Interventions related to cardiovascular complications in people hospitalized by covid-19: a scoping review

Matos, José Hiago Feitosa de; Gomes, Emiliana Bezerra; Formiga, Natália Pinheiro Fabricio; Nascimento, Maria Naiane Rolim; Lima, Gabriela de Sousa; Moreira, Thereza Maria Magalhães

doi:10.1590/0034-7167-2020-0568

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 74 (suppl 1) • 2021 • https://doi.org/10.1590/0034-7167-2020-0568 copy

Interventions related to cardiovascular complications in people hospitalized by covid-19: a scoping review

Intervenciones relacionadas con complicaciones cardiovasculares en personas hospitalizadas por covid-19: revisión de alcance

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To describe the scientific evidence of complications and the need for cardiovascular interventions in people hospitalized by Covid-19.

Method:

a scoping review carried out according to The Joanna Briggs Institute recommendations, in the MEDLINE, CINAHL, SCOPUS and Web of Science databases.

Results:

A total of 11 published studies from December of 2019 to April of 2020, presenting low levels of evidence were selected. The evidence described the myocardial injury as the most common cardiac complication reported in Covid-19, reported in approximately 8% to 12% of all severe individuals, with indications for oxygen therapy interventions, thrombotic disorders prevention and treatment, hemodynamic monitoring and assessment tests of cardiac function’s performance, along with biochemical markers of myocardial injury, yet not addressing nursing interventions.

Conclusion:

Cardiovascular complications and interventions have not shown consensus on the found evidence, requiring causal analysis by explanatory studies that support multi-professional clinical protocols in health.

Descriptors:
Coronavirus Infections; Cardiovascular Diseases; Hospital Care Services; Cardiovascular Nursing; Review

Code	Study reference	Origin	Study design	LE^* * LE- level of evidence.	Evidence of studies found
1	Bansal. (2020)⁽²⁰20 Bansal M. Cardiovascular disease and COVID-19. Diabetes Metabol Syndrome: Clin Res Rev. 2020;14(3):247-50. doi: 10.1016/j.dsx.2020.03.013 https://doi.org/10.1016/j.dsx.2020.03.01... ⁾	India	Narrative review	5	-Myocardial injury is the most common cardiac complication reported in Covid-19. Occurs in approximately 8% to 12% of all patients.
2	Klok et al. (2020)⁽²¹21 Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, Kaptein FHJ, Van Paassen J, Stals MAM, Huisman MV. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020; 191:145-147. doi: 10.1016/j.thromres.2020. 04.013 https://doi.org/10.1016/j.thromres.2020.... ⁾	Netherlands	Cohort	2B	- Thrombocytopenia is associated with three times higher the risk of severe Covid-19.
3	Wang et al. (2020)⁽²²22 Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical Features of 69 Cases With Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis. 2020;71(15):769-777. doi: 10.1093/cid/ciaa272 https://doi.org/10.1093/cid/ciaa272... ⁾	China	Cohort	2B	-The person with Covid-19 has an increase in inflammatory cytokines, which causes an imbalance between high metabolic demand and low oxygen supply to the tissues, causing hypoxemia, arrhythmias, and acute myocardial infarction.
4	Guan et al. (2020)⁽²³23 Guan W, Ni Z, Hu Yu, Liang W, Ou C, He J et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020; 382:1708-20. doi: 10.1056/NEJMoa2002032 https://doi.org/10.1056/NEJMoa2002032... ⁾	China	Cohort	2B	-Early diagnosis and management contribute to the decrease of cardiovascular complications and mortality by Covid-19.
5	Guo et al. (2020)⁽²⁴24 Guo T, Fan Y, Chen M, Wu X, Zhang L, He T et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19) 2020. JAMA Cardiology. 2020;5(7):811-8. doi: 10.1001/jamacardio.2020.1017 https://doi.org/10.1001/jamacardio.2020.... ⁾	China	Cohort	2B	-Myocardial injury is significantly associated with fatal Covid-19 results.
6	Driggin et al. (2020)⁽²⁵25 Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Bondi-Zoccai G, et al. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic. J Am Coll Cardiol. 2020;75(18):2352-2371. doi: 10.1016/j.jacc.2020.03.031 https://doi.org/10.1016/j.jacc.2020.03.0... ⁾	United States	Review with meta-analysis	1A	- The infection has been associated with multiple cardiovascular complications, including acute myocardial injury, myocarditis, arrhythmias, and thromboembolism.
7	Jing et al. (2020)⁽²⁶26 Jing ZC, Zhu HD, Yan XW, Chai WZ, Zhanget S. Recommendations from the Peking Union Medical College Hospital for the management of acute myocardial infarction during the COVID-19 outbreak. Eur Heart J. 2020;41(19):1791-4. doi: 10.1093/eurheartj/ehaa258 https://doi.org/10.1093/eurheartj/ehaa25... ⁾	France	Guideline	5	-Covid-19 infection causes several cardiovascular complications, including acute myocardial infarction, myocarditis and malignant arrhythmias.
8	Lakkireddy et al. (2020)⁽²⁷27 Lakkireddy DR, Chung MK, Gopinathannair R, Patton KK, Gluckman TJ, Turagam M. Guidance for Cardiac Electrophysiology During the Coronavirus (COVID-19) Pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association. Heart Rhythm. 2020. doi: 10.1016/j.hrthm.2020.03.028 https://doi.org/10.1016/j.hrthm.2020.03.... ⁾	United States	Guideline	5	-The importance of electrophysiology as an investigative aspect especially suitable in the provision of virtual and remote care, along with the support and readiness of the health team capable of providing the necessary care.
9	Ammirati et al. (2020)⁽²⁸28 Ammirati E, Wang DW. SARS-CoV-2 inflames the heart. The importance of awareness of myocardial injury in COVID-19 patients. Int J Cardiol. 2020; 311:122-123. doi:10.1016/j.ijcard.2020.03.086 https://doi.org/10.1016/j.ijcard.2020.03... ⁾	China	Editorial	5	-The elevation of troponin during hospitalization is an important prognostic marker and should appear as a warning sign for cardiovascular complications. -The use of hydroxychloroquine in combination with azithromycin can prolong the QT^ QT- measures the duration of electrical activation and recovery of the ventricular myocardium. interval of the electrocardiographic tracing and cause malignant arrhythmia.
10	Han et al. (2020)⁽²⁹29 Han Y, Zeng H, Jiang H, Yang Y, Yuan Z, Cheng X, et al. CSC Expert Consensus on Principles of Clinical Management of Patients with Severe Emergent Cardiovascular Diseases during the COVID-19 Epidemic. Circulation AHA. 2020;48(3):189-194. doi: 10.3760/cma.j.cn112148-20200210-00066 https://doi.org/10.3760/cma.j.cn112148-2... ⁾	China	Guideline	5	-Myocardial hypoxia contributes to the exacerbation of cardiovascular diseases.
11	Incurrdi et al. (2020)⁽³⁰30 Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D, et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):819-24. doi: 10.1001/jamacardio.2020.1096 https://doi.org/10.1001/jamacardio.2020.... ⁾	Italy	Editorial	5	-The recognition by the scientific community of acute myocarditis as a possible complication associated with Covid-19 can be useful for the rigorous monitoring of affected patients and to intensify the knowledge of these complications for public health authorities.

Code	Cardiovascular complications	Indicated interventions
1	- Acute coronary syndrome - Arrhythmias - Acute myocardial infarction	- Carry out triage and quick management; - Establish appropriate protocols for diagnosis, triage, isolation and case management; - Carry out diagnostic tests (cardiac enzymes and echocardiography); - Carefully give angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, chloroquine/hydroxychloroquine;
2	- Risk of venous and arterial thromboembolism	- Use of low molecular weight heparin;
3	- Low oxygen saturation	- Carry out oxygen support; - Follow up with arterial blood gases; - Assess the need for an Intensive Care Unit (ICU) and mechanical ventilation;
4	- Myocardial injury with elevated creatine kinase	- Use mechanical ventilation; - Proceed with ICU admission; - Employ oxygen support; - Carry out cardiac enzyme tests;
5	- Malignant arrhythmias	- Prescribing medical therapy; - Manage medical therapy.
6	- Acute myocardial infarction - Myocarditis	- Carry out routine electrocardiogram; - Carry out cardiac enzyme tests;
7	- Acute myocardial infarction	- Perform intravenous thrombolysis; - Redo electrocardiogram, bedbound echocardiogram and chest X-ray during thrombolysis; - Check myocardial perfusion; - Carry out computed tomography scan immediately after thrombolysis;
8	- Arrhythmias	- Carry out routine electrocardiogram; - Carry out transesophageal echocardiogram; - Carry out cardioversion;
9	- Myocarditis - Arrhythmias	- Carry out electrocardiographic monitoring; - Monitor the QT* interval when using chloroquine or combining antiviral medication; - Provide high potassium infusion to patients with long QT syndrome or on medication that prolong the QT interval to avoid hypokalemia; - Monitor the QT* interval 24 hours after starting therapy; - Assess electrolyte conditions during the use of hydroxychloroquine or chloroquine and/or antiviral;
10	- Atherosclerosis - Acute coronary syndrome	- Consider a differential diagnosis; - Carry out cardiac catheterization; - Carry out negative pressure ventilation when emergency intervention or surgical procedure is required; - Transfer to ICU with negative pressure ventilation for continuous treatment; - Carry out electrocardiogram if cardiac complications are suspected; - Proceed with early rehabilitation;
11	- Acute myocarditis - Pericardial effusion	- Carry out echocardiography; - Manage medication: aspirin, hydroxychloroquine, lopinavir/ritonavir, methylprednisolone.

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[1] Corresponding author: José Hiago Feitosa de Matos. E-mail: jose.hiago3@gmail.com