LAUSR

To the editor, The article ‘COVID-19 and cardiac injury: clinical manifestations, biomarkers, mechanisms, diagnosis, treatment and follow up,’ outlines, in a general manner, much of the evidence that we have until this moment, to update the information on how the SARS-CoV-2 virus can cause severe heart disease, or even worsen existing ones. The study also concludes that patients with previous cardiovascular diseases prior to the COVID-19 infection have an extremely bad prognosis, having higher risks of complications and death.[1] As reported, 12% of the patients with COVID-19 presents acute heart injuries. One of the popular complications of the virus is severe congestive heart failure, and ultimately, sudden cardiac death, this happens due to the injury that the virus causes to the pulmonary vascular beds, which naturally leads to an imbalance in the pulmonary perfusion on the context of pulmonary ventilation, this consequently contributes to a pulmonary hypertension and pulmonary heart disease. These cascades of events result in a direct heart failure.[2] According to a study by Goldraich et al., patients who arrive at the hospital with CHF, must be tested for SARS-Cov-2 as there may be an overlap in the symptoms of these diseases, and besides laboratory evaluation, echocardiography and radiography might be requested as complementary exams. The study also quotes that the blood pressure and the hemodynamics of the patient must be preserved because covid can present as systemic inflammation and these vasodilators are able to worsen the condition eventually.[3] Furthermore, strategies as telemedicine and online appointments can be allies in the control of chronic HF and in the prevention of infections. In this context, the means of practicing nonconventional medicine, mentioned before, are imperative in the pandemic scenario, as it has been described in the study ‘decreases in acute heart failure hospitalizations during COVID-19’ a reduction in the number of hospital admissions due to HF during this period, which is related to people’s fear of being contaminated in hospital environments. Therefore, the number of treated HF cases has decreased. However, the prevalence of severe cases has increased, which leads to a possible postponement when seeking medical care, by looking for it only when the case is of a high severeness. Thereupon, by using telemedicine and online care it is possible to treat light/mild cases early without risk of contamination, thus avoiding a progression to severe stages of the disease.