COVID-19-associated cardiogenic shock: Difference between revisions

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__NOTOC__
__NOTOC__
{{Main|COVID-19}}
{{SI}}
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]'''<br>
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]'''<br>
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]'''<br>
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]'''<br>
 
                                                               
{{COVID-19}}  
{{CMG}}; {{AE}}: {{Sara.Zand}} {{ABehjat}}
                                                                 
{{CMG}}; {{AE}}: {{ABehjat}}


{{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
{{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==
==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.
[[SARS-COV-2]] or [[COVID-19]] is a specific strain of [[coronavirus]] that is responsible for an ongoing global [[pandemic]]. [[COVID-19]] may lead to [[respiratory ]] disease and also multi-organ dysfunction including [[biventricular failure]] and profound [[ shock]] and life threatening [[cardiogenic shock]]. [[Cardiogenic shock ]] shoulb be considered  while [[cardiac ethiology]] is evident  in [[patients]] with persistent [[hypotesion]] despite fluide resuscitation in the presence of [[end organs dysfunction]]. [[Cardiogenic shock]] may present as a consequence of [[cytokine storm ]] pathway or direct invasion of [[cardiovascular system]] by [[virus]] via [[ACE2]] receptos on the cells. [[Cardiogenic shock]] may progress to develop quicky in [[covid-19]] [[patients]] and any delay for diagnosis and treatment of such [[patients]] will increase [[mortality rate]]. In mild or severe types of [[covid-19]] with sudden collapse of [[hemodynamic]], considering different causes of [[cardiogenic shock]] including [[fulminant myocarditis]], acute [[STEMI]], massive [[pulmonary thromboembolism]], [[stress cardiomyopathy]], are helpful to [[clinical]] approach and quickly initiation of treatment. [[Mortality rate]] of [[covid-19]] [[patients]] with [[cardiogenic shock]] among reported cases in literature was 75% despite use of [[pharmacological]] and [[mechanichal]] [[hemodynamic]] support.


==Historical Perspective==
==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==
==Classification==
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==Pathophysiology==
==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]]
* 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==
==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>
Common causes of [[cardiogenic shock]] in [[patients]] with [[covid-19]] include:<ref name="pmid32499016">{{cite journal |vauthors=Sánchez-Recalde Á, Solano-López J, Miguelena-Hycka J, Martín-Pinacho JJ, Sanmartín M, Zamorano JL |title=COVID-19 and cardiogenic shock. Different cardiovascular presentations with high mortality |journal=Rev Esp Cardiol (Engl Ed) |volume=73 |issue=8 |pages=669–672 |date=August 2020 |pmid=32499016 |pmc=7184000 |doi=10.1016/j.rec.2020.04.012 |url=}}</ref><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]]
* Acute [[myocarditis]]
*[[Acute coronary syndrome]]
* [[Stress cardiomyopathy]]
* [[Pulmonary thromboembolism]]
* Worsening of previous [[left ventricular failure]] due to [[COVID-19]]
* Worsening of previous [[left ventricular failure]] due to [[COVID-19]]
* [[COVID-19-associated multisystem inflammatory syndrome]]in children (MIS-C)
* [[COVID-19-associated multisystem inflammatory syndrome]]in children (MIS-C)
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[[Cardiogenic shock]] related to COVID-19 must be differentiated from other diseases which include: <ref name="BoukhrisHillani2020">{{cite journal|last1=Boukhris|first1=Marouane|last2=Hillani|first2=Ali|last3=Moroni|first3=Francesco|last4=Annabi|first4=Mohamed Salah|last5=Addad|first5=Faouzi|last6=Ribeiro|first6=Marcelo Harada|last7=Mansour|first7=Samer|last8=Zhao|first8=Xiaohui|last9=Ybarra|first9=Luiz Fernando|last10=Abbate|first10=Antonio|last11=Vilca|first11=Luz Maria|last12=Azzalini|first12=Lorenzo|title=Cardiovascular Implications of the COVID-19 Pandemic: A Global Perspective|journal=Canadian Journal of Cardiology|year=2020|issn=0828282X|doi=10.1016/j.cjca.2020.05.018}}</ref> <ref name="RajagopalKeller2020">{{cite journal|last1=Rajagopal|first1=Keshava|last2=Keller|first2=Steven P.|last3=Akkanti|first3=Bindu|last4=Bime|first4=Christian|last5=Loyalka|first5=Pranav|last6=Cheema|first6=Faisal H.|last7=Zwischenberger|first7=Joseph B.|last8=El Banayosy|first8=Aly|last9=Pappalardo|first9=Federico|last10=Slaughter|first10=Mark S.|last11=Slepian|first11=Marvin J.|title=Advanced Pulmonary and Cardiac Support of COVID-19 Patients|journal=Circulation: Heart Failure|volume=13|issue=5|year=2020|issn=1941-3289|doi=10.1161/CIRCHEARTFAILURE.120.007175}}</ref>  
[[Cardiogenic shock]] related to COVID-19 must be differentiated from other diseases which include: <ref name="BoukhrisHillani2020">{{cite journal|last1=Boukhris|first1=Marouane|last2=Hillani|first2=Ali|last3=Moroni|first3=Francesco|last4=Annabi|first4=Mohamed Salah|last5=Addad|first5=Faouzi|last6=Ribeiro|first6=Marcelo Harada|last7=Mansour|first7=Samer|last8=Zhao|first8=Xiaohui|last9=Ybarra|first9=Luiz Fernando|last10=Abbate|first10=Antonio|last11=Vilca|first11=Luz Maria|last12=Azzalini|first12=Lorenzo|title=Cardiovascular Implications of the COVID-19 Pandemic: A Global Perspective|journal=Canadian Journal of Cardiology|year=2020|issn=0828282X|doi=10.1016/j.cjca.2020.05.018}}</ref> <ref name="RajagopalKeller2020">{{cite journal|last1=Rajagopal|first1=Keshava|last2=Keller|first2=Steven P.|last3=Akkanti|first3=Bindu|last4=Bime|first4=Christian|last5=Loyalka|first5=Pranav|last6=Cheema|first6=Faisal H.|last7=Zwischenberger|first7=Joseph B.|last8=El Banayosy|first8=Aly|last9=Pappalardo|first9=Federico|last10=Slaughter|first10=Mark S.|last11=Slepian|first11=Marvin J.|title=Advanced Pulmonary and Cardiac Support of COVID-19 Patients|journal=Circulation: Heart Failure|volume=13|issue=5|year=2020|issn=1941-3289|doi=10.1161/CIRCHEARTFAILURE.120.007175}}</ref>  
   
   
:*[[distributive shock]]
:*[[Distributive shock]]
:*[[hypovolemic shock]]   
:*[[Hypovolemic shock]]   
:*mixed ([[distributive]] and [[cardiogenic shock]]).  
:*Mixed ([[distributive]] and [[cardiogenic shock]]).  
Some hemodynamic parameters would help differentiate significant types of shock: <ref>{{cite book | last = Jameson | first = J | title = Harrison's principles of internal medicine | publisher = McGraw-Hill Education | location = New York | year = 2018 | isbn = 1259644030 }}</ref>
Some hemodynamic parameters would help differentiate significant types of shock: <ref>{{cite book | last = Jameson | first = J | title = Harrison's principles of internal medicine | publisher = McGraw-Hill Education | location = New York | year = 2018 | isbn = 1259644030 }}</ref>
{| class="wikitable"
{| class="wikitable"
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==Epidemiology and Demographics==
==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 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===  
===Age===  
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==Risk Factors==
==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, [[COVID-19 risk factors|click here]]. Moreover, in order to read more on the risk factors of cardiogenic shock, generally, [[cardiogenic shock risk factors|click here]].<br />
* There are no established risk factors for COVID-19-associated cardiogenic shock.
* To view risk factors for the severe form of COVID-19 disease, [[COVID-19 risk factors|click here]].  
* Moreover, in order to read more on the risk factors of cardiogenic shock, generally, [[cardiogenic shock risk factors|click here]].<br />


==Screening==
==Screening==
There is insufficient evidence to recommend routine screening for [[COVID-19]]-associated [[cardiogenic shock]].
 
* There is insufficient evidence to recommend routine screening for [[COVID-19]]-associated [[cardiogenic shock]].


==Natural History, Complications and Prognosis==
==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. <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> <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>
*[[Cardiogenic shock]] can develop suddenly in [[covid-19]] [[ patients]] without underlying risk factors of [[cardiovascular disease]].<ref name="pmid33733043">{{cite journal |vauthors=Purdy A, Ido F, Sterner S, Tesoriero E, Matthews T, Singh A |title=Myocarditis in COVID-19 presenting with cardiogenic shock: a case series |journal=Eur Heart J Case Rep |volume=5 |issue=2 |pages=ytab028 |date=February 2021 |pmid=33733043 |pmc=7953948 |doi=10.1093/ehjcr/ytab028 |url=}}</ref>
*If left untreated, [[patients]] with [[cardiogenic shock]] may progress to develope [[hemodynamic collapse]], [[death]].
* Prognosis is generally poor, and  [[mortality rate]] of [[cardiogenic shock]] in [[covid-19]] reported cases was approximately 75%. <ref name="pmid32499016">{{cite journal |vauthors=Sánchez-Recalde Á, Solano-López J, Miguelena-Hycka J, Martín-Pinacho JJ, Sanmartín M, Zamorano JL |title=COVID-19 and cardiogenic shock. Different cardiovascular presentations with high mortality |journal=Rev Esp Cardiol (Engl Ed) |volume=73 |issue=8 |pages=669–672 |date=August 2020 |pmid=32499016 |pmc=7184000 |doi=10.1016/j.rec.2020.04.012 |url=}}</ref>
* In spite of using [[Extracorporeal membrane oxygenation]] ([[ECMO]]), 83% of [[patients]] who suffered of [[cardiogenic shock]] in [[covid-19]] died. <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> <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>


== Diagnosis ==
== Diagnosis ==
===Diagnostic Study of Choice===
===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> To view cardiogenic shock diagnostic criteria, [[cardiogenic shock diagnostic criteria|click here]].
 
* A diagnosis of [[cardiogenic shock]] related to [[COVID-19]] can be made when systolic [[Blood Pressure]] is lower than 90 mmHg for more than 30 minutes,
[[cardiac index]] ≤ 2.2L/min per m². [[pulmonary capillary wedge pressure]] ≥ 15 mmHg with impaired organ [[perfusion]] including:
:*[[Urine output]] is less than 30 m/hr
:*[[Cool extermities]]
:* [[Altered mental status]]
:* Serum [[lactate]]> 2 mmol/L
:* Use of [[pharmacological]] or [[mechanical support]] to maintain an BP ≥ 90mmHg<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>


===History and Symptoms:===
===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.
*[[Cardiogenic shock]] should be considered in [[covid-19]] [[patients]] who present with suddenly [[hypotension]], [[cool extremities]], [[reslesness]], [[shortness of breath]], [[chest discomfort]], [[palpitation]].
*[[Cardiac biomarkers ]] sampling, [[cardiac monitoring ]], obtaining [[ECG]], evaluation of [[cardiac function]] by [[echocardiography]]  are considered.
* In the presence of [[tachyarrhythmia]] or [[bradyarrhythmia]] and evidence of [[hypotension]] and [[pulmonary edema]], evaluation about [[fulminant myocarditis]], acute [[STEMI]] are warranted.
* In the presence of unilateral or bilateral lower limbs [[edema]] and suddenly refractory [[hypotension ]], [[tachycardia]], and [[tachypnea]], massive [[pulmonary thromboembolism]] should be considered.  


A 69-year-old patient from Italy has been reported by Tavazzi et al., as a cardiogenic shock-associated COVID-19 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>


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>
* Table bellow shown the [[clinical characteristics]] of [[patients]] with [[covid-19]] associated with [[cardiogenic shock]]:<ref name="pmid32499016">{{cite journal |vauthors=Sánchez-Recalde Á, Solano-López J, Miguelena-Hycka J, Martín-Pinacho JJ, Sanmartín M, Zamorano JL |title=COVID-19 and cardiogenic shock. Different cardiovascular presentations with high mortality |journal=Rev Esp Cardiol (Engl Ed) |volume=73 |issue=8 |pages=669–672 |date=August 2020 |pmid=32499016 |pmc=7184000 |doi=10.1016/j.rec.2020.04.012 |url=}}</ref><ref name="pmid33733043">{{cite journal |vauthors=Purdy A, Ido F, Sterner S, Tesoriero E, Matthews T, Singh A |title=Myocarditis in COVID-19 presenting with cardiogenic shock: a case series |journal=Eur Heart J Case Rep |volume=5 |issue=2 |pages=ytab028 |date=February 2021 |pmid=33733043 |pmc=7953948 |doi=10.1093/ehjcr/ytab028 |url=}}</ref> <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>


* A 42-year-old woman, who had [[dyslipidemia]] as a [[cardiovascular]] risk factor
 
* 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]].
{| style="border: 2px solid #4479BA; align="left"
* 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]].
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Age, sex}}
* A 37-year-old woman, obese with a history of [[deep venous thrombosis]], had symptoms of [[dyspnea]] and chest pain
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|Cardiovascular history}}
! style="width: 400px; background: #4479BA;" | {{fontcolor|#FFF|Symptoms}}
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Timing according to covid-19 infection }}
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Echocardiography, catheterization}}
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Covid-19 severity}}
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Diagnosis}}
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Treatment}}
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Outcome}}
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 42 years, [[female]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Dyslipidemia]], [[oral contraceptive]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Dyspnea]], [[cough]], [[diarrhea]], [[vomiting]], [[anosmia]], [[dysgeusia]] suddenly [[cardiovascular arrest]], [[ventricular arrhythmia]] storm refractory to [[antiarrhythmic therapy]], [[sinus rhythm]], new [[LBBB]]  on [[ECG]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 12 days
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Severe [[biventricular dysfunction]] in [[echocardiography]], [[normal epicardial coronary arteries]] in [[coronary angiography]], no [[pulmonary thromboembolism]] in [[pulmonary angiography]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Mild
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Fulminant myocarditis]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Cardiopulmonary resuscitation]] at presentation, implantation of [[VA-ECMO]], [[intra-aortic counter pulsation]] for [[unloading ]] [[left ventricle]], [[temporary pacemaker]] implantation
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Refractory shock]], [[death]]
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 50 years, [[male]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | None
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Severe]] [[respiratory distress]], [[severe hypotension]] with [[lateral wall]] [[ST segments elevation]] after admission
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 8 days
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Severe]] [[left ventricular dysfunction]] with akinesia of the basal and midsegments, [[apical hypercontractility]] in [[echocardiography]],  
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Severe bilateral [[lung]] [[pneumonia]] requiring [[mechanical ventilation]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Inverted]] [[takotsubo cardiomyopathy]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Mechanical ventilation]], [[hydroxychloroquine]], [[antiretroviral agents]], [[antibiotics]],[[ corticosteroids]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Survived
 
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 75 years, [[male]]
 
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[None]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Chest pain]], [[dyspnea]], inferior [[STEMI]], [[complete heart block]], frequent episodes of [[ventricular fibrillation]] requiring [[cardioversion]], [[intubation]], [[mechanical ventilation]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 2 days
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Biventricular failure]], predominantly right sided in [[echocardiography]], [[right coronary artery]] [[thrombosis]] in urgent [[coronary angiography]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |  Severe bilateral [[SARSE-COV-2]] [[pneumonia]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[STEMI]], [[right coronary artery thrombosis]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Stenting of [[right coronary artery]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Electromechanical dissociation]] a few hours after [[PCI]], [[death]]
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 37 years, [[female]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Obese]], history of [[deep vein thrombosis]] 8 years ago after [[fracture]] and [[immobilization]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Dyspnea]], [[chest pain]], suddenly developed severe [[hypotension]], S02< 80%
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 10 days
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Urgent [[CT angiography]] of [[pulmonary arteries]]: bilateral [[pulmonary thromboembolism]], [[right ventricular dilation]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Patchy]] peripheral [[lung]] [[opacification]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Massive]] [[pulmonary thromboembolism]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Systemic [[thrombolytic]] therapy
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Cardiogenic shock]], [[death]]
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 53 years, [[male]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | None
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Cough]], [[fever]], [[shortness of breath]], [[tachycardia]], [[tachypnea]], cool extremities, J point elevation in inferolatel leads of [[ECG]], low [[cardiac output]] calculated by [[Fick index]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Confimed by [[PCR]] 5 week ago, treating with supportive therapy at home
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[LVEF]]=25%, global [[hypokinesis]], [[right ventricular]] dilation with dysfunction in [[echocardiography]], [[normal epicardial coronary arteries]] in [[coronary angiography]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Mild]] [[pulmonary vascular congestion]] on [[CXR]], normally otherwise
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Covid-19]] induced [[cardiomyopathy]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |  [[Hydroxychloroquine]], [[isosorbide dinitrate]], [[hydralazine]], [[carvedilol]], [[eplerenone]], [[steroid]] therapy, [[inotrope]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Improving]] [[LVEF]] to 50% after 4 days of therapy, and [[LVEF]] 60% after 10 weeks of therapy, [[survived]]
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 30 years, [[female]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |[[ Obesity]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |[[Fatigue]], [[shortness of breath]], [[tachycardia]], [[tachypnea]], [[hypotension]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Confimed by [[PCR]] 9 days ago
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[LVEF]]=45%, moderate diffuse [[hypokinesis]], moderate [[pericardial effusion]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Patchy]] airspace disease in [[chest CT]] scan
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Covid-19]] induced [[cardiomyopathy]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |  [[Hydroxychloroquine]], [[vitamin C]], [[zinc]], [[atorvastatin]], [[milrinone]] , [[methylprednisolone]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Improving]] [[LVEF]] to 55% after 6 weeks of discharge, survived
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 69 years, [[male]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |[[ None]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |[[Cough]], [[shortness of breath]], [[weakness]], [[tachypnea]], [[hypotension]], suddenly [[oxygen desaturation]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 4 days
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[LVEF]]=25%, severe diffuse [[left ventricle]] [[hypokinesia]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Diffuse]] bilateral interstitial [[inflammation]], subpleural [[consolidation]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Covid-19]] induced [[cardiomyopathy]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |  [[Norepinephrine]], [[VA]] [[ECMO]], [[IABP]], [[intubation]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |Increased [[LVEF]] to narmal value, few hours after weaning of [[ECMO]] died of [[septic shock]] due to [[pseudomonas]] ,[[klebsiella]]
|}
{{clear}}


=== Physical Examination ===
=== 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]] in [[covid-19]] associated [[cardiogenic shock]] include:
**Assessment of consciousness level
:*Assessment of [[consciousness]] level
**Extremities, whether they are warm or cool, is helpful for evaluation of [[cardiogenic shock]]
:*[[Extremities]], [[warm]] or [[cool]]
**Vital signs ([[tachycardia]] and [[hypotension]] and [[tachypnea]])
:*[[Vital signs]] ([[tachycardia]] and [[hypotension]] and [[tachypnea]])
**Evaluation of volume status: [[CVP]] (increased [[JVP]]), [[edema]]
:*Evaluation of [[volume]] status: [[CVP]] (increased [[JVP]]), lower limbs [[edema]])
**Skin pallor
:*[[Skin]] [[pallor]]
:* Ascultation of [[Rale]] in [[lung]] fields and [[cardiac]] [[murmurs]]


=== Laboratory Findings ===
=== 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]])
**serum [[brain natriuretic peptide]] ([[BNP]])
**[[Troponin]]
**[[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
**[[cTnT]] and [[cTnI]] levels
**The association of elevated [[CK-MB]] and [[BNP]]
**The association of elevated [[CK-MB]] and [[BNP]]


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


=== X-ray ===
=== 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 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===
===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===
===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>
*Findings of [[cardiac MRI]] in the case series of young [[males]] with [[covid-19]] and  [[biventricular failure]] are: (doi:10.1161/CIRCHEARTFAILUREURE.120.007485)
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]].<br />
*: Mild nonspecific late [[gadolinium enhancement]] in some cases
*: NO evidence of [[myocardial edema]] on T2 weighted imaging


===Other Imaging Findings===
===Other Imaging Findings===
Line 157: Line 262:


===Cardiogenic shock medical therapy:===
===Cardiogenic shock medical therapy:===
The maistay of therapy of [[cardiogenic shock]] in [[covid-19]] [[patients]] is [[respiratory]] and [[circulatory]] support.<ref name="pmid32499016">{{cite journal |vauthors=Sánchez-Recalde Á, Solano-López J, Miguelena-Hycka J, Martín-Pinacho JJ, Sanmartín M, Zamorano JL |title=COVID-19 and cardiogenic shock. Different cardiovascular presentations with high mortality |journal=Rev Esp Cardiol (Engl Ed) |volume=73 |issue=8 |pages=669–672 |date=August 2020 |pmid=32499016 |pmc=7184000 |doi=10.1016/j.rec.2020.04.012 |url=}}</ref>
* In [[patients]] with [[myocarditis]], administration of [[corticosteroid]]s and [[immunoglobulins]] are recommended.
* [[Cardiogenic shock]] in the setting of [[stress cardiomyopathy]] can be triggered by [[catecholamine]] discharge secondary to [[hypoxia]] or [[sepsis]] and should be managed by [[mechanical support]].
* Treatment of [[cardiogenic shock]] due to [[pulmonary thromboembolism]] include implantation of [[VA ECMO]], [[thrombolysis]], [[percutaneous treatment]] in case of [[thrombolysis]] contraindicated or failed.
* In the presence of [[cardiogenic shock]] due to [[acute coronary thrombosis]] , [[revascularization]] by [[PCI]] or [[CABG]] based on the [[arterial]] anatomical involvement are warranted.
* In the case series of young [[males]] with [[covid-19]] and [[cardiogenic shock]] and  [[biventricular failure]]  with high level of [[hyperinflammatory]] biomarkers, use of moderate-dose [[steroid]], [[anticoagulant]],  [[supportive care]] led to recovery of [[shock]] quickly.<ref name="pmid32844662">{{cite journal |vauthors=Chau VQ, Giustino G, Mahmood K, Oliveros E, Neibart E, Oloomi M, Moss N, Mitter SS, Contreras JP, Croft L, Serrao G, Parikh AG, Lala A, Trivieri MG, LaRocca G, Anyanwu A, Pinney SP, Mancini DM |title=Cardiogenic Shock and Hyperinflammatory Syndrome in Young Males With COVID-19 |journal=Circ Heart Fail |volume=13 |issue=10 |pages=e007485 |date=October 2020 |pmid=32844662 |doi=10.1161/CIRCHEARTFAILURE.120.007485 |url=}}</ref>


* General approach for [[patients]] with [[shock]] is:
* [[Fluid resuscitation]] (crystalloid IV fluids are more efficient than colloid solutions)
* [[Fluid resuscitation]] (crystalloid IV fluids are more efficient than colloid solutions)
* Administration of [[vasopressors]] and [[inotropes]] to stabilize [[shock]]
* 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>
* Mixed etiologies of [[shock]] should be considered in [[covid-19]] [[infection]] 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:===
===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 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>
*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]]. <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===
===Surgery===
Line 171: Line 284:


===Primary Prevention ===
===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===
===Secondary Prevention===
*There are no established measures for the secondary prevention of [[COVID-19]]-associated [[myocarditis]].
*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==
==References==

Latest revision as of 18:22, 26 November 2021

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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: : Sara Zand, M.D.[2] Alieh Behjat, M.D.[3]

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

SARS-COV-2 or COVID-19 is a specific strain of coronavirus that is responsible for an ongoing global pandemic. COVID-19 may lead to respiratory disease and also multi-organ dysfunction including biventricular failure and profound shock and life threatening cardiogenic shock. Cardiogenic shock shoulb be considered while cardiac ethiology is evident in patients with persistent hypotesion despite fluide resuscitation in the presence of end organs dysfunction. Cardiogenic shock may present as a consequence of cytokine storm pathway or direct invasion of cardiovascular system by virus via ACE2 receptos on the cells. Cardiogenic shock may progress to develop quicky in covid-19 patients and any delay for diagnosis and treatment of such patients will increase mortality rate. In mild or severe types of covid-19 with sudden collapse of hemodynamic, considering different causes of cardiogenic shock including fulminant myocarditis, acute STEMI, massive pulmonary thromboembolism, stress cardiomyopathy, are helpful to clinical approach and quickly initiation of treatment. Mortality rate of covid-19 patients with cardiogenic shock among reported cases in literature was 75% despite use of pharmacological and mechanichal hemodynamic support.

Historical Perspective


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

Classification

Pathophysiology

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

Causes

Common causes of cardiogenic shock in patients with covid-19 include:[7][8] [9]

Differentiating COVID-19 associated cardiogenic shock from other Diseases

Cardiogenic shock related to COVID-19 must be differentiated from other diseases which include: [10] [11]

Some hemodynamic parameters would help differentiate significant types of shock: [12]

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

Age

Gender

Race

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

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

cardiac index ≤ 2.2L/min per m². pulmonary capillary wedge pressure ≥ 15 mmHg with impaired organ perfusion including:

History and Symptoms:



Age, sex Cardiovascular history Symptoms Timing according to covid-19 infection Echocardiography, catheterization Covid-19 severity Diagnosis Treatment Outcome
42 years, female Dyslipidemia, oral contraceptive Dyspnea, cough, diarrhea, vomiting, anosmia, dysgeusia suddenly cardiovascular arrest, ventricular arrhythmia storm refractory to antiarrhythmic therapy, sinus rhythm, new LBBB on ECG 12 days Severe biventricular dysfunction in echocardiography, normal epicardial coronary arteries in coronary angiography, no pulmonary thromboembolism in pulmonary angiography Mild Fulminant myocarditis Cardiopulmonary resuscitation at presentation, implantation of VA-ECMO, intra-aortic counter pulsation for unloading left ventricle, temporary pacemaker implantation Refractory shock, death
50 years, male None Severe respiratory distress, severe hypotension with lateral wall ST segments elevation after admission 8 days Severe left ventricular dysfunction with akinesia of the basal and midsegments, apical hypercontractility in echocardiography, Severe bilateral lung pneumonia requiring mechanical ventilation Inverted takotsubo cardiomyopathy Mechanical ventilation, hydroxychloroquine, antiretroviral agents, antibiotics,corticosteroids Survived
75 years, male None Chest pain, dyspnea, inferior STEMI, complete heart block, frequent episodes of ventricular fibrillation requiring cardioversion, intubation, mechanical ventilation 2 days Biventricular failure, predominantly right sided in echocardiography, right coronary artery thrombosis in urgent coronary angiography Severe bilateral SARSE-COV-2 pneumonia STEMI, right coronary artery thrombosis Stenting of right coronary artery Electromechanical dissociation a few hours after PCI, death
37 years, female Obese, history of deep vein thrombosis 8 years ago after fracture and immobilization Dyspnea, chest pain, suddenly developed severe hypotension, S02< 80% 10 days Urgent CT angiography of pulmonary arteries: bilateral pulmonary thromboembolism, right ventricular dilation Patchy peripheral lung opacification Massive pulmonary thromboembolism Systemic thrombolytic therapy Cardiogenic shock, death
53 years, male None Cough, fever, shortness of breath, tachycardia, tachypnea, cool extremities, J point elevation in inferolatel leads of ECG, low cardiac output calculated by Fick index Confimed by PCR 5 week ago, treating with supportive therapy at home LVEF=25%, global hypokinesis, right ventricular dilation with dysfunction in echocardiography, normal epicardial coronary arteries in coronary angiography Mild pulmonary vascular congestion on CXR, normally otherwise Covid-19 induced cardiomyopathy Hydroxychloroquine, isosorbide dinitrate, hydralazine, carvedilol, eplerenone, steroid therapy, inotrope Improving LVEF to 50% after 4 days of therapy, and LVEF 60% after 10 weeks of therapy, survived
30 years, female Obesity Fatigue, shortness of breath, tachycardia, tachypnea, hypotension Confimed by PCR 9 days ago LVEF=45%, moderate diffuse hypokinesis, moderate pericardial effusion Patchy airspace disease in chest CT scan Covid-19 induced cardiomyopathy Hydroxychloroquine, vitamin C, zinc, atorvastatin, milrinone , methylprednisolone Improving LVEF to 55% after 6 weeks of discharge, survived
69 years, male None Cough, shortness of breath, weakness, tachypnea, hypotension, suddenly oxygen desaturation 4 days LVEF=25%, severe diffuse left ventricle hypokinesia Diffuse bilateral interstitial inflammation, subpleural consolidation Covid-19 induced cardiomyopathy Norepinephrine, VA ECMO, IABP, intubation Increased LVEF to narmal value, few hours after weaning of ECMO died of septic shock due to pseudomonas ,klebsiella

Physical Examination

Laboratory Findings

  • In addition, the increase of some biomarkers demonstrates poor prognosis, increased mortality, and more severe symptoms in COVID-19 patients:[19]

Electrocardiogram

X-ray

Echocardiography or Ultrasound

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.[21]


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

MRI

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:

The maistay of therapy of cardiogenic shock in covid-19 patients is respiratory and circulatory support.[7]

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. [24] [16]

Surgery

Primary Prevention

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

  1. https://www.cdc.gov/coronavirus/2019-ncov/about/index.html. Missing or empty |title= (help)
  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.
  3. "Coronavirus (COVID-19) events as they happen".
  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.
  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.
  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.
  7. 7.0 7.1 7.2 7.3 Sánchez-Recalde Á, Solano-López J, Miguelena-Hycka J, Martín-Pinacho JJ, Sanmartín M, Zamorano JL (August 2020). "COVID-19 and cardiogenic shock. Different cardiovascular presentations with high mortality". Rev Esp Cardiol (Engl Ed). 73 (8): 669–672. doi:10.1016/j.rec.2020.04.012. PMC 7184000 Check |pmc= value (help). PMID 32499016 Check |pmid= value (help).
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. Jameson, J (2018). Harrison's principles of internal medicine. New York: McGraw-Hill Education. ISBN 1259644030.
  13. 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).
  14. 14.0 14.1 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.
  15. 15.0 15.1 Purdy A, Ido F, Sterner S, Tesoriero E, Matthews T, Singh A (February 2021). "Myocarditis in COVID-19 presenting with cardiogenic shock: a case series". Eur Heart J Case Rep. 5 (2): ytab028. doi:10.1093/ehjcr/ytab028. PMC 7953948 Check |pmc= value (help). PMID 33733043 Check |pmid= value (help).
  16. 16.0 16.1 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).
  17. 17.0 17.1 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.
  18. 18.0 18.1 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.
  19. 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.
  20. Tse, FirstName (2011). Oxford Desk Reference : Cardiology. Oxford: OUP Oxford. ISBN 978-0-19-956809-3.
  21. 21.0 21.1 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.
  22. Chau VQ, Giustino G, Mahmood K, Oliveros E, Neibart E, Oloomi M, Moss N, Mitter SS, Contreras JP, Croft L, Serrao G, Parikh AG, Lala A, Trivieri MG, LaRocca G, Anyanwu A, Pinney SP, Mancini DM (October 2020). "Cardiogenic Shock and Hyperinflammatory Syndrome in Young Males With COVID-19". Circ Heart Fail. 13 (10): e007485. doi:10.1161/CIRCHEARTFAILURE.120.007485. PMID 32844662 Check |pmid= value (help).
  23. 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).
  24. 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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