Managing Covid-19 in patients with heart failure: current status and future prospects.

INTRODUCTION: COVID-19 may contribute to decompensation of previously stable chronic HF or cause a de-novo heart failure, which may come from the hyperinflammatory response and subsequent increase in metabolic demand. AREAS COVERED: Two independent investigators searched MEDLINE (via PubMed), Europe PMC, and ScienceDirect databases with the following search terms: COVID-19, heart failure, COVID-19 drugs, heart failure drugs, and device therapy. All of the included full-text articles were rigorously evaluated by both authors in case there was disagreement about whether research should be included or not. In total, 157 studies were included and underwent extensive reading by the authors. EXPERT OPINION: The World Health Organization (WHO) and the National Institute of Health (NIH) have published COVID-19 drug recommendations, although recommendations for HF-specific drug choices in COVID-19 are still lacking. We hope that this review can answer the void of comprehensive research data regarding the management options of HF in the COVID-19 condition so that clinicians can at least choose a more beneficial therapy or avoid combination therapies that have a high burden of side effects on HF; thus, morbidity and mortality in COVID-19 patients with HF may be reduced.

Detection and management of myocarditis and fulminant myocarditis

Myocarditis is commonly caused due to systemic viral infection with cardiotropic nature. In the acute phase this disorder could cause lethal hemodynamic or arrhythmic disorders. Newest studies showed that the use of guideline-directed medical care in the care of myocarditis will lead to better outcomes. This condition varies in presentation ranging from mild to life-threatening such as cardiogenic shock. With the current advances in early detection and circulatory support using extracorporeal membrane oxygenation (ECMO) myocarditis could be managed very well. Cases of myocarditis related to COVID-19 has been reported however as per this time there has no confirmed pathological evidence regarding direct causation between COVID-19 and myocarditis however in these severely ill patients’ elevations in cardiac biomarkers (cTn BNP and NTproBNP) occurs and the administration of immunosuppressant could increase the chance of remission. Keyword: Myocarditis fulminant COVID-19.

Deteksi Dan Penanganan Awal Miokarditis Dan Miokarditis Fulminan

Miokarditis umumnya terjadi akibat infeksi sistemik dari virus yang bersifat kardiotropik. Pada kondisi miokarditis akut ini dapat menyebabkan gangguan hemodinamik atau aritmia letal. Studi terbaru menunjukkan tatalaksana miokarditis terkait penyebab ditambah dengan guideline directed medical care akan memberi keluaran yang baik. Presentasi klinis miokarditis beragam dari yang tidak terlalu berat sampai dengan syok kardiogenik. Dengan perkembangan terapi saat ini, bantuan sirkulasi extracorporeal membrane oxygenation (ECMO) dan deteksi dini miokarditis fulminan, maka miokarditis dapat tertangani dengan baik. Dugaan miokarditis fulminan pada COVID-19 telah dilaporkan pada beberapa laporan kasus namun belum ada bukti patologi yang telah terkonfirmasi dari spesimen miokard adanya keterlibatan virus pada miokarditis COVID-19. Pada kasus dengan gambaran critical ill didapatkan tanda dan bukti peningkatan biomarker kerusakan miokard (cTn) dan peningkatan biomarker akibat stress dinding ventrikel kiri (BNP atau NTproBNP). Pada beberapa kasus, pemberian imunosupresan dan monitoring yang baik dapat meningkatkan peluang remisi. Kata kunci : Miokarditis, fulminan, COVID-19