ABC | Volume 114, Nº5, May 2020

Review Article Abstract In face of the pandemic of the novel coronavirus disease 2019 (COVID-19), the management of patients with cardiovascular risk factors and/or disease is challenging. The cardiovascular complications evidenced in patients with COVID-19 derive from several mechanisms, ranging from direct viral injury to complications secondary to the inflammatory and thrombotic responses to the infection. The proper care of patients with COVID-19 requires special attention to the cardiovascular system aimed at better outcomes. Introduction Currently the world faces the pandemic of the novel coronavirus disease 2019 (COVID-19), which emerged in December 2019 in the city of Wuhan, province of Hubei, in China. 1,2 The initial cases were described as pneumonia that rapidly progressed to acute respiratory distress syndrome (ARDS). This novel virus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the seventh coronavirus identified so far and differs from the other coronaviruses that cause common cold and mild pneumonia (229E, OC43, NL63 and HKU1). The SARS-CoV-2 is similar to the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV), responsible for the infections occurring in China in 2002- 2003 and in the Middle East in 2012, respectively. 1,2 Despite the phylogenetic similarities between SARS-CoV-2 and the zoonotic coronaviruses that caused SARS and MERS, the SARS-CoV-2 spread is much higher, contributing to an infection dissemination ten times faster than that of the SARS-CoV. 2-4 The basic reproduction number (R0) of COVID-19 is 2.78, meaning that, on average, each individual infected can transmit the disease to three others. 5 A study recently published in Science has stated, by use of a mathematical model, that 85% of the COVID-19 transmissions occur from asymptomatic individuals. 6 Because of its fast dissemination, COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. 4 At the current time, COVID-19 affects more than 181 countries and the number of cases keeps increasing exponentially. Up to April 2, 2020, 1,015,403 cases and 53,030 deaths had been registered around the world, yielding a lethality of 5.2%. Up to that same date, 8,044 confirmed cases and 324 deaths had been registered in Brazil, with a mortality of 4%. Initial Brazilian data have shown 90% of the deaths occurring among individuals aged over 60 years and 84% of the patients with at least one comorbidity, 51% with cardiovascular disease (CVD) and 37.7% with diabetes. 7 The analysis of 44,672 confirmed cases of COVID-19 in Wuhan has evidenced an overall case-fatality rate of 2.3%; however, among those with preexisting comorbidities, the case- fatality rate was higher: 10.5% for CVD, 7.3% for diabetes and 6% for hypertension. 8 In addition, cardiovascular complications due to COVID-19, such as myocardial injury (20% of the cases), arrhythmias (16%), myocarditis (10%), heart failure (HF) and shock (up to 5% of the cases), have been reported. 9-11 This review was aimed at aiding healthcare professionals (clinicians, emergencists, cardiologists and intensivists) involved in the care of patients with COVID-19, proposing an Keywords Coronavirus; COVID-19; Cardiovascular Diseases/ complications; Heart/physiopathology; Pandemics; Respiratory Distress Syndrome, Adult; Risk Factors; Patient Care. Mailing Adddress: Ludhmila Abrahão Hajjar • Universidade de São Paulo Instituto do Câncer do Estado de São Paulo – Av. Dr. Arnaldo, 251. CEP 01246-000, São Paulo, SP – Brazil E-mail: ludhmila@usp.br Manuscript received April 03, 2020, revised manuscript April 03, 2020, accepted April 03, 2020 DOI: https://doi.org/10.36660/abc.20200279 The Heart and COVID-19: What Cardiologists Need to Know Isabela Bispo Santos da Silva Costa, 1,2 Cristina Salvadori Bittar, 1,2 Stephanie Itala Rizk, 1,2 Antônio Everaldo de Araújo Filho, 1 Karen Alcântara Queiroz Santos, 1 Theuran Inahja Vicente Machado, 1 Fernanda Thereza de Almeida Andrade, 1 Thalita Barbosa González, 1 Andrea Nataly Galarza Arévalo, 1 Juliano Pinheiro de Almeida, 1 Fernando Bacal, 2 Gláucia Maria Moraes de Oliveira, 3 Marcus Vinícius Guimarães de Lacerda, 4 Silvio Henrique Barberato, 5,6 Antonio Carlos Palandri Chagas, 2,7 Carlos Eduardo Rochitte, 2,8 José Antonio Franchini Ramires, 2 Roberto Kalil Filho, 2 Ludhmila Abrahão Hajjar 1,2 Universidade de São Paulo - Instituto do Câncer do Estado de São Paulo, 1 São Paulo, SP - Brazil Universidade de São Paulo Instituto do Coração, 2 São Paulo, SP - Brazil Universidade Federal do Rio de Janeiro – Cardiologia, 3 Rio de Janeiro, RJ - Brazil Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, 4 Manaus, AM - Brazil CardioEco Centro de Diagnóstico Cardiovascular, 5 Curitiba, PR - Brazil Quanta Diagnóstico – Ecocardiografia, 6 Curitiba, PR - Brazil Faculdade de Medicina da Fundação do ABC, 7 Santo André, SP - Brazil Hospital do Coração, 8 São Paulo, SP – Brazil 805