficient than colloid solutions)
Administration of vasopressors and inotropes to stabilize shock
Assess other types of shock and mixed etiologies of shock if hemodynamics not refining, specifically in patients with a previous cardiac abnormality ^[21]

Mechanical Support:

In treating patients with cardiogenic shock related to COVID-19, the efficacy of extracorporeal membrane oxygenation (ECMO) is indistinct, however it may be used in the most critically ill and highly selective patients.
Although specialists implicate ECMO and mechanical circulatory support devices in severe cased of COVID-19 related cardiogenic shock, the mortality rate if high in those patients who undergo this treatment.
It has been reported in a case series from China, that most of these patients had a poor prognosis and did not survive despite implicating ECMO. ^[22] ^[14]

Surgery

Surgical intervention is not recommended for the management of COVID-19-associated cardiogenic shock.

Primary Prevention

There are no established measures for the primary prevention of COVID-19-associated cardiogenic shock.

For primary preventive measures of COVID-19, click here.

Secondary Prevention

There are no established measures for the secondary prevention of COVID-19-associated myocarditis.

For secondary preventive measures of [COVID-19], click here.

References

↑ https://www.cdc.gov/coronavirus/2019-ncov/about/index.html. Missing or empty |title= (help)
↑ Lu, Jian; Cui, Jie; Qian, Zhaohui; Wang, Yirong; Zhang, Hong; Duan, Yuange; Wu, Xinkai; Yao, Xinmin; Song, Yuhe; Li, Xiang; Wu, Changcheng; Tang, Xiaolu (2020). "On the origin and continuing evolution of SARS-CoV-2". National Science Review. doi:10.1093/nsr/nwaa036. ISSN 2095-5138.
↑ "Coronavirus (COVID-19) events as they happen".
↑ ^4.0 ^4.1 ^4.2 Tavazzi, Guido; Pellegrini, Carlo; Maurelli, Marco; Belliato, Mirko; Sciutti, Fabio; Bottazzi, Andrea; Sepe, Paola Alessandra; Resasco, Tullia; Camporotondo, Rita; Bruno, Raffaele; Baldanti, Fausto; Paolucci, Stefania; Pelenghi, Stefano; Iotti, Giorgio Antonio; Mojoli, Francesco; Arbustini, Eloisa (2020). "Myocardial localization of coronavirus in COVID‐19 cardiogenic shock". European Journal of Heart Failure. 22 (5): 911–915. doi:10.1002/ejhf.1828. ISSN 1388-9842.
↑ Siddiqi, Hasan K.; Mehra, Mandeep R. (2020). "COVID-19 illness in native and immunosuppressed states: A clinical–therapeutic staging proposal". The Journal of Heart and Lung Transplantation. 39 (5): 405–407. doi:10.1016/j.healun.2020.03.012. ISSN 1053-2498.
↑ Ye, Qing; Wang, Bili; Mao, Jianhua (2020). "The pathogenesis and treatment of the `Cytokine Storm' in COVID-19". Journal of Infection. 80 (6): 607–613. doi:10.1016/j.jinf.2020.03.037. ISSN 0163-4453.
↑ Mahajan, Kunal; Chandra, K.Sarat (2020). "Cardiovascular comorbidities and complications associated with coronavirus disease 2019". Medical Journal Armed Forces India. doi:10.1016/j.mjafi.2020.05.004. ISSN 0377-1237.
↑ Belhadjer, Zahra; Méot, Mathilde; Bajolle, Fanny; Khraiche, Diala; Legendre, Antoine; Abakka, Samya; Auriau, Johanne; Grimaud, Marion; Oualha, Mehdi; Beghetti, Maurice; Wacker, Julie; Ovaert, Caroline; Hascoet, Sebastien; Selegny, Maëlle; Malekzadeh-Milani, Sophie; Maltret, Alice; Bosser, Gilles; Giroux, Nathan; Bonnemains, Laurent; Bordet, Jeanne; Di Filippo, Sylvie; Mauran, Pierre; Falcon-Eicher, Sylvie; Thambo, Jean-Benoît; Lefort, Bruno; Moceri, Pamela; Houyel, Lucile; Renolleau, Sylvain; Bonnet, Damien (2020). "Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic". Circulation. doi:10.1161/CIRCULATIONAHA.120.048360. ISSN 0009-7322.
↑ Boukhris, Marouane; Hillani, Ali; Moroni, Francesco; Annabi, Mohamed Salah; Addad, Faouzi; Ribeiro, Marcelo Harada; Mansour, Samer; Zhao, Xiaohui; Ybarra, Luiz Fernando; Abbate, Antonio; Vilca, Luz Maria; Azzalini, Lorenzo (2020). "Cardiovascular Implications of the COVID-19 Pandemic: A Global Perspective". Canadian Journal of Cardiology. doi:10.1016/j.cjca.2020.05.018. ISSN 0828-282X.
↑ Rajagopal, Keshava; Keller, Steven P.; Akkanti, Bindu; Bime, Christian; Loyalka, Pranav; Cheema, Faisal H.; Zwischenberger, Joseph B.; El Banayosy, Aly; Pappalardo, Federico; Slaughter, Mark S.; Slepian, Marvin J. (2020). "Advanced Pulmonary and Cardiac Support of COVID-19 Patients". Circulation: Heart Failure. 13 (5). doi:10.1161/CIRCHEARTFAILURE.120.007175. ISSN 1941-3289.
↑ Jameson, J (2018). Harrison's principles of internal medicine. New York: McGraw-Hill Education. ISBN 1259644030.
↑ Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M; et al. (2020). "Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State". JAMA. doi:10.1001/jama.2020.4326. PMC 7082763 Check |pmc= value (help). PMID 32191259 Check |pmid= value (help).
↑ ^13.0 ^13.1 Sánchez-Recalde, Ángel; Solano-López, Jorge; Miguelena-Hycka, Javier; Martín-Pinacho, Jesús Javier; Sanmartín, Marcelo; Zamorano, José L. (2020). "COVID-19 and cardiogenic shock. Different cardiovascular presentations with high mortality". Revista Española de Cardiología (English Edition). doi:10.1016/j.rec.2020.04.012. ISSN 1885-5857.
↑ ^14.0 ^14.1 Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H; et al. (2020). "Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study". Lancet Respir Med. 8 (5): 475–481. doi:10.1016/S2213-2600(20)30079-5. PMC 7102538 Check |pmc= value (help). PMID 32105632 Check |pmid= value (help).
↑ ^15.0 ^15.1 Dhakal, Bishnu P.; Sweitzer, Nancy K.; Indik, Julia H.; Acharya, Deepak; William, Preethi (2020). "SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart". Heart, Lung and Circulation. doi:10.1016/j.hlc.2020.05.101. ISSN 1443-9506.
↑ Tse, FirstName (2011). Oxford Desk Reference : Cardiology. Oxford: OUP Oxford. ISBN 978-0-19-956809-3.
↑ ^17.0 ^17.1 Lal, Sean; Hayward, Christopher S.; De Pasquale, Carmine; Kaye, David; Javorsky, George; Bergin, Peter; Atherton, John J.; Ilton, Marcus K.; Weintraub, Robert G.; Nair, Priya; Rudas, Mate; Dembo, Lawrence; Doughty, Robert N.; Kumarasinghe, Gayathri; Juergens, Craig; Bannon, Paul G.; Bart, Nicole K.; Chow, Clara K.; Lattimore, Jo-Dee; Kritharides, Leonard; Totaro, Richard; Macdonald, Peter S. (2020). "COVID-19 and Acute Heart Failure: Screening the Critically Ill – A Position Statement of the Cardiac Society of Australia and New Zealand (CSANZ)". Heart, Lung and Circulation. doi:10.1016/j.hlc.2020.04.005. ISSN 1443-9506.
↑ Aboughdir, Maryam; Kirwin, Thomas; Abdul Khader, Ashiq; Wang, Brian (2020). "Prognostic Value of Cardiovascular Biomarkers in COVID-19: A Review". Viruses. 12 (5): 527. doi:10.3390/v12050527. ISSN 1999-4915.
↑ Tse, FirstName (2011). Oxford Desk Reference : Cardiology. Oxford: OUP Oxford. ISBN 978-0-19-956809-3.
↑ ^20.0 ^20.1 Driggin, Elissa; Madhavan, Mahesh V.; Bikdeli, Behnood; Chuich, Taylor; Laracy, Justin; Biondi-Zoccai, Giuseppe; Brown, Tyler S.; Der Nigoghossian, Caroline; Zidar, David A.; Haythe, Jennifer; Brodie, Daniel; Beckman, Joshua A.; Kirtane, Ajay J.; Stone, Gregg W.; Krumholz, Harlan M.; Parikh, Sahil A. (2020). "Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic". Journal of the American College of Cardiology. 75 (18): 2352–2371. doi:10.1016/j.jacc.2020.03.031. ISSN 0735-1097.
↑ ^21.0 ^21.1 Dhakal BP, Sweitzer NK, Indik JH, Acharya D, William P (2020). "SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart". Heart Lung Circ. doi:10.1016/j.hlc.2020.05.101. PMC 7274628 Check |pmc= value (help). PMID 32601020 Check |pmid= value (help).
↑ MacLaren, Graeme; Fisher, Dale; Brodie, Daniel (2020). "Preparing for the Most Critically Ill Patients With COVID-19". JAMA. 323 (13): 1245. doi:10.1001/jama.2020.2342. ISSN 0098-7484.

Template:WS Template:WH

[1] ttps://www.cdc.gov/coronavirus/2019-ncov/about/index.html. Missing or empty |title= (help)

[LuCui2020-2] Lu, Jian; Cui, Jie; Qian, Zhaohui; Wang, Yirong; Zhang, Hong; Duan, Yuange; Wu, Xinkai; Yao, Xinmin; Song, Yuhe; Li, Xiang; Wu, Changcheng; Tang, Xiaolu (2020). "On the origin and continuing evolution of SARS-CoV-2". National Science Review. doi:10.1093/nsr/nwaa036. ISSN 2095-5138.

[urlCoronavirus_(COVID-19)_events_as_they_happen-3] "Coronavirus (COVID-19) events as they happen".

[TavazziPellegrini2020-4] 4.0 ^4.1 ^4.2 Tavazzi, Guido; Pellegrini, Carlo; Maurelli, Marco; Belliato, Mirko; Sciutti, Fabio; Bottazzi, Andrea; Sepe, Paola Alessandra; Resasco, Tullia; Camporotondo, Rita; Bruno, Raffaele; Baldanti, Fausto; Paolucci, Stefania; Pelenghi, Stefano; Iotti, Giorgio Antonio; Mojoli, Francesco; Arbustini, Eloisa (2020). "Myocardial localization of coronavirus in COVID‐19 cardiogenic shock". European Journal of Heart Failure. 22 (5): 911–915. doi:10.1002/ejhf.1828. ISSN 1388-9842.

[SiddiqiMehra2020-5] Siddiqi, Hasan K.; Mehra, Mandeep R. (2020). "COVID-19 illness in native and immunosuppressed states: A clinical–therapeutic staging proposal". The Journal of Heart and Lung Transplantation. 39 (5): 405–407. doi:10.1016/j.healun.2020.03.012. ISSN 1053-2498.

[YeWang2020-6] Ye, Qing; Wang, Bili; Mao, Jianhua (2020). "The pathogenesis and treatment of the `Cytokine Storm' in COVID-19". Journal of Infection. 80 (6): 607–613. doi:10.1016/j.jinf.2020.03.037. ISSN 0163-4453.

[MahajanChandra2020-7] Mahajan, Kunal; Chandra, K.Sarat (2020). "Cardiovascular comorbidities and complications associated with coronavirus disease 2019". Medical Journal Armed Forces India. doi:10.1016/j.mjafi.2020.05.004. ISSN 0377-1237.

[BelhadjerMéot2020-8] Belhadjer, Zahra; Méot, Mathilde; Bajolle, Fanny; Khraiche, Diala; Legendre, Antoine; Abakka, Samya; Auriau, Johanne; Grimaud, Marion; Oualha, Mehdi; Beghetti, Maurice; Wacker, Julie; Ovaert, Caroline; Hascoet, Sebastien; Selegny, Maëlle; Malekzadeh-Milani, Sophie; Maltret, Alice; Bosser, Gilles; Giroux, Nathan; Bonnemains, Laurent; Bordet, Jeanne; Di Filippo, Sylvie; Mauran, Pierre; Falcon-Eicher, Sylvie; Thambo, Jean-Benoît; Lefort, Bruno; Moceri, Pamela; Houyel, Lucile; Renolleau, Sylvain; Bonnet, Damien (2020). "Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic". Circulation. doi:10.1161/CIRCULATIONAHA.120.048360. ISSN 0009-7322.

[BoukhrisHillani2020-9] Boukhris, Marouane; Hillani, Ali; Moroni, Francesco; Annabi, Mohamed Salah; Addad, Faouzi; Ribeiro, Marcelo Harada; Mansour, Samer; Zhao, Xiaohui; Ybarra, Luiz Fernando; Abbate, Antonio; Vilca, Luz Maria; Azzalini, Lorenzo (2020). "Cardiovascular Implications of the COVID-19 Pandemic: A Global Perspective". Canadian Journal of Cardiology. doi:10.1016/j.cjca.2020.05.018. ISSN 0828-282X.

[RajagopalKeller2020-10] Rajagopal, Keshava; Keller, Steven P.; Akkanti, Bindu; Bime, Christian; Loyalka, Pranav; Cheema, Faisal H.; Zwischenberger, Joseph B.; El Banayosy, Aly; Pappalardo, Federico; Slaughter, Mark S.; Slepian, Marvin J. (2020). "Advanced Pulmonary and Cardiac Support of COVID-19 Patients". Circulation: Heart Failure. 13 (5). doi:10.1161/CIRCHEARTFAILURE.120.007175. ISSN 1941-3289.

[11] Jameson, J (2018). Harrison's principles of internal medicine. New York: McGraw-Hill Education. ISBN 1259644030.

[pmid32191259-12] Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M; et al. (2020). "Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State". JAMA. doi:10.1001/jama.2020.4326. PMC 7082763 Check |pmc= value (help). PMID 32191259 Check |pmid= value (help).

[Sánchez-RecaldeSolano-López2020-13] 13.0 ^13.1 Sánchez-Recalde, Ángel; Solano-López, Jorge; Miguelena-Hycka, Javier; Martín-Pinacho, Jesús Javier; Sanmartín, Marcelo; Zamorano, José L. (2020). "COVID-19 and cardiogenic shock. Different cardiovascular presentations with high mortality". Revista Española de Cardiología (English Edition). doi:10.1016/j.rec.2020.04.012. ISSN 1885-5857.

[pmid32105632-14] 14.0 ^14.1 Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H; et al. (2020). "Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study". Lancet Respir Med. 8 (5): 475–481. doi:10.1016/S2213-2600(20)30079-5. PMC 7102538 Check |pmc= value (help). PMID 32105632 Check |pmid= value (help).

[DhakalSweitzer2020-15] 15.0 ^15.1 Dhakal, Bishnu P.; Sweitzer, Nancy K.; Indik, Julia H.; Acharya, Deepak; William, Preethi (2020). "SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart". Heart, Lung and Circulation. doi:10.1016/j.hlc.2020.05.101. ISSN 1443-9506.

[16] Tse, FirstName (2011). Oxford Desk Reference : Cardiology. Oxford: OUP Oxford. ISBN 978-0-19-956809-3.

[LalHayward2020-17] 17.0 ^17.1 Lal, Sean; Hayward, Christopher S.; De Pasquale, Carmine; Kaye, David; Javorsky, George; Bergin, Peter; Atherton, John J.; Ilton, Marcus K.; Weintraub, Robert G.; Nair, Priya; Rudas, Mate; Dembo, Lawrence; Doughty, Robert N.; Kumarasinghe, Gayathri; Juergens, Craig; Bannon, Paul G.; Bart, Nicole K.; Chow, Clara K.; Lattimore, Jo-Dee; Kritharides, Leonard; Totaro, Richard; Macdonald, Peter S. (2020). "COVID-19 and Acute Heart Failure: Screening the Critically Ill – A Position Statement of the Cardiac Society of Australia and New Zealand (CSANZ)". Heart, Lung and Circulation. doi:10.1016/j.hlc.2020.04.005. ISSN 1443-9506.

[AboughdirKirwin2020-18] Aboughdir, Maryam; Kirwin, Thomas; Abdul Khader, Ashiq; Wang, Brian (2020). "Prognostic Value of Cardiovascular Biomarkers in COVID-19: A Review". Viruses. 12 (5): 527. doi:10.3390/v12050527. ISSN 1999-4915.

[19] Tse, FirstName (2011). Oxford Desk Reference : Cardiology. Oxford: OUP Oxford. ISBN 978-0-19-956809-3.

[DrigginMadhavan2020-20] 20.0 ^20.1 Driggin, Elissa; Madhavan, Mahesh V.; Bikdeli, Behnood; Chuich, Taylor; Laracy, Justin; Biondi-Zoccai, Giuseppe; Brown, Tyler S.; Der Nigoghossian, Caroline; Zidar, David A.; Haythe, Jennifer; Brodie, Daniel; Beckman, Joshua A.; Kirtane, Ajay J.; Stone, Gregg W.; Krumholz, Harlan M.; Parikh, Sahil A. (2020). "Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic". Journal of the American College of Cardiology. 75 (18): 2352–2371. doi:10.1016/j.jacc.2020.03.031. ISSN 0735-1097.

[pmid32601020-21] 21.0 ^21.1 Dhakal BP, Sweitzer NK, Indik JH, Acharya D, William P (2020). "SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart". Heart Lung Circ. doi:10.1016/j.hlc.2020.05.101. PMC 7274628 Check |pmc= value (help). PMID 32601020 Check |pmid= value (help).

[MacLarenFisher2020-22] MacLaren, Graeme; Fisher, Dale; Brodie, Daniel (2020). "Preparing for the Most Critically Ill Patients With COVID-19". JAMA. 323 (13): 1245. doi:10.1001/jama.2020.2342. ISSN 0098-7484.

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 {{SK}}: Novel coronavirus, COVID-19, Wuhan coronavirus, coronavirus disease-19, coronavirus disease 2019, SARS-CoV-2, COVID-19, 2019-nCoV, 2019 novel coronavirus, cardiovascular finding in COVID-19, cardiogenic shock, COVID-19 associated cardiogenic shock
 ==Overview==
-In Italy, for the first time in a 69-year-old patient, who was presented with [[cardiogenic shock]] due to [[COVID-19]] infection [[myocardial]] involvement by viral particles was pathologically proved through [[biopsy]]. Two mechanisms are more probable to contribute to [[cardiogenic shock]] related to [[Covid-19]] that includes direct invasion and [[cytokine storm]]. According to a recent study, one-third of critically ill patients with COVID-19 of an ICU in Washington State had clinical signs of [[cardiogenic shock]] and [[cardiomyopathy]]. According to an observational study in China, [[COVID-19]] associated [[cardiogenic shock]] has a poor prognosis.
+The first confirmed instance of [[cardiogenic shock]] due to [[COVID-19]] infection through [[myocardial]] infection by viral particles was in a 69-year-old patient from Italy. This was confirmed via [[biopsy]]. Since then, the two most probable mechanisms of [[cardiogenic shock]] related to [[Covid-19|COVID-19]] are direct invasion and [[cytokine storm]]. According to a recent study out of an ICU in Washington state, one-third of critically ill patients with COVID-19 had clinical signs of [[cardiogenic shock]] and [[cardiomyopathy]]. According to another observational study in China, [[COVID-19]] associated [[cardiogenic shock]] has a poor prognosis.
 ==Historical Perspective==
-*In December 2019, a novel coronavirus named SARS-CoV-2 resulted in Coronavirus disease 2019, which caused respiratory disease outbreak identified firstly in Wuhan, China.<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/about/index.html|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref name="LuCui2020">{{cite journal|last1=Lu|first1=Jian|last2=Cui|first2=Jie|last3=Qian|first3=Zhaohui|last4=Wang|first4=Yirong|last5=Zhang|first5=Hong|last6=Duan|first6=Yuange|last7=Wu|first7=Xinkai|last8=Yao|first8=Xinmin|last9=Song|first9=Yuhe|last10=Li|first10=Xiang|last11=Wu|first11=Changcheng|last12=Tang|first12=Xiaolu|title=On the origin and continuing evolution of SARS-CoV-2|journal=National Science Review|year=2020|issn=2095-5138|doi=10.1093/nsr/nwaa036}}</ref>
+*The [[novel coronavirus]], [[SARS-CoV-2]], is identified as the cause of an outbreak of [[respiratory illness]] first detected in Wuhan, China in late December 2019. It was named [[SARS-CoV-2]] for its similarity [[severe acute respiratory syndrome]] related [[coronaviruses]] such as [[SARS-CoV]], which caused [[acute respiratory distress syndrome]] ([[ARDS]]) in 2002–2003. <ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/about/index.html|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref name="LuCui2020">{{cite journal|last1=Lu|first1=Jian|last2=Cui|first2=Jie|last3=Qian|first3=Zhaohui|last4=Wang|first4=Yirong|last5=Zhang|first5=Hong|last6=Duan|first6=Yuange|last7=Wu|first7=Xinkai|last8=Yao|first8=Xinmin|last9=Song|first9=Yuhe|last10=Li|first10=Xiang|last11=Wu|first11=Changcheng|last12=Tang|first12=Xiaolu|title=On the origin and continuing evolution of SARS-CoV-2|journal=National Science Review|year=2020|issn=2095-5138|doi=10.1093/nsr/nwaa036}}</ref>
-*On March 12, 2020, the WHO declared coronavirus disease 2019(COVID-19) outbreak to be a pandemic.<ref name="urlCoronavirus (COVID-19) events as they happen">{{cite web |url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen |title=Coronavirus (COVID-19) events as they happen |format= |work= |accessdate=}}</ref>
+*On March 12, 2020, the WHO declared the Coronavirus disease 2019 (COVID-19) outbreak to be a pandemic.<ref name="urlCoronavirus (COVID-19) events as they happen">{{cite web |url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen |title=Coronavirus (COVID-19) events as they happen |format= |work= |accessdate=}}</ref>
-*In Italy, for the first time in a 69-year-old patient, who was presented with [[cardiogenic shock]] due to [[COVID-19]] infection, [[myocardial]] involvement by viral particles was pathologically proved through [[biopsy]]. <ref name="TavazziPellegrini2020">{{cite journal|last1=Tavazzi|first1=Guido|last2=Pellegrini|first2=Carlo|last3=Maurelli|first3=Marco|last4=Belliato|first4=Mirko|last5=Sciutti|first5=Fabio|last6=Bottazzi|first6=Andrea|last7=Sepe|first7=Paola Alessandra|last8=Resasco|first8=Tullia|last9=Camporotondo|first9=Rita|last10=Bruno|first10=Raffaele|last11=Baldanti|first11=Fausto|last12=Paolucci|first12=Stefania|last13=Pelenghi|first13=Stefano|last14=Iotti|first14=Giorgio Antonio|last15=Mojoli|first15=Francesco|last16=Arbustini|first16=Eloisa|title=Myocardial localization of coronavirus in COVID‐19 cardiogenic shock|journal=European Journal of Heart Failure|volume=22|issue=5|year=2020|pages=911–915|issn=1388-9842|doi=10.1002/ejhf.1828}}</ref>
+*The first confirmed instance of [[cardiogenic shock]] due to [[COVID-19]] infection through [[myocardial]] infection by viral particles was in a 69-year-old patient from Italy. This was confirmed via [[biopsy]]. <ref name="TavazziPellegrini2020">{{cite journal|last1=Tavazzi|first1=Guido|last2=Pellegrini|first2=Carlo|last3=Maurelli|first3=Marco|last4=Belliato|first4=Mirko|last5=Sciutti|first5=Fabio|last6=Bottazzi|first6=Andrea|last7=Sepe|first7=Paola Alessandra|last8=Resasco|first8=Tullia|last9=Camporotondo|first9=Rita|last10=Bruno|first10=Raffaele|last11=Baldanti|first11=Fausto|last12=Paolucci|first12=Stefania|last13=Pelenghi|first13=Stefano|last14=Iotti|first14=Giorgio Antonio|last15=Mojoli|first15=Francesco|last16=Arbustini|first16=Eloisa|title=Myocardial localization of coronavirus in COVID‐19 cardiogenic shock|journal=European Journal of Heart Failure|volume=22|issue=5|year=2020|pages=911–915|issn=1388-9842|doi=10.1002/ejhf.1828}}</ref>
-*To view the historical perspective of COVID-19, [[COVID-19 historical perspective|click here]].
+To view the historical perspective of COVID-19, [[COVID-19 historical perspective|click here]].
 ==Classification==
@@ Line 22: / Line 24: @@
 ==Pathophysiology==
-Two mechanisms are more probable to contribute to [[cardiogenic shock]] related to [[Covid-19|Covid-19:]]<ref name="SiddiqiMehra2020">{{cite journal|last1=Siddiqi|first1=Hasan K.|last2=Mehra|first2=Mandeep R.|title=COVID-19 illness in native and immunosuppressed states: A clinical–therapeutic staging proposal|journal=The Journal of Heart and Lung Transplantation|volume=39|issue=5|year=2020|pages=405–407|issn=10532498|doi=10.1016/j.healun.2020.03.012}}</ref> <ref name="YeWang2020">{{cite journal|last1=Ye|first1=Qing|last2=Wang|first2=Bili|last3=Mao|first3=Jianhua|title=The pathogenesis and treatment of the `Cytokine Storm' in COVID-19|journal=Journal of Infection|volume=80|issue=6|year=2020|pages=607–613|issn=01634453|doi=10.1016/j.jinf.2020.03.037}}</ref>
+The two most likely mechanisms that contribute to [[Covid-19|COVID-19]] [[cardiogenic shock]] are: <ref name="SiddiqiMehra2020">{{cite journal|last1=Siddiqi|first1=Hasan K.|last2=Mehra|first2=Mandeep R.|title=COVID-19 illness in native and immunosuppressed states: A clinical–therapeutic staging proposal|journal=The Journal of Heart and Lung Transplantation|volume=39|issue=5|year=2020|pages=405–407|issn=10532498|doi=10.1016/j.healun.2020.03.012}}</ref> <ref name="YeWang2020">{{cite journal|last1=Ye|first1=Qing|last2=Wang|first2=Bili|last3=Mao|first3=Jianhua|title=The pathogenesis and treatment of the `Cytokine Storm' in COVID-19|journal=Journal of Infection|volume=80|issue=6|year=2020|pages=607–613|issn=01634453|doi=10.1016/j.jinf.2020.03.037}}</ref>
 * Direct invasion of the virus into the [[cardiomyocytes]]
-* [[Cytokine storm]] activated by [[T helper cells]] ([[Th1]] and [[Th2]]) and trigger a systemic hyperinflammatory response
+* [[Cytokine storm]] activated by [[T helper cells]] ([[Th1]] and [[Th2]]) that triggers a systemic hyperinflammatory response
 ==Causes==
-The causes of [[cardiogenic shock]] related to [[COVID-19]] might include: <ref name="MahajanChandra2020">{{cite journal|last1=Mahajan|first1=Kunal|last2=Chandra|first2=K.Sarat|title=Cardiovascular comorbidities and complications associated with coronavirus disease 2019|journal=Medical Journal Armed Forces India|year=2020|issn=03771237|doi=10.1016/j.mjafi.2020.05.004}}</ref> <ref name="BelhadjerMéot2020">{{cite journal|last1=Belhadjer|first1=Zahra|last2=Méot|first2=Mathilde|last3=Bajolle|first3=Fanny|last4=Khraiche|first4=Diala|last5=Legendre|first5=Antoine|last6=Abakka|first6=Samya|last7=Auriau|first7=Johanne|last8=Grimaud|first8=Marion|last9=Oualha|first9=Mehdi|last10=Beghetti|first10=Maurice|last11=Wacker|first11=Julie|last12=Ovaert|first12=Caroline|last13=Hascoet|first13=Sebastien|last14=Selegny|first14=Maëlle|last15=Malekzadeh-Milani|first15=Sophie|last16=Maltret|first16=Alice|last17=Bosser|first17=Gilles|last18=Giroux|first18=Nathan|last19=Bonnemains|first19=Laurent|last20=Bordet|first20=Jeanne|last21=Di Filippo|first21=Sylvie|last22=Mauran|first22=Pierre|last23=Falcon-Eicher|first23=Sylvie|last24=Thambo|first24=Jean-Benoît|last25=Lefort|first25=Bruno|last26=Moceri|first26=Pamela|last27=Houyel|first27=Lucile|last28=Renolleau|first28=Sylvain|last29=Bonnet|first29=Damien|title=Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic|journal=Circulation|year=2020|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.120.048360}}</ref>
+The causes of [[cardiogenic shock]] related to [[COVID-19]] may include: <ref name="MahajanChandra2020">{{cite journal|last1=Mahajan|first1=Kunal|last2=Chandra|first2=K.Sarat|title=Cardiovascular comorbidities and complications associated with coronavirus disease 2019|journal=Medical Journal Armed Forces India|year=2020|issn=03771237|doi=10.1016/j.mjafi.2020.05.004}}</ref> <ref name="BelhadjerMéot2020">{{cite journal|last1=Belhadjer|first1=Zahra|last2=Méot|first2=Mathilde|last3=Bajolle|first3=Fanny|last4=Khraiche|first4=Diala|last5=Legendre|first5=Antoine|last6=Abakka|first6=Samya|last7=Auriau|first7=Johanne|last8=Grimaud|first8=Marion|last9=Oualha|first9=Mehdi|last10=Beghetti|first10=Maurice|last11=Wacker|first11=Julie|last12=Ovaert|first12=Caroline|last13=Hascoet|first13=Sebastien|last14=Selegny|first14=Maëlle|last15=Malekzadeh-Milani|first15=Sophie|last16=Maltret|first16=Alice|last17=Bosser|first17=Gilles|last18=Giroux|first18=Nathan|last19=Bonnemains|first19=Laurent|last20=Bordet|first20=Jeanne|last21=Di Filippo|first21=Sylvie|last22=Mauran|first22=Pierre|last23=Falcon-Eicher|first23=Sylvie|last24=Thambo|first24=Jean-Benoît|last25=Lefort|first25=Bruno|last26=Moceri|first26=Pamela|last27=Houyel|first27=Lucile|last28=Renolleau|first28=Sylvain|last29=Bonnet|first29=Damien|title=Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic|journal=Circulation|year=2020|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.120.048360}}</ref>
 * Newly emerging COVID-19 associated [[myocarditis]], [[cardiac arrhythmias]], [[cardiomyopathy]], or an [[acute coronary syndrome]] deteriorated into [[cardiogenic shock]]
@@ Line 74: / Line 76: @@
 ==Epidemiology and Demographics==
-*According to a recent study, one-third of critically ill patients with COVID-19 of an ICU in Washington State had clinical signs of [[cardiogenic shock]] and [[cardiomyopathy]].<ref name="pmid32191259">{{cite journal| author=Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M | display-authors=etal| title=Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. | journal=JAMA | year= 2020 | volume=  | issue=  | pages=  | pmid=32191259 | doi=10.1001/jama.2020.4326 | pmc=7082763 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32191259  }} </ref> There are few anecdotal reports of [[cardiogenic shock]] related to [[COVID-19]]. <ref name="TavazziPellegrini2020">{{cite journal|last1=Tavazzi|first1=Guido|last2=Pellegrini|first2=Carlo|last3=Maurelli|first3=Marco|last4=Belliato|first4=Mirko|last5=Sciutti|first5=Fabio|last6=Bottazzi|first6=Andrea|last7=Sepe|first7=Paola Alessandra|last8=Resasco|first8=Tullia|last9=Camporotondo|first9=Rita|last10=Bruno|first10=Raffaele|last11=Baldanti|first11=Fausto|last12=Paolucci|first12=Stefania|last13=Pelenghi|first13=Stefano|last14=Iotti|first14=Giorgio Antonio|last15=Mojoli|first15=Francesco|last16=Arbustini|first16=Eloisa|title=Myocardial localization of coronavirus in COVID‐19 cardiogenic shock|journal=European Journal of Heart Failure|volume=22|issue=5|year=2020|pages=911–915|issn=1388-9842|doi=10.1002/ejhf.1828}}</ref> <ref name="Sánchez-RecaldeSolano-López2020">{{cite journal|last1=Sánchez-Recalde|first1=Ángel|last2=Solano-López|first2=Jorge|last3=Miguelena-Hycka|first3=Javier|last4=Martín-Pinacho|first4=Jesús Javier|last5=Sanmartín|first5=Marcelo|last6=Zamorano|first6=José L.|title=COVID-19 and cardiogenic shock. Different cardiovascular presentations with high mortality|journal=Revista Española de Cardiología (English Edition)|year=2020|issn=18855857|doi=10.1016/j.rec.2020.04.012}}</ref>
+*According to a recent study out of an ICU in Washington state, one-third of critically ill patients with COVID-19 had clinical signs of [[cardiogenic shock]] and [[cardiomyopathy]].<ref name="pmid32191259">{{cite journal| author=Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M | display-authors=etal| title=Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. | journal=JAMA | year= 2020 | volume=  | issue=  | pages=  | pmid=32191259 | doi=10.1001/jama.2020.4326 | pmc=7082763 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32191259  }} </ref> There are few anecdotal reports of [[cardiogenic shock]] related to [[COVID-19]]. <ref name="TavazziPellegrini2020">{{cite journal|last1=Tavazzi|first1=Guido|last2=Pellegrini|first2=Carlo|last3=Maurelli|first3=Marco|last4=Belliato|first4=Mirko|last5=Sciutti|first5=Fabio|last6=Bottazzi|first6=Andrea|last7=Sepe|first7=Paola Alessandra|last8=Resasco|first8=Tullia|last9=Camporotondo|first9=Rita|last10=Bruno|first10=Raffaele|last11=Baldanti|first11=Fausto|last12=Paolucci|first12=Stefania|last13=Pelenghi|first13=Stefano|last14=Iotti|first14=Giorgio Antonio|last15=Mojoli|first15=Francesco|last16=Arbustini|first16=Eloisa|title=Myocardial localization of coronavirus in COVID‐19 cardiogenic shock|journal=European Journal of Heart Failure|volume=22|issue=5|year=2020|pages=911–915|issn=1388-9842|doi=10.1002/ejhf.1828}}</ref> <ref name="Sánchez-RecaldeSolano-López2020">{{cite journal|last1=Sánchez-Recalde|first1=Ángel|last2=Solano-López|first2=Jorge|last3=Miguelena-Hycka|first3=Javier|last4=Martín-Pinacho|first4=Jesús Javier|last5=Sanmartín|first5=Marcelo|last6=Zamorano|first6=José L.|title=COVID-19 and cardiogenic shock. Different cardiovascular presentations with high mortality|journal=Revista Española de Cardiología (English Edition)|year=2020|issn=18855857|doi=10.1016/j.rec.2020.04.012}}</ref>
 ===Age===
@@ Line 103: / Line 105: @@
 ===Diagnostic Study of Choice===
-* The diagnosis of [[cardiogenic shock]] related to [[COVID-19]] is made when Systolic [[Blood Pressure]] is lower than 90 mmHg for more than 15 minutes with impaired organ perfusion while [[Urine output]] is less than 30 m/hr in a patient with [[COVID-19]] disease.<ref name="DhakalSweitzer2020">{{cite journal|last1=Dhakal|first1=Bishnu P.|last2=Sweitzer|first2=Nancy K.|last3=Indik|first3=Julia H.|last4=Acharya|first4=Deepak|last5=William|first5=Preethi|title=SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart|journal=Heart, Lung and Circulation|year=2020|issn=14439506|doi=10.1016/j.hlc.2020.05.101}}</ref>
+* A diagnosis of [[cardiogenic shock]] related to [[COVID-19]] can be made when Systolic [[Blood Pressure]] is lower than 90 mmHg for more than 15 minutes with impaired organ perfusion while [[Urine output]] is less than 30 m/hr in a patient with [[COVID-19]] disease.<ref name="DhakalSweitzer2020">{{cite journal|last1=Dhakal|first1=Bishnu P.|last2=Sweitzer|first2=Nancy K.|last3=Indik|first3=Julia H.|last4=Acharya|first4=Deepak|last5=William|first5=Preethi|title=SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart|journal=Heart, Lung and Circulation|year=2020|issn=14439506|doi=10.1016/j.hlc.2020.05.101}}</ref>
-* To view cardiogenic shock diagnostic criteria, [[cardiogenic shock diagnostic criteria|click here]].
+To view cardiogenic shock diagnostic criteria, [[cardiogenic shock diagnostic criteria|click here]].
 ===History and Symptoms:===
-* The history of patients presented [[cardiogenic shock]] related to [[COVID-19]], according to a few anecdotal reports were different. Some did not have any [[cardiovascular]] risk factors.
+* According to anecdotal reports, some patients that have presented with [[COVID-19]] related [[cardiogenic shock]] did not have any [[cardiovascular]] risk factors.
-* A 69-year-old patient from Italy has been reported by Tavazzi et al., as a cardiogenic shock-associated COVID-19 case.
+* A 69-year-old patient from Italy has been reported by Tavazzi et al., as a COVID-19-associated cardiogenic shock case.
-* The patient had flu-like symptoms when he was hospitalized and quickly deteriorated into [[respiratory distress]] and [[cardiogenic shock]]. <ref name="TavazziPellegrini2020">{{cite journal|last1=Tavazzi|first1=Guido|last2=Pellegrini|first2=Carlo|last3=Maurelli|first3=Marco|last4=Belliato|first4=Mirko|last5=Sciutti|first5=Fabio|last6=Bottazzi|first6=Andrea|last7=Sepe|first7=Paola Alessandra|last8=Resasco|first8=Tullia|last9=Camporotondo|first9=Rita|last10=Bruno|first10=Raffaele|last11=Baldanti|first11=Fausto|last12=Paolucci|first12=Stefania|last13=Pelenghi|first13=Stefano|last14=Iotti|first14=Giorgio Antonio|last15=Mojoli|first15=Francesco|last16=Arbustini|first16=Eloisa|title=Myocardial localization of coronavirus in COVID‐19 cardiogenic shock|journal=European Journal of Heart Failure|volume=22|issue=5|year=2020|pages=911–915|issn=1388-9842|doi=10.1002/ejhf.1828}}</ref>
+** This patient had flu-like symptoms when hospitalized and quickly deteriorated into [[respiratory distress]] and [[cardiogenic shock]]. <ref name="TavazziPellegrini2020">{{cite journal|last1=Tavazzi|first1=Guido|last2=Pellegrini|first2=Carlo|last3=Maurelli|first3=Marco|last4=Belliato|first4=Mirko|last5=Sciutti|first5=Fabio|last6=Bottazzi|first6=Andrea|last7=Sepe|first7=Paola Alessandra|last8=Resasco|first8=Tullia|last9=Camporotondo|first9=Rita|last10=Bruno|first10=Raffaele|last11=Baldanti|first11=Fausto|last12=Paolucci|first12=Stefania|last13=Pelenghi|first13=Stefano|last14=Iotti|first14=Giorgio Antonio|last15=Mojoli|first15=Francesco|last16=Arbustini|first16=Eloisa|title=Myocardial localization of coronavirus in COVID‐19 cardiogenic shock|journal=European Journal of Heart Failure|volume=22|issue=5|year=2020|pages=911–915|issn=1388-9842|doi=10.1002/ejhf.1828}}</ref>
 * Four patients with [[cardiogenic shock]] complication related to [[COVID-19]] were reported by Sanchez-Recalde, et al.
-* They were hospitalized between 1 March and 15 April 2020 including:<ref name="Sánchez-RecaldeSolano-López2020">{{cite journal|last1=Sánchez-Recalde|first1=Ángel|last2=Solano-López|first2=Jorge|last3=Miguelena-Hycka|first3=Javier|last4=Martín-Pinacho|first4=Jesús Javier|last5=Sanmartín|first5=Marcelo|last6=Zamorano|first6=José L.|title=COVID-19 and cardiogenic shock. Different cardiovascular presentations with high mortality|journal=Revista Española de Cardiología (English Edition)|year=2020|issn=18855857|doi=10.1016/j.rec.2020.04.012}}</ref>
+** These patients were hospitalized between March 1, 2020 and April 15, 2020 and included:<ref name="Sánchez-RecaldeSolano-López2020">{{cite journal|last1=Sánchez-Recalde|first1=Ángel|last2=Solano-López|first2=Jorge|last3=Miguelena-Hycka|first3=Javier|last4=Martín-Pinacho|first4=Jesús Javier|last5=Sanmartín|first5=Marcelo|last6=Zamorano|first6=José L.|title=COVID-19 and cardiogenic shock. Different cardiovascular presentations with high mortality|journal=Revista Española de Cardiología (English Edition)|year=2020|issn=18855857|doi=10.1016/j.rec.2020.04.012}}</ref>
+***A 42-year-old woman, who had [[dyslipidemia]] as a [[cardiovascular]] risk factor
-* A 42-year-old woman, who had [[dyslipidemia]] as a [[cardiovascular]] risk factor
+***A 50-year-old man, without any [[cardiovascular]] risk factors, admitted with severe bilateral [[pneumonia]] related to COVID-19. After a few hours, he developed [[cardiogenic shock]]
-* A 50-year-old man, without any [[cardiovascular]] risk factors, admitted by severe bilateral [[pneumonia]] related to COVID-19. After a few hours, he developed [[cardiogenic shock]].
+***A 75-year-old man who did not have any [[cardiovascular]] risk factors and was admitted due to [[dyspnea]], [[chest pain]], and bilateral [[COVID-19]] [[pneumonia]]
-* A 75-year-old man did not have any [[cardiovascular]] risk factors and was admitted due to [[dyspnea]], [[chest pain]], and bilateral [[SARS-CoV-2]] [[pneumonia]].
+***A 37-year-old woman, with a history of obesity and [[deep venous thrombosis]], and had symptoms of [[dyspnea]] and chest pain
-* A 37-year-old woman, obese with a history of [[deep venous thrombosis]], had symptoms of [[dyspnea]] and chest pain
 === Physical Examination ===
-Physical examination may be remarkable for [[Covid-19 associated cardiogenic shock]]:<ref>{{cite book | last = Tse | first = FirstName | title = Oxford Desk Reference : Cardiology | publisher = OUP Oxford | location = Oxford | year = 2011 | isbn = 978-0-19-956809-3 }} </ref>
+Physical examination findings that may be of note for the diagnosis of [[Covid-19 associated cardiogenic shock]] include:<ref>{{cite book | last = Tse | first = FirstName | title = Oxford Desk Reference : Cardiology | publisher = OUP Oxford | location = Oxford | year = 2011 | isbn = 978-0-19-956809-3 }} </ref>
 :*Assessment of consciousness level
 :*Extremities, whether they are warm or cool, is helpful for evaluation of [[cardiogenic shock]]
@@ Line 131: / Line 134: @@
 === Laboratory Findings ===
-*In [[COVID-19]] patients, it is essential to differentiate the shock types. Two tests are more valuable to clarify this, which are elevated in [[cardiogenic shock]] related to [[COVID-19]] : <ref name="LalHayward2020">{{cite journal|last1=Lal|first1=Sean|last2=Hayward|first2=Christopher S.|last3=De Pasquale|first3=Carmine|last4=Kaye|first4=David|last5=Javorsky|first5=George|last6=Bergin|first6=Peter|last7=Atherton|first7=John J.|last8=Ilton|first8=Marcus K.|last9=Weintraub|first9=Robert G.|last10=Nair|first10=Priya|last11=Rudas|first11=Mate|last12=Dembo|first12=Lawrence|last13=Doughty|first13=Robert N.|last14=Kumarasinghe|first14=Gayathri|last15=Juergens|first15=Craig|last16=Bannon|first16=Paul G.|last17=Bart|first17=Nicole K.|last18=Chow|first18=Clara K.|last19=Lattimore|first19=Jo-Dee|last20=Kritharides|first20=Leonard|last21=Totaro|first21=Richard|last22=Macdonald|first22=Peter S.|title=COVID-19 and Acute Heart Failure: Screening the Critically Ill – A Position Statement of the Cardiac Society of Australia and New Zealand (CSANZ)|journal=Heart, Lung and Circulation|year=2020|issn=14439506|doi=10.1016/j.hlc.2020.04.005}}</ref>
+*In [[COVID-19]] patients, it is essential to differentiate the type of shock. Two tests are best able to clarify this, and result in higher levels in patients with [[cardiogenic shock]] related to [[COVID-19]]. These tests are: <ref name="LalHayward2020">{{cite journal|last1=Lal|first1=Sean|last2=Hayward|first2=Christopher S.|last3=De Pasquale|first3=Carmine|last4=Kaye|first4=David|last5=Javorsky|first5=George|last6=Bergin|first6=Peter|last7=Atherton|first7=John J.|last8=Ilton|first8=Marcus K.|last9=Weintraub|first9=Robert G.|last10=Nair|first10=Priya|last11=Rudas|first11=Mate|last12=Dembo|first12=Lawrence|last13=Doughty|first13=Robert N.|last14=Kumarasinghe|first14=Gayathri|last15=Juergens|first15=Craig|last16=Bannon|first16=Paul G.|last17=Bart|first17=Nicole K.|last18=Chow|first18=Clara K.|last19=Lattimore|first19=Jo-Dee|last20=Kritharides|first20=Leonard|last21=Totaro|first21=Richard|last22=Macdonald|first22=Peter S.|title=COVID-19 and Acute Heart Failure: Screening the Critically Ill – A Position Statement of the Cardiac Society of Australia and New Zealand (CSANZ)|journal=Heart, Lung and Circulation|year=2020|issn=14439506|doi=10.1016/j.hlc.2020.04.005}}</ref>
 **serum [[brain natriuretic peptide]] ([[BNP]])
 **[[Troponin]]
-*The increase of some biomarkers demonstrates poor prognosis, increased mortality, and more severe symptoms in [[COVID-19]] patients:<ref name="AboughdirKirwin2020">{{cite journal|last1=Aboughdir|first1=Maryam|last2=Kirwin|first2=Thomas|last3=Abdul Khader|first3=Ashiq|last4=Wang|first4=Brian|title=Prognostic Value of Cardiovascular Biomarkers in COVID-19: A Review|journal=Viruses|volume=12|issue=5|year=2020|pages=527|issn=1999-4915|doi=10.3390/v12050527}}</ref>
+*In addition, the increase of some biomarkers demonstrates poor prognosis, increased mortality, and more severe symptoms in [[COVID-19]] patients:<ref name="AboughdirKirwin2020">{{cite journal|last1=Aboughdir|first1=Maryam|last2=Kirwin|first2=Thomas|last3=Abdul Khader|first3=Ashiq|last4=Wang|first4=Brian|title=Prognostic Value of Cardiovascular Biomarkers in COVID-19: A Review|journal=Viruses|volume=12|issue=5|year=2020|pages=527|issn=1999-4915|doi=10.3390/v12050527}}</ref>
 **[[cTnT]] and [[cTnI]] levels
 **The association of elevated [[CK-MB]] and [[BNP]]
@@ Line 145: / Line 148: @@
 === X-ray ===
-*In a patient with [[COVID-19]]-associated [[cardiogenic shock]], [[CXR]] could manifest coexisting acute respiratory illness and also cardiogenic [[pulmonary edema]]. Observing some findings, such as [[cardiomegaly]] and increased vascular markings, can suggest preexisting [[heart failure]]. <ref name="DrigginMadhavan2020">{{cite journal|last1=Driggin|first1=Elissa|last2=Madhavan|first2=Mahesh V.|last3=Bikdeli|first3=Behnood|last4=Chuich|first4=Taylor|last5=Laracy|first5=Justin|last6=Biondi-Zoccai|first6=Giuseppe|last7=Brown|first7=Tyler S.|last8=Der Nigoghossian|first8=Caroline|last9=Zidar|first9=David A.|last10=Haythe|first10=Jennifer|last11=Brodie|first11=Daniel|last12=Beckman|first12=Joshua A.|last13=Kirtane|first13=Ajay J.|last14=Stone|first14=Gregg W.|last15=Krumholz|first15=Harlan M.|last16=Parikh|first16=Sahil A.|title=Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic|journal=Journal of the American College of Cardiology|volume=75|issue=18|year=2020|pages=2352–2371|issn=07351097|doi=10.1016/j.jacc.2020.03.031}}</ref>
+*In a patient with [[COVID-19]]-associated [[cardiogenic shock]], [[CXR]] could manifest coexisting acute respiratory illness and also cardiogenic [[pulmonary edema]]. Some findings, such as [[cardiomegaly]] and increased vascular markings, can suggest preexisting [[heart failure]]. <ref name="DrigginMadhavan2020">{{cite journal|last1=Driggin|first1=Elissa|last2=Madhavan|first2=Mahesh V.|last3=Bikdeli|first3=Behnood|last4=Chuich|first4=Taylor|last5=Laracy|first5=Justin|last6=Biondi-Zoccai|first6=Giuseppe|last7=Brown|first7=Tyler S.|last8=Der Nigoghossian|first8=Caroline|last9=Zidar|first9=David A.|last10=Haythe|first10=Jennifer|last11=Brodie|first11=Daniel|last12=Beckman|first12=Joshua A.|last13=Kirtane|first13=Ajay J.|last14=Stone|first14=Gregg W.|last15=Krumholz|first15=Harlan M.|last16=Parikh|first16=Sahil A.|title=Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic|journal=Journal of the American College of Cardiology|volume=75|issue=18|year=2020|pages=2352–2371|issn=07351097|doi=10.1016/j.jacc.2020.03.031}}</ref>
 ===Echocardiography or Ultrasound===
-*[[Echocardiography]] is an appropriate way, in order to identify the extent of cardiac involvement in [[COVID-19]]-associated [[cardiogenic shock]] cases.<ref name="LalHayward2020">{{cite journal|last1=Lal|first1=Sean|last2=Hayward|first2=Christopher S.|last3=De Pasquale|first3=Carmine|last4=Kaye|first4=David|last5=Javorsky|first5=George|last6=Bergin|first6=Peter|last7=Atherton|first7=John J.|last8=Ilton|first8=Marcus K.|last9=Weintraub|first9=Robert G.|last10=Nair|first10=Priya|last11=Rudas|first11=Mate|last12=Dembo|first12=Lawrence|last13=Doughty|first13=Robert N.|last14=Kumarasinghe|first14=Gayathri|last15=Juergens|first15=Craig|last16=Bannon|first16=Paul G.|last17=Bart|first17=Nicole K.|last18=Chow|first18=Clara K.|last19=Lattimore|first19=Jo-Dee|last20=Kritharides|first20=Leonard|last21=Totaro|first21=Richard|last22=Macdonald|first22=Peter S.|title=COVID-19 and Acute Heart Failure: Screening the Critically Ill – A Position Statement of the Cardiac Society of Australia and New Zealand (CSANZ)|journal=Heart, Lung and Circulation|year=2020|issn=14439506|doi=10.1016/j.hlc.2020.04.005}}</ref>
+*[[Echocardiography]] is an appropriate way to identify the extent of cardiac involvement in [[COVID-19]]-associated [[cardiogenic shock]] cases.<ref name="LalHayward2020">{{cite journal|last1=Lal|first1=Sean|last2=Hayward|first2=Christopher S.|last3=De Pasquale|first3=Carmine|last4=Kaye|first4=David|last5=Javorsky|first5=George|last6=Bergin|first6=Peter|last7=Atherton|first7=John J.|last8=Ilton|first8=Marcus K.|last9=Weintraub|first9=Robert G.|last10=Nair|first10=Priya|last11=Rudas|first11=Mate|last12=Dembo|first12=Lawrence|last13=Doughty|first13=Robert N.|last14=Kumarasinghe|first14=Gayathri|last15=Juergens|first15=Craig|last16=Bannon|first16=Paul G.|last17=Bart|first17=Nicole K.|last18=Chow|first18=Clara K.|last19=Lattimore|first19=Jo-Dee|last20=Kritharides|first20=Leonard|last21=Totaro|first21=Richard|last22=Macdonald|first22=Peter S.|title=COVID-19 and Acute Heart Failure: Screening the Critically Ill – A Position Statement of the Cardiac Society of Australia and New Zealand (CSANZ)|journal=Heart, Lung and Circulation|year=2020|issn=14439506|doi=10.1016/j.hlc.2020.04.005}}</ref>
 ===CT scan===
-*Generally, the [[CT scan]] is  not suggested being a primary imaging study, for evaluating a case with [[cardiogenic shock]] related to [[COVID-19]]. However, it can be suggestive of a coexisting [[ARDS]] by demonstrating a ground-glass opacity.<ref name="DrigginMadhavan2020">{{cite journal|last1=Driggin|first1=Elissa|last2=Madhavan|first2=Mahesh V.|last3=Bikdeli|first3=Behnood|last4=Chuich|first4=Taylor|last5=Laracy|first5=Justin|last6=Biondi-Zoccai|first6=Giuseppe|last7=Brown|first7=Tyler S.|last8=Der Nigoghossian|first8=Caroline|last9=Zidar|first9=David A.|last10=Haythe|first10=Jennifer|last11=Brodie|first11=Daniel|last12=Beckman|first12=Joshua A.|last13=Kirtane|first13=Ajay J.|last14=Stone|first14=Gregg W.|last15=Krumholz|first15=Harlan M.|last16=Parikh|first16=Sahil A.|title=Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic|journal=Journal of the American College of Cardiology|volume=75|issue=18|year=2020|pages=2352–2371|issn=07351097|doi=10.1016/j.jacc.2020.03.031}}</ref>
+*Generally, a[[CT scan]] is not suggested as a primary imaging study for evaluating a case of [[cardiogenic shock]] related to [[COVID-19]]. However, it can useful for observing coexisting [[ARDS]] by demonstrating a ground-glass opacity.<ref name="DrigginMadhavan2020">{{cite journal|last1=Driggin|first1=Elissa|last2=Madhavan|first2=Mahesh V.|last3=Bikdeli|first3=Behnood|last4=Chuich|first4=Taylor|last5=Laracy|first5=Justin|last6=Biondi-Zoccai|first6=Giuseppe|last7=Brown|first7=Tyler S.|last8=Der Nigoghossian|first8=Caroline|last9=Zidar|first9=David A.|last10=Haythe|first10=Jennifer|last11=Brodie|first11=Daniel|last12=Beckman|first12=Joshua A.|last13=Kirtane|first13=Ajay J.|last14=Stone|first14=Gregg W.|last15=Krumholz|first15=Harlan M.|last16=Parikh|first16=Sahil A.|title=Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic|journal=Journal of the American College of Cardiology|volume=75|issue=18|year=2020|pages=2352–2371|issn=07351097|doi=10.1016/j.jacc.2020.03.031}}</ref>
-*To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].
+To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].
 ===MRI===
-*Routinely, in patients with [[COVID-19]]-associated [[cardiogenic shock]], Cardiac [[MRI]] for the assessment of preexisting disorders such as [[myocarditis]] should not be done.<ref name="pmid32601020">{{cite journal| author=Dhakal BP, Sweitzer NK, Indik JH, Acharya D, William P| title=SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart. | journal=Heart Lung Circ | year= 2020 | volume=  | issue=  | pages=  | pmid=32601020 | doi=10.1016/j.hlc.2020.05.101 | pmc=7274628 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32601020  }} </ref>
+*Generally, in patients with [[COVID-19]]-associated [[cardiogenic shock]], Cardiac [[MRI]] for the assessment of preexisting disorders such as [[myocarditis]] should not be done.<ref name="pmid32601020">{{cite journal| author=Dhakal BP, Sweitzer NK, Indik JH, Acharya D, William P| title=SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart. | journal=Heart Lung Circ | year= 2020 | volume=  | issue=  | pages=  | pmid=32601020 | doi=10.1016/j.hlc.2020.05.101 | pmc=7274628 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32601020  }} </ref>
-* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]].<br />
+To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]].<br />
 ===Other Imaging Findings===
@@ Line 170: / Line 177: @@
 * [[Fluid resuscitation]] (crystalloid IV fluids are more efficient than colloid solutions)
 * Administration of [[vasopressors]] and [[inotropes]] to stabilize [[shock]]
-* Assess other types of [[shock]] and mixed etiologies of [[shock]] if hemodynamics not refining, specifically, in patients with a previous [[cardiac abnormality]] <ref name="pmid32601020">{{cite journal| author=Dhakal BP, Sweitzer NK, Indik JH, Acharya D, William P| title=SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart. | journal=Heart Lung Circ | year= 2020 | volume=  | issue=  | pages=  | pmid=32601020 | doi=10.1016/j.hlc.2020.05.101 | pmc=7274628 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32601020  }} </ref>
+* Assess other types of [[shock]] and mixed etiologies of [[shock]] if hemodynamics not refining, specifically in patients with a previous [[cardiac abnormality]] <ref name="pmid32601020">{{cite journal| author=Dhakal BP, Sweitzer NK, Indik JH, Acharya D, William P| title=SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart. | journal=Heart Lung Circ | year= 2020 | volume=  | issue=  | pages=  | pmid=32601020 | doi=10.1016/j.hlc.2020.05.101 | pmc=7274628 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32601020  }} </ref>
 ===Mechanical Support:===
-*In treating patients with [[cardiogenic shock]] related to [[COVID-19]], the efficacy of [[extracorporeal membrane oxygenation]] ([[ECMO]]) is indistinct.
+*In treating patients with [[cardiogenic shock]] related to [[COVID-19]], the efficacy of [[extracorporeal membrane oxygenation]] ([[ECMO]]) is indistinct, however it may be used in the most critically ill and highly selective patients.
-*It might be used in most critically ill and highly selective patients.
+*Although specialists implicate [[ECMO]] and mechanical circulatory support devices in severe cased of [[COVID-19]] related [[cardiogenic shock]], the mortality rate if high in those patients who undergo this treatment.
-*Although specialists implicate [[ECMO]] and mechanical circulatory support devices in severe patients with [[cardiogenic shock]] related to [[COVID-19]], most of these cases die.
+*It has been reported in a case series from China, that most of these patients had a poor prognosis and did not survive despite implicating [[ECMO]]. <ref name="MacLarenFisher2020">{{cite journal|last1=MacLaren|first1=Graeme|last2=Fisher|first2=Dale|last3=Brodie|first3=Daniel|title=Preparing for the Most Critically Ill Patients With COVID-19|journal=JAMA|volume=323|issue=13|year=2020|pages=1245|issn=0098-7484|doi=10.1001/jama.2020.2342}}</ref> <ref name="pmid32105632">{{cite journal| author=Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H | display-authors=etal| title=Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. | journal=Lancet Respir Med | year= 2020 | volume= 8 | issue= 5 | pages= 475-481 | pmid=32105632 | doi=10.1016/S2213-2600(20)30079-5 | pmc=7102538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32105632  }} </ref>
-*It has been reported in a case series from China that most of these patients had a poor prognosis and did not survive despite implicating [[ECMO]]. <ref name="MacLarenFisher2020">{{cite journal|last1=MacLaren|first1=Graeme|last2=Fisher|first2=Dale|last3=Brodie|first3=Daniel|title=Preparing for the Most Critically Ill Patients With COVID-19|journal=JAMA|volume=323|issue=13|year=2020|pages=1245|issn=0098-7484|doi=10.1001/jama.2020.2342}}</ref> <ref name="pmid32105632">{{cite journal| author=Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H | display-authors=etal| title=Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. | journal=Lancet Respir Med | year= 2020 | volume= 8 | issue= 5 | pages= 475-481 | pmid=32105632 | doi=10.1016/S2213-2600(20)30079-5 | pmc=7102538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32105632  }} </ref>
 ===Surgery===
@@ Line 183: / Line 189: @@
 ===Primary Prevention ===
-*There are no established measures for the primery prevention of [[COVID-19]]-associated [[cardiogenic shock]].
+*There are no established measures for the primary prevention of [[COVID-19]]-associated [[cardiogenic shock]].
-*For primary preventive measures of [[COVID-19]], [[COVID-19 primary prevention|click here]].
+For primary preventive measures of [[COVID-19]], [[COVID-19 primary prevention|click here]].
 ===Secondary Prevention===
 *There are no established measures for the secondary prevention of [[COVID-19]]-associated [[myocarditis]].
-*For secondary preventive measures of [COVID-19], [[COVID-19 secondary prevention|click here]].
+For secondary preventive measures of [COVID-19], [[COVID-19 secondary prevention|click here]].
 ==References==