Table 1

COVID-19: system wise manifestations and management

System	Features	Investigation	Treatment	Comments
CVS	Palpitation Hypertension Myocarditis Cardiomyopathy may result from myocarditis, profound systemic inflammation and/or microvascular dysfunction.	ECG: diffuse ST-elevations as seen in myopericarditis, nonspecific ST changes, low voltage in the limb leads, and PVCs Cardiac markers: Troponin, NT Pro-BNP, CRP, Ferritin, D-Dimer, IL-6, LDH POCUS.	Stable patients: guideline-directed medical therapy for heart failure. Patients with refractory shock: consider PAC to help guide the use of inotropes, vasopressors or mechanical support (ECMO). Endomyocardial biopsy may have a role in select patients being considered for clinical trials of anti-inflammatory therapy.	SARS Cov-2 uses tissue ACE-2 as receptor. Vascular endothelium and myocardium is affected thus. SARS-CoV-2 can lead to immune cell recruitment and myocarditis. Released cytokines have the potential to trigger cardiomyocyte dysfunction and cardiac depression. ACE inhibitors, ARBs upregulate expression of ACE-2, usage may potentiate risks.
RS	Cough Pneumonitis ARDS	CT chest: ground glass opacities- typically bilateral and peripheral, Ground glass opacities consolidations or cordlike opacities, ‘reverse halo’, ‘crazy-paving’.	Oxygen Ventilation-NIV, invasive ECMO Airway clearance, bronchial hygiene.	Increased pulmonary vascular permeability due to increased production of angiotensin II. Two type of presentations of hypoxia: ARDS with poor lung compliance Non-ARDS inflammatory pulmonary microvascular disease-good lung compliance.
Hemat	Leukopenia, Lymphopenia Thrombocytopenia Microthrombi DIC Covid-19-associated coagulopathy (CAC). Antiphospholipid antibody syndrome like combined artero venous thrombo-inflammation	CAC: Elevations in fibrinogen and D-dimer levels with parallel rise in markers of inflammation (eg, CRP).	Supportive. Blood component therapy should be reserved for those with active bleeding, requiring an invasive procedure, or who are otherwise at high risk for bleeding complications.	Thrombocytopenia may be caused by reduced production, increased destruction, and increased consumption Unlike classic DIC, the degree of aPTT elevation is often less than PT elevation (likely due to increased factor VIII), the thrombocytopenia is mild (platelet count ~100×10⁹/L), and microangiopathy is rare.
Renal	Renal injury Prerenal failure? Azotemia?	Proteinuria Hematuria Acute kidney injury scoring.	Diuretics, Dialysis/CRRT using HCO/MCO membrane, endotoxin removal by polystrene fibers functionalized with polymyxin B1.	Effect on kidneys via- cytokine damage, organ cross-talk and systemic effects of fluid overload, third spacing, hypotension, endothelial damage, rhabdomyolysis, endotoxins.
CNS	Headache, dizziness, impaired consciousness, acute cerebrovascular problems.	EEG CSF study for virus Imaging	Supportive	Possibility of non-convulsive status epilepticus should be ruled out in all critical patients with change on mental status.
GIT	Anorexia, nausea, vomiting, diarrhea, abdominal pain, bleeding.12	Fecal RT-PCR for SARS-COV-2.	Supportive	SARS‐CoV‐2 enters gastrointestinal epithelial cells, and the feces of COVID‐19 patients are potentially infectious. Fecal excretion may persist after sputum becomes negative in patients for 1‐11 days.
General	Sepsis, multiorgan failure Anosmia Petechial rash Papular de squamation.	RT-PCR from nasopharyngeal swab, CT scan chest, inflammatory markers.	Supportive- systemic antiviral/hydroxychloroquin/Immunotherapies (anti IL-6) Surviving sepsis guidelines.	Cytokine release syndrome, cytokine storm causing fever and multiorgan dysfunction Topical anti-inflammatory drugs.
Anti viral Therapy	QTc prolongations Arrythmias Hepatic injury Renal injury.	ECG Liver and renal function tests.	Minimize or use with caution medications that cause further worsening Concerns with coadministrations of ondansetron and antibiotics.	Assess disease severity Correlate with antiviral side effects Decide anesthesia plan accordingly.

ACE, angiotensin converting enzyme; aPTT, activated partial thromboplastin time; ARB, angiotensin receptor blocker; ARDS, adult respiratory distress syndrome; CNS, central nervous system; CRP, C reactive protein; CRRT, continuous renal replacement therapy; CSF, cerebrospinal fluid; CVS, cardio vascular system; DIC, disseminated intravascular coagulation; ECG, electrocardiogram; ECMO, extracorporeal membrane oxygenation; EEG, electro encephalogram; GIT, gastrointestinal tract; HCO/MCO, high cut-off/ medium cut-off; IL-6, interleukin-6 ; LDH, lactate dehydrogenase; NIV, non-invasive ventilation; NT Pro-BNP, N terminal pro hormone brain natriuretic peptide; POCUS, point-of-care ultrasound; PT, prothrombin time; PVC, premature ventricular complex; RS, respiratory system; RT-PCR, reverse transcription polymerase chain reaction; SARS-COV-2, severe acute respiratory syndrome coronavirus-2.