Coronavirus disease 2019 (COVID-19) first emerged in a group of patients who presented with severe pneumonia in Wuhan, China, in December 2019. A novel virus, now called SARSCoV- 2 (Severe Acute Respiratory Syndrome Coronavirus-2), was isolated from lower respiratory tract samples. The current outbreak of infection has spread to over 100 countries and killed more than 340,000 people as of 25th May, 2020. The predominant clinical manifestation of COVID-19 is a respiratory disease- ranging from mild flu-like symptoms to fulminant pneumonia and Acute Respiratory Distress Syndrome (ARDS). Patients with pre-existing cardiovascular risk factors are considered more susceptible to the virus, and these conditions are often worsened by the infection. Furthermore, COVID-19 infection has led to de novo cardiac complications, like acute myocardial injury and arrhythmias. In this review, we have focused on the cardiovascular manifestations of COVID-19 infection that have been reported in the literature so far. We have also outlined the effect of pre-existing cardiovascular disease as well as risk factors on the clinical course and outcomes of COVID-19 infection.

Cardiac conduction disturbances such as left bundle branch block (LBBB) and atrioventricular blocks (AVB) occur frequently following transcatheter aortic valve replacement (TAVR) and may be associated with adverse clinical events. There is a lack of consensus regarding permanent pacemaker implantation in the case of occurrence of TAVR-related bundle branch blocks or combination of AVB and bundle blocks. Furthermore, there are no guidelines regarding the use of the leadless pacemaker in this setting. We present a patient who underwent successful implantation of a leadless pacemaker for a new LBBB post-TAVR.

The management of postprocedure severe aortic periprosthetic regurgitation after transcatheter aortic valve replacement (TAVR) is unknown. While valve-in-valve TAVR has been associated with favorable outcomes for degenerative surgically implanted bioprosthetic valves, there are no evidence-based guidelines for immediate TAVR valve in TAVR valve for periprosthetic regurgitation. We present a patient who underwent a TAVR valve in TAVR valve implantation within 48 h of her first procedure and showed a good response.

Anthracyclines are cornerstone chemotherapeutic agents for several cancers but carry a substantial risk of cardiotoxicity. Multiple cardioprotective drugs have been investigated to prevent cardiac dysfunction in patients receiving anthracycline-based chemotherapy. This study evaluated and ranked the cardioprotective effects of these agents using network meta-analysis. A comprehensive search of PubMed, Cochrane, Scopus, and Web of Science from inception to September 22, 2024 identified randomized clinical trials and cohort studies assessing cardioprotective agents in cancer patients treated with anthracyclines. Interventions included angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists, statins, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and metformin. The primary outcome was change in left ventricular ejection fraction (LVEF). Secondary outcomes were left ventricular end-diastolic diameter (LVEDD), chemotherapy-related cardiac dysfunction (CTRCD), heart failure (HF), HF hospitalization, and all-cause mortality. Thirty-five studies were included, comprising 31 randomized controlled trials and 4 retrospective studies. Overall, cardioprotective therapy significantly improved LVEF, reduced CTRCD, all-cause mortality, HF incidence, and LVEDD, but had no significant effect on HF hospitalization. Subgroup and network meta-analyses showed that ACEIs plus beta-blockers, beta-blockers alone, statins, and ACEIs significantly improved LVEF versus controls, with ACEIs ranking highest. For CTRCD prevention, statins and beta-blockers significantly reduced risk, whereas ACEIs plus beta-blockers had the most favorable ranking. For mortality, the available retrospective SGLT2 inhibitor studies suggested an association with lower risk; however, because no randomized anthracycline-specific SGLT2 inhibitor trials were available and follow-up duration differed from the RCT evidence for other agents, this finding should be considered hypothesis-generating rather than definitive comparative evidence. ACEIs, beta-blockers, and statins appear effective for preserving cardiac function during anthracycline therapy. Treatment rankings, particularly for outcomes supported by sparse or observational evidence, should be interpreted cautiously, and further randomized trials are needed, particularly to evaluate SGLT2 inhibitors.