The following are eight key points to remember from this review on the cardiovascular impact of acute coronavirus 2019 (COVID-19):

1. Acute myocardial injury – defined as elevated troponin – is common in COVID-19 and occurs in 20-30% of patients hospitalized for the disease. It is associated with a significant increase in risk of all-cause death.
2. The authors define “acute COVID-19 cardiovascular syndrome” or ACovCS myocarditis-like syndrome involving acute myocardial injury often associated with reduced left ventricular ejection fraction in the absence of obstructive coronary artery disease.
3. ACovCS may be due to acute coronary syndrome, demand ischemia, microvascular ischemic injury, injury related to cytokine dysregulation, or myocarditis.
4. The mechanisms of ACovCS are unclear. In one case report, endomyocardial biopsy of a patient with ACovCS and cardiogenic shock showed low-grade myocardial inflammation, with localization of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) within macrophages but not cardiomyocytes.
5. Acute cellular injury due to SARS-CoV-2 cardiomyocyte, pericyte, or fibroblast infection via ACE2-mediated entry and subsequent viral replication is theoretical but unproven.
6. A second unproven hypothesis for COVID-19 related myocardial injury is centered on an inflammatory storm and cytokine excess.
7. Given the exposure risks involved in the transfer of patients for diagnostic procedures, the overall guiding principle is that acute myocardial injury in the setting of COVID-19 can be managed conservatively if possible until resolution of the viral syndrome.
8. Based on historical expert recommendations for non-COVID myocarditis, rest and abstinence from aerobic activity is reasonable for a period of 3-6 months until resolution of myocardial inflammation on magnetic resonance imaging or normalization of troponin.

Perspective:

To summarize with one key point; there is very little we know and much to learn about cardiovascular disease in COVID-19.

Clinical Topics: Acute Coronary Syndromes, COVID-19 Hub, Heart Failure and Cardiomyopathies, Prevention, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure

Keywords: Acute Coronary Syndrome, Coronary Artery Disease, Coronavirus, COVID-19, Cytokines, Inflammation, Myocardial Ischemia, Myocarditis, Myocytes, Cardiac, Peptidyl-Dipeptidase A, Primary Prevention, SARS Virus, severe acute respiratory syndrome coronavirus 2, Shock, Cardiogenic, Stroke Volume, Troponin, Ventricular Function, Left

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