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COVID-19 has been associated with a variety of cardiac manifestations. Myocarditis and pericarditis have been reported as one of the many cardiac manifestations in association with COVID-19. We describe below three cases of myocarditis, pericarditis with associated pericardial effusion and myopericarditis, respectively, in the setting of COVID-19. Although these entities may occur in isolation, they often occur in association to varying degrees. It could either be the initial diagnosis at the time of presentation or it could occur later in the course of COVID-19 infection. Pericarditis may occasionally be associated with significant pericardial effusion and tamponade requiring therapeutic pericardiocentesis. The assessment of pericardial effusion has been found to be exudative and is usually negative for SARS-CoV-2. Treatment of pericarditis with nonsteroidal anti-inflammatory drugs, colchicine, and corticosteroids has proven to be safe in COVID-19. Myocarditis may present with severe left ventricular systolic dysfunction and cardiogenic shock requiring inotropes and mechanical circulatory support.

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Background: The novel coronavirus disease-2019 (COVID-19) spread rapidly around the world and was declared as the second pandemic of the 21^st century. The first case was detected in Qatar on February 29, 2020. In order to protect patients and staff in Heart Hospital, the only tertiary cardiac center in Qatar, new measures were implemented to reduce the spread of infection in our hospital. Methodology: A 13-bed high dependency isolation unit was allocated to receive cardiac patients with appreciate infection control measures. Another isolation unit was also established in coronary care unit for critical patients. All patients admitted to Heart Hospital were tested for COVID-19 on admission. Patients were transferred out of isolation, if result was negative. Patients with positive results were either transferred to a COVID facility before or after planned cardiac procedure depending on their cardiovascular disease risk. Results: Six hundred and seven patients were admitted to both the isolation units, most of them were men (89%). Forty-four percent were diagnosed with ST elevation myocardial infarction, 22% were non-STEMI or unstable angina, 17% were decompensated heart failure, 7% were elective cases for coronary angiography or electrophysiology procedures, 8% for other diagnosis, and 1% for both cardiac arrest and post cardiac surgery. 85.2% of the patients admitted to isolation units were tested negative and transferred to normal wards to complete their treatment. Eighty percent of the patients tested positive or reactive for COVID-19 had epidemiological risk, 8.4% had suggestive symptoms, and 11.6% had abnormal chest X-ray. Conclusion: This study demonstrated the importance of the isolation unit with infection control measures in controlling the transmission of COVID-19 in a hospital setting such as the Heart Hospital. Epidemiological risk factors including recent travel, close contact with suspected or confirmed cases within 14 days or less, living in shared accommodation or living in lockdown area were the main risk factors for spreading COVID-19 infection which can be managed by minimizing social activities.

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Background: The novel severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) outbreak has affected ST-elevation myocardial infarction (STEMI) care worldwide. Reports from China, Europa, and North America showed a significant decline in STEMI volume with a simultaneous increase in time from symptoms to hospital presentation. Aim: The aim of the study was to study the effect of the SARS-CoV-2 outbreak on primary percutaneous coronary intervention (PPCI) volume performed for STEMI, symptom onset to hospital presentation time (symptom-to-door [S2D]), and door-to-balloon time (D2B) at the main nationwide PPCI center in Qatar. Methods: A retrospective evaluation of prospectively collected quality improvement cardiac catheterization data in Qatar was performed. PPCI volume and S2D and D2B time during the outbreak from March 9, 2020, to May 14, 2020, were compared with that of the same period from the prior year and the period immediately preceding the outbreak. Results: Since the SARS-CoV-2 outbreak in Qatar, 137 PPCI procedures were performed. There was a 40% reduction in the volume of PPCI when compared with the period immediately preceding the outbreak and 16% reduction in volume when compared with that of the same period in 2019. The median S2D time was 115 min (interquartile range [IQR: 124]), which was not statistically different from that of the preceding period or the same period in 2019. D2B time during the outbreak increased by an average of 7 min when compared with that of the same period preceding the outbreak (median: 47 min [IQR: 28] during the outbreak vs. median: 40 min [IQR: 21] during the preceding period, P = 0.016). Conclusion: In a statewide PPCI program in Qatar, we observed a mild reduction in PPCI cases during the SARS-CoV-2 outbreak (16% when compared with the same period in 2019), with a modest increase in D2B time. PPCI can be performed effectively during the SARS-CoV-2 outbreak at very high-volume centers with the adoption of strict infection control measures. With proper training and monitoring, both target D2B and hospital staff safety can be achieved.

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Pressured by the enormous human and economic costs of the COVID-19 pandemic, certain countries and political figures have advocated the use of drugs and vaccines that did not go through the required regulatory stages of the development. Although the reason for bypassing these stages in a race to produce a treatment and vaccine for the COVID-19 patients could have been caused by good intentions to stop the human suffering from the pandemic, nonetheless, history has taught us that the results of this action could be catastrophic. In this article, we briefly review the lessons and tragedies in the evolution of human subject research regulations emphasizing the need for the proper evaluation of drugs and vaccines for COVID-19.

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the cause of COVID-19, was first reported in Wuhan, China. SARS-CoV-2 especially involves alveolar epithelial cells, which results in respiratory symptoms more severe in patients with cardiovascular disease (CVD) probably linked with increased secretion of angiotensin-converting enzyme 2 in these patients compared with healthy individuals. Cardiac manifestations may contribute to overall mortality and even be the primary cause of death in many of these patients. A higher prevalence of hypertension (HTN) followed by diabetes mellitus and CVD was observed in COVID-19 patients. A higher case-fatality rate was seen among patients with pre-existing comorbid conditions, such as diabetes, chronic respiratory disease, HTN, and cancer, compared to a lesser rate in the entire population. Cardiovascular (CV) manifestations of COVID-19 encompass a wide spectrum, including myocardial injury, infarction, myocarditis-simulating ST-segment elevation myocardial infarction, nonischemic cardiomyopathy, coronary vasospasm, pericarditis, or stress (takotsubo) cardiomyopathy. This review is intended to summarize our current understanding of the CV manifestations of COVID-19 and also to study the relationship between SARS-CoV-2 and CVDs and discuss possible mechanisms of action behind SARS-CoV-2 infection-induced damage to the CV system.

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Thrombotic complications in patients with coronavirus disease 2019 (COVID-19) infection have been increasingly recognized, particularly those affecting the cardiovascular system. Patients with COVID-19 infection can suffer from increased coagulopathy as well as myocardial injury. In this review, we discuss these complications with special focus on management challenges in patients with acute coronary disease based on the available evidence from published literature.

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Background: The COVID-19 Pandemic has put enormous pressure on the healthcare system globally, causing many healthcare organizations to cancel elective admission for coronary angiograms. The purpose of this study is to assess changes in ST segment elevation myocardial infarction (STEMI) practice, including the number of patients, door to balloon time and time from the onset of symptoms until reperfusion therapy in a tertiary center in Saudi Arabia. Methods: This is a single center retrospective observational study, comparing all STEMI patients in the last five months of 2019 (Pre-COVID-19 period) with the first 5 months of 2020 (COVID -19 period) in regards to the volume of STEMI patients, symptoms onset to ER arrival time, door to balloon timing and the reperfusion therapy strategy. Results: A total number of 173 STEMI patients were analyzed; 81 STEMI patients in the Pre-COVID-19 period and 92 STEMI patients in the COVID-19 period. When compared with pre-COVID period, there was a statistically non-significant increase in STEMI patients (12%), slight delay in the door to balloon timing; 94 vs 87 minutes. As well, there was more delay from onset of symptoms to presentation to the ER (>12 hours from symptoms onset to ER arrival (16% vs, 4% in group 1). Primary percutaneous coronary intervention (PPCI) was the main modality between the 2 groups without significant differences (100% Pre-COVID vs. 97% COVID-19 period). Conclusion: There was some delay of STEMI patient's presentation to the hospital during Covid-19 timing, without significant changes in the medical practice of care.

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Background: The COVID-19 pandemic has caused major disruption in the health care deliveries and activities worldwide including hospital admission. Method: We used hospitals discharged coded data from January 1, 2019 to June 30, 2020 to examine the impact of COVID-19 outbreak on the pattern of cardiovascular admission among Hamad Medical Corporation hospitals in the State of Qatar. Results: In this retrospective observational study, we documented significant changes in the pattern of cardiovascular admissions in our hospitals. There was a significant reduction in hospitalizations of various subsets of cardiac disease. Admissions for acute myocardial infarction dropped by 31%, acute decompensated dropped by 48%, unstable angina dropped by 79% and arrythmia by 80%. Primary percutaneous coronary intervention procedures declined briefly. However, the total deaths remained the same despite the increase in mortality rate due to reduced admissions number. Conclusion: We postulate the fear of contracting the disease and the lock-down mentality during COVID-19 outbreak contribute to reduction of cardiovascular admission to our hospital.

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Patients with chronic heart failure (HF) are among the most vulnerable populations in the COVID era. HF patients infected with COVID-19 are at a significant risk of severe illness and death. They usually present with shortness of breath and radiologic signs of an acute decompensation, which can mask the manifestations of COVID-19. Delay in the diagnosis increases the risk of individual poor outcomes and jeopardizes healthcare workers if protective and isolation measures are not established promptly. Furthermore, the COVID-19 pandemic is forcing health-care systems to modify the delivery of care to patients. Outpatient services are being done virtually, and elective procedures postponed. These may have an impact on the quality of life and survival of chronic HF patients. We present two cases of patients with the previous history of HF who developed an acute exacerbation secondary to COVID-19 infection. In this review, we focused on the main challenges physicians face when dealing with COVID-19 in chronic HF patients at the individual and system levels.

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Review of the literature and reported case series has not reported an increased risk of SARS-CoV-2 infection in heart transplant recipients. However, this population is at increased risk of a more severe infection with increased mortality because of age and the presence of multiple comorbid conditions There is no significant difference in presenting symptoms in transplant recipients as compared to nontransplant patients, although diarrhea has been reported to be more frequent in transplant patients, a common side effect of immunosuppressive medications. Standard preventive measures have been shown to be equally protective in heart transplant recipients. Risk factors for severe disease and mortality are similar in both transplant recipients and nontransplant patients and include older age and the presence of comorbidities hypertension being the most common. The SARS-CoV-2 infection did not increase the risk of transplant allograft rejection. Currently, there are no specific treatment recommendations for SARS-CoV-2 infection in transplant recipients. However, the International Society of Heart and Lung and Transplant has issued guidance on how to modulate immunosuppressive therapy during SARS-CoV-2 infection.

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Coronavirus disease 2019 (COVID-19) is associated with a wide spectrum of cardiovascular (CV) manifestations. Primary cardiac manifestations of COVID-19 disease include acute coronary syndrome (ACS), myocarditis, and arrhythmias. Secondary cardiac involvement is usually due to a systemic inflammatory syndrome and can manifest as acute myocardial injury/biomarker elevation and/or heart failure (congestive heart failure). Elevated cardiac biomarkers indicate an unfavorable prognosis. Health-care systems of the world are rapidly learning more about the manifestations of COVID-19 on the CV system, as well as the strategies for the management of infected patients with CV disease. There is still a paucity of literature on the management of non-ST-segment elevation ACSs in the current literature. Herein, we report the case of a 53-year-old male patient, who presented with severe COVID-19 pneumonia deteriorating into adult respiratory distress syndrome requiring mechanical ventilation. The patient had a history of coronary artery disease. During the course of treatment, he developed sudden cardiac arrest with diffuse ST-segment depression, which was treated by percutaneous coronary intervention to the left anterior descending artery. The patient had a favorable outcome with excellent recovery from the disease.

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The coronavirus disease 2019 (COVID-19) pandemic has strained our healthcare system. Certain changes in practice were mandatory to protect our sonographers who carry a very high risk of being infected, and the patients whom we serve. This article aims to share this experience with you.

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