**Management of hospitalized COVID-19 patients with complications of acute cardiomyopathy or heart failure** ### **Introduction** Cardiomyopathy has been observed in patients with severe COVID-19 disease and evidence suggests that cardiovascular involvement has a high mortality rate.. The action of viral infection with SARS-CoV-2 on the heart has been proposed through at least three distinct mechanisms.. This phenomenon has been well described in other inflammatory conditions such as sepsis.. SARS-CoV-2 can directly infect the heart.. Hearts express the viral receptor ACE2. , and MRI and ECG-based imaging findings have reported myocardial involvement.. Its effects on ACE2 affect small vessels.. This can cause dysfunction of these vessels and tissue ischemia, ultimately leading to deleterious outcomes in the ventricles.. Of the 21 patients with severe covid-19, approximately 30% had evidence of cardiomyopathy with decreased LVEF on echocardiogram, increased biomarkers heart, A decrease in SVO2 or clinical signs of shock is defined.. Cases from China show that 20-30% of patients with severe covid-19 have increased troponin. ### **blood test** An increase in "serum troponin" and "NT pro-BNP" increases the risk of death in patients.. These markers indicate that patients are at the highest risk of developing cardiomyopathy or cardiac shock.. In addition, CRP, ferritin, D-dimer, IL-6 and LDH are significantly increased in patients with deep systemic inflammation.. Prognosis... ### *Corresponding signs in ECG** ECG findings with COVID-19 can include disseminated ST elevation in myopiccarditis, non-specific ST changes, low voltage in limb leads and PVCs.... ### **Echocardiography** Echocardiography can be useful for evaluating the structure and function of the ventricles, wall motion abnormalities, and estimating cardiac hemodynamics.. Nevertheless, minimizing the scan time in patients with positive covid-19 is necessary to reduce the risk of transmission.... Currently, transesophageal echocardiography plays a significant role in transmission of #aerial imaging.. **Clinical points in case of suspected myocarditis** In hospitalized patients with a diagnosis of covid-19, cardiac biomarkers should be assessed on admission and for follow-up approximately 24-48 hours later.. Myocarditis should be considered in covid-19 patients with elevated cardiac biomarkers or worsening hemodynamics or arrhythmias.. LV/RV size and function, wall motion abnormalities or pericardial effusions.. Stable patients with suspected cardiac problems Vascularists should continue to treat heart failure with drug therapy according to previous guidelines.. In patients with refractory shock, PAC should be used as a guide.. Consider inotropes, vasopressors, or mechanical support.... ### **a) Medical Supportive Care** 1...avoid excessive fluid resuscitation....goal is (CVP 6-8mmHg)....if RV dysfunction is significant or high (PEEP), up to (CVPs 12-15) may be desirable..effective CVP can be calculated by measuring CVP-PEEP..dysfunction, consider dobutamine....4...epinephrine and vasopressin should be considered for resistant hypotension... ### **b) Mechanical support/ECMO** There are several factors that must be considered before placing a COVID-19 patient on ECMO.... ECMO is a limited resource and should be reserved for those with the greatest chance of recovery.... However, in patients with cardiomyopathy and significant cardiac shock, VA ECMO may be necessary.... VA ECMO with successful outcomes for patients with COVID-19 and heart failure Ripiromi...*D.*D.. Lia Mirsafai** as a **cardiologist in Sari** can provide medical services in the field of heart and blood vessels to dear patients.... To receive advice and guidance regarding **cardiomyopathy in patients with covid-19**, you can contact phone number 09120470655.. ### **c) antiviral/anti-inflammatory* Treatment strategies including hydroxychloroquine and azithromycin, anti-inflammatory methods such as intravenous globulin (IVIG), tocilizumab, anakinra, IV steroids and antiviral treatment strategies such as remdesivir, lopinavir and ritonavir have been used in patients with covid-19. https://www.acc.org/latest-in-cardiology/articles/2020/04/16/14/42/management-of-the-hospitalized-covid-19-coronavirus-2019-patient-with-acute-cardiomyopathy-or-heart-failure