Cardiovascular disease and COVID-19, a deadly combination: A review about direct and indirect impact of a pandemic

Table 1 Potential causes for changes in acute cardiac care during the coronavirus disease 2019 pandemic

Potential causes for changes in acute cardiac care during the coronavirus disease 2019 pandemic
Patients were afraid of infection with severe acute respiratory syndrome coronavirus-2 during hospitalization
Misinterpretation of thoracic complaints and/or dyspnea as non-cardiac by patients and doctors
Changed approach of AMI care with longer door-to-device times and adaption of reperfusion strategies
Planned reduction of elective procedures in order to keep resources for care of COVID-19 patients

AMI: Acute myocardial infarction; COVID-19: Coronavirus disease 2019.

Table 2 Cardiac arrhythmias described in patients with severe acute respiratory syndrome coronavirus-2 infection[53]

Supraventricular arrhythmias	Ventricular arrhythmias	Bradycardias
+Atrial fibrillation	+Ventricular premature complexes	+Sinus bradycardia
+Sinus tachycardia	+Non-sustained ventricular tachycardia	+Conduction disturbances (atrioventricular block / bundle branch block)
+Supraventricular tachycardia	+Polymorphic ventricular tachycardia (Torsade des pointes)
+Atrial premature complexes	+Sustained ventricular tachycardia

Table 3 Mechanisms of arrhythmogenicity[55]

Mechanisms of arrhythmogenicity
QT prolonging drugs (anti-coronavirus disease 2019 pharmacotherapies/antibiotic-associated diarrheas/other agents)
Drug-drug interactions
Previous heart rhythm conditions (long QT and Brugada syndrome)
Acute myocardial injury/myocarditis
Hypoxia
Systemic inflammation
Autonomic dysfunction (sympathetic/parasympathetic)
Electrolyte abnormalities
Cardiovascular comorbidities (hypertension, coronary artery disease, and cardiomyopathy)

Table 4 Measures to prevent ventricular arrhythmias[58]

Measures to prevent ventricular arrhythmias
Stop QT prolonging drugs in patients with baseline QTc > 500 ms or with known LQTS
Stop QT prolonging drugs when QTc increases to > 500 ms or if QTc is prolonged by > 60 ms compared to baseline measurement
Control effectively fever in Brugada patients
Avoid the use of chloroquine/hydroxychloroquine, macrolides, fluoroquinolones, and protease inhibitors in patients with known risk factors such as prolonged QTc and electrolyte abnormalities (hypokalemia and hypomagnesemia)
Avoid concomitant use of QT prolonging antiarrhythmic drugs, including class IA and class III agents
Avoid hypokalaemia and hypomagnesemia
Monitor QT via ECG or kardia mobile application

LQTS: Long QT syndrome.

Table 5 QT prolonging drugs to avoid during severe acute respiratory syndrome coronavirus-2 infection[58]

Antiarrhythmics	Antibiotics	Antiviral agents	Antiemetics	Antipsychotics
+Class IA: Quinidine; Procainamide; +Class III: Amiodarone, Sotalol	+Chloroquine/Hydroxychloroquine; +Macrolides (Azithromycin); +Quinolones	+Lopinavir/Ritonavir; +Favipiravir; +Tocilizumab	+Domperidone	+Haloperidol