Patients with CV comorbidities are at increased risk of the more severe presentation and complications of COVID-19. Check renal function when contrast is indicated. Hypertensive patients may also have LV hypertrophy or heart disease and be at increased risk of developing arrhythmias, particularly when hypoxic.192 Plasma potassium levels should be monitored because arrhythmias may be exacerbated by the frequent occurrence of low plasma potassium levels or hypokalaemia that was first noted in SARS coronavirus infection193 and early reports suggests is also prominent in hospitalized COVID-19-infected patients.194 This is thought to be due to increased urinary loss of potassium, which may be exacerbated by diuretic therapy. Of note, some of the investigational drugs for COVID-19 may have relevant interactions with NOACs. CS and OHCA are time-dependent diseases needing relevant resources and optimal trained systems and dedicated networks for optimal outcome. 10. Figure 12 Recommendations for management of patients with NSTE-ACS in the context of COVID-19 outbreak, Figure 13 Management of patients with STEMI during COVID-19 pandemic, Figure 14 Management of patients with cardiogenic shock (CS)/out-of-hospital cardiac arrest (OHCA) during COVID-19 pandemic, Figure 15 Hypertension management in the COVID-19 context, Figure 20 Patient information during the COVID-19 pandemic Part 1, Figure 21 Patient information during the COVID-19 pandemic Part 2, Table 1 Types of diagnostic approaches in COVID-1954, 65; *-still in experimental phase, now available for research; POC â point of care, Table 2 Testing priorities for COVID-19 pandemic according to Center for Disease Control, US, Table 3 General recommendations for Health Care Personnel, with adaption differentiated according to local community level of risk and containment strategies, Table 5 SARS-CoVâ2 related personal protection management73, 81, Table 6 Non-invasive cardiovascular stress testing and imaging tests with the potential for deferral in the light of the COVID pandemic (Reproduced from Gluckman127), Table 7 Impact on the healthcare system and regional involvement in the epidemic, Table 8 Strategical categorization of invasive cardiac procedures during the COVID-19 outbreak, Table 9 Recommendations for fibrinolytic therapy (Extracted from 114), Table 10 Doses of fibrinolytic agents and antithrombotic co-therapies (Extracted from 114), Table 11 Detailed inclusion and exclusion criteria for triage in intensive care unit upon admission (modified from Christian et al)142, Table 12 Criteria for little or no likelihood of benefit with ICU treatment (occurrence of at least 1 criterion), Table 13 Management of chronic coronary syndromes during COVID-19 pandemic, Table 14 Categorization of electrophysiological procedures in the context of COVID-19, Table 15 Arrhythmological considerations of novel experimental pharmacological therapies in COVID-19 infection, Table 16 Interactions of anticoagulant drugs with COVID-19 therapies, Table 17 Concomitant conditions that may be associated with more severe course of SARS-CoVâ2 infection. Therefore, this text reflects a consensus based on limited evidence. Am Heart J 2006; Mueller C, McDonald K, de Boer RA, Maisel A, Cleland JGF, Kozhuharov N, Coats AJS, Metra M, Mebazaa A, Ruschitzka F, Lainscak M, Filippatos G, Seferovic PM, Meijers WC, Bayes-Genis A, Mueller T, Richards M, Januzzi JL, Jr., Heart Failure Association of the European Society of C. Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations. Electrocardiogram abnormalities related to anti-malarials in systemic lupus erythematosus. Dyspnoea (shortness of breath) is one of the typical symptoms in COVID-19. In this context, in order to minimize risk for COVID-19 transmission, the use of telemedicine is highly desirable especially for vulnerable groups, such as older patients. Lip GYH, Coca A, Kahan T, Boriani G, Manolis AS, Olsen MH, Oto A, Potpara TS, Steffel J, Marin F, de Oliveira Figueiredo MJ, de Simone G, Tzou WS, Chiang CE, Williams B, Reviewers, Dan GA, Gorenek B, Fauchier L, Savelieva I, Hatala R, van Gelder I, Brguljan-Hitij J, Erdine S, Lovic D, Kim YH, Salinas-Arce J, Field M. Hypertension and cardiac arrhythmias: a consensus document from the European Heart Rhythm Association (EHRA) and ESC Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLEACE). Lancet Infect Dis 2020; Zeng J, Huang J, Pan L. How to balance acute myocardial infarction and COVID-19: the protocols from Sichuan Provincial People's Hospital. The same solutions already discussed for ICUs are therefore also applicable to intermediate care units. N Engl J Med 2020; Zhao S, Lin Q, Ran J, Musa SS, Yang G, Wang W, Lou Y, Gao D, Yang L, He D, Wang MH. TTE is very important, not only to evaluate pre-existing LV dysfunction in HF, but also to assess patients suspected of having SARS CoV 2-associated myocarditis.153 During all medical procedures, an attention should be given to prevent viral transmission to HCP. Biomed Res Int 2018; U.S. Food and Drug Administration. Burrell LM, Risvanis J, Kubota E, Dean RG, MacDonald PS, Lu S, Tikellis C, Grant SL, Lew RA, Smith AI, Cooper ME, Johnston CI. Prog Cardiovasc Dis 2020. https://doi.org/10.1016/j.pcad.2020.03.001. Despite the lack of definitive evidence on their efficacy, drugs with suspected viricide effect that are being used âoff-labelâ include chloroquine/hydroxychloroquine, protease inhibitors (like lopinavir-ritonavir or, in a minority of cases, darunavir-cobicistat), remdesivir and azithromycin.217-220 In specific cases, interferon and, for the ARDS glucocorticoids and/or tocilizumab, may also be administered.221. Circulation 2018; Gluckman TJ. J Nephrol 2020; Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, Lee M. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. So far no specific ECG changes have been described in patients with SARS-CoVâ2 infection. Although reports are not available for COVID-19, a correlation between increased appropriate ICD therapies and influenza epidemic has been shown.212. Third, in patients with COVID-19 as well as with other pneumonias or patients with ARDS, at this point in time, no specific therapeutic intervention can be justified based on the use of cardiac troponin T/I as a prognostic marker.26,34,66,89,111-113. Eur Heart J 2018; Christ-Crain M, Breidthardt T, Stolz D, Zobrist K, Bingisser R, Miedinger D, Leuppi J, Tamm M, Mueller B, Mueller C. Use of B-type natriuretic peptide in the risk stratification of community-acquired pneumonia. Development of a triage protocol for critical care during an influenza pandemic. Proc Natl Acad Sci U S A 2020; Sheahan TP, Sims AC, Graham RL, Menachery VD, Gralinski LE, Case JB, Leist SR, Pyrc K, Feng JY, Trantcheva I, Bannister R, Park Y, Babusis D, Clarke MO, Mackman RL, Spahn JE, Palmiotti CA, Siegel D, Ray AS, Cihlar T, Jordan R, Denison MR, Baric RS. Allergy 2020. https://doi.org/10.1111/all.14238. Chloroquine has been widely used as an antimalarial drug and in the treatment of rheumatological diseases like systemic lupus erythematosus and rheumatoid arthritis, and has been found to inhibit SARS-CoVâ2 growth in vitro.218-220 Hydroxychloroquine is an analogue of chloroquine with less gastric intolerance and less concerns for drug interactions. J Clin Med 2020; Basille D, Plouvier N, Trouve C, Duhaut P, Andrejak C, Jounieaux V. Non-steroidal Anti-inflammatory Drugs may Worsen the Course of Community-Acquired Pneumonia: A Cohort Study. Association of Renin-Angiotensin System Inhibitors With Severity or Risk of Death in Patients With Hypertension Hospitalized for Coronavirus Disease 2019 (COVID-19) Infection in Wuhan, China. By 10 March 2020, 4296 persons world-wide had died from COVID-19 infection. Characteristics of and Public Health Responses to the Coronavirus Disease 2019 Outbreak in China. Acute Infection and Myocardial Infarction. Figure 1 gives an overview of the evolution of laboratory-confirmed cases of COVID-19 in Europe. Accordingly, a high level of vigilance is necessary to prevent contracting the infection when managing patients using CPAP, when intubation is performed or the transesophageal echocardiogram (TEE) probe is inserted. Respiratory: Many factors can make pregnant women more vulnerable to hard respiratory infections. The susceptibility to the infection and the clinical course of COVID-19 in heart transplant recipients is not known. http://kjfy.meetingchina.org/msite/news/show/cn/3337.html (March 16, 2020; date last accessed). Nat Rev Cardiol 2019; Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, and the Northwell C-RC, Barnaby DP, Becker LB, Chelico JD, Cohen SL, Cookingham J, Coppa K, Diefenbach MA, Dominello AJ, Duer-Hefele J, Falzon L, Gitlin J, Hajizadeh N, Harvin TG, Hirschwerk DA, Kim EJ, Kozel ZM, Marrast LM, Mogavero JN, Osorio GA, Qiu M, Zanos TP. Section 3. Physiol Rev 2018; Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, Somasundaran M, Sullivan JL, Luzuriaga K, Greenough TC, Choe H, Farzan M. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Lancet 2020; Lee IK, Wang CC, Lin MC, Kung CT, Lan KC, Lee CT. For a detailed overview of all known direct or indirect (through drug-drug interactions) arrhythmological effects of experimental pharmacological therapies in COVID-19 patients, see Table 15. If the target time cannot be met and fibrinolysis is not contraindicated, fibrinolysis should then become first line therapy; Consider immediate complete revascularization if indicated and appropriate in order to avoid staged procedures and reduce hospital stay; All physicians involved in the management of patients with, Resource allocation should still try to deliver a standardized team-based approach including availability and feasibility of mechanical circulatory support (. Nat Rev Immunol 2019; Maffia P, Guzik TJ. These treatments are initiated during hospital admission and potential drug-drug interactions are summarized in. Eur Heart J 2020; Yu CM, Wong RS, Wu EB, Kong SL, Wong J, Yip GW, Soo YO, Chiu ML, Chan YS, Hui D, Lee N, Wu A, Leung CB, Sung JJ. Hypertension 2020; Sun ML, Yang JM, Sun YP, Su GH. N Engl J Med 2020. https://doi.org/10.1056/NEJMoa2007621, Bean D, Kraljevic Z, Searle T, Bendayan R, Pickles A, Folarin A, Roguski L, Noor K, Shek A, o'gallagher K, Zakeri R, Shah A, Teo J, Dobson RJB. Grasselli G, Pesenti A, Cecconi M. Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. Angiotensin Receptor Neprilysin Inhibitor for Functional Mitral Regurgitation. This must be observed in order for testing to be reliable and safe for staff and patients. J Infect Dis 2015; de Wilde AH, Jochmans D, Posthuma CC, Zevenhoven-Dobbe JC, van Nieuwkoop S, Bestebroer TM, van den Hoogen BG, Neyts J, Snijder EJ. For known CCS patients, clinical follow-up should be done mostly via tele-health (a dedicated telephone line should be made available to patients). Drug interaction checker. https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak (April 6, 2020; date last accessed). Developed in collaboration with the European Heart Rhythm Association (EHRA). For patients with wide QRS complex (⥠120 ms) due to bundle branch block or ventricular pacing, QTc adjustment is needed. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. By 7 May, 3.67 million had tested positive and more than 250 000 had died.1 The overall case-fatality rate is very country-specific for COVID-19 infection and depending on the phase of the epidemic, testing, registration, demography, healthcare capacity and governmental decisions.2, For most countries, it is uncertain how the registration is organized which makes the comparison of case-fatality rates between countries difficult.
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