Coronavirus disease 2019 is delaying the diagnosis and management of chest pain acute coronary syndromes myocarditis and heart failure

摘要

Coronavirus disease 2019 (COVID-19) was first identified in December 2019, yet within months it had spread to pandemic levels with critical global health implications to the clinical practice of all specialties. In cardiology, COVID-19 has imposed an unfortunate conundrum: the disease is significantly associated with death in patients with pre-existing cardiovascular disease, [ , ] and yet hospital admissions and certain cardiac procedures have significantly declined compared with prior years [ ]. This creates a potentially multiplicative problem if COVID-19 and its etiologic virus, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), directly or indirectly cause increased cardiac damage while patients with cardiac disease are simultaneously undertreated for pre-existing or illness. Here, we assess how COVID-19 may have influenced this apparent decline in cardiac care. We also consider how clinicians can optimize the diagnostic process to provide appropriate and timely patient care in the setting of increased uncertainty regarding the etiology of acute cardiovascular disease. This process is dynamic and will necessitate adaptive strategies over time, particularly as many hospitals, states and countries transition slowly toward the re-escalation of standard operations while being mindful of COVID-19 resurgence.