Read on Twitter
Cardiology thread:
In heart pts, flu can cause heart attacks/worsen heart failure/predispose to pneumonia. #COVID19 may be no different. Heart pts are more likely to have severe Covid infection than others, esp elderly/post-transplant/cardiomyopathy pts https://www.nature.com/articles/s41569-020-0360-5
1/
In heart pts, flu can cause heart attacks/worsen heart failure/predispose to pneumonia. #COVID19 may be no different. Heart pts are more likely to have severe Covid infection than others, esp elderly/post-transplant/cardiomyopathy pts https://www.nature.com/articles/s41569-020-0360-5
1/
#COVID19 can PRESENT as cardiac issue: STEMI with near/normal coronaries, Cardiogenic shock needing circulatory support, heart failure/sev LV dysf (?myocarditis), Atrial fibrillation, decompensation of prior CHF, arrhythmias due to HCQS/azithro etc https://www.medpagetoday.com/infectiousdisease/covid19/85520
2/
2/
Heart disease/diabetes/HT pts have higher mortality with Covid. These factors are clustered in elderly. Whether 
mortality is due to old age or comorbidities is not resolved. Data suggests mortality in Covid pts with myocardial injury by Trop/ECG
https://jamanetwork.com/journals/jamacardiology/fullarticle/2763844?resultClick=1
3/
mortality is due to old age or comorbidities is not resolved. Data suggests mortality in Covid pts with myocardial injury by Trop/ECGhttps://jamanetwork.com/journals/jamacardiology/fullarticle/2763844?resultClick=1
3/
Principles in cardiac emergency:
1. Transmission control & HCW protection is top concern
2. Assess for both Covid & cardiac problems & treat both concomitantly
3. Interventions to be deferred unless life-threatening
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.047011
4/
1. Transmission control & HCW protection is top concern
2. Assess for both Covid & cardiac problems & treat both concomitantly
3. Interventions to be deferred unless life-threatening
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.047011
4/
During Covid pandemic no routine hospital visits for cardiac/diabetic/HTN. Video consults (WhatsApp/FaceTime even if no dedicated software) encouraged. All routine interventions incl CTOs/structural heart to be deferred unless life-saving
Tips:
5/
Tips:
5/
Recent controversy on ACEI/ARB use in hypertensives during Covid pandemic has backers for both harms & benefits. But, evidence for harm are so tenuous that most experts/societies advice continuation of these drugs unless new data emerges
6/
6/
Pt presenting with breathlessness, NSTEMI & STEMI to be managed as if Covid+ unless otherwise proven by test. HCWs to wear appropriate protective gear (including PPE for urgent interventions). Nebulisation/NIV to be avoided. If sats <90% intubate/ventilate rather than wait
7/ https://twitter.com/kambismashayek1/status/1245974819545456640
7/ https://twitter.com/kambismashayek1/status/1245974819545456640
NSTEMI: manage conservatively unless hemodynamic instability or severe ongoing ischemia. Risk assessment & intervention to be electively done later. In pts with primarily non-cardiac presentations, avoid measuring Troponin: Type 2 NSTEMI should stay out of the lab at any cost
8/
8/
Routine follow-up echoes to be avoided. If echo is imperative, echocardiographer shud don PPE & preferably perform study from left side of the pt to minimise contact.
Non-essential TEE should be totally avoided during Covid pandemic: https://www.asecho.org/wp-content/uploads/2020/04/COPE_COVID_Supplement_FINAL.pdf
Other imaging:
9/ https://twitter.com/geraldmaurer/status/1246481275352989696
Non-essential TEE should be totally avoided during Covid pandemic: https://www.asecho.org/wp-content/uploads/2020/04/COPE_COVID_Supplement_FINAL.pdf
Other imaging:
9/ https://twitter.com/geraldmaurer/status/1246481275352989696
Off-label use of Hydroxychloroquine for prevention or treatment of Covid is not based on robust evidence. Potential toxicity of HCQS & chloroquine should be discussed with pt if prescribed or if demanded by patient
https://amp.scroll.in/pulse/957938/death-of-assam-doctor-raises-questions-about-malaria-drug-recommended-for-covid-19-health-workers
10/
https://amp.scroll.in/pulse/957938/death-of-assam-doctor-raises-questions-about-malaria-drug-recommended-for-covid-19-health-workers
10/
Cardiac arrest in suspected Covid infection:
11/11 https://twitter.com/circaha/status/1248250318158090244
11/11 https://twitter.com/circaha/status/1248250318158090244
