scholarly journals Cardiac Echocardiography in COVID-19 Infection

2020 ◽  
Vol 04 (01) ◽  
pp. 56-60
Author(s):  
Rohan Kapur ◽  
Naveen Garg ◽  
K. K. Kapur ◽  
Pranav Kapoor ◽  
Poonam Malhotra Kapoor

AbstractThe novel COVID-19 disease mainly affects respiratory organs; however, involvement of cardiovascular system is also not uncommon. Cardiac involvement can manifest as myocarditis, heart failure, myocardial infarction, pulmonary embolism, or arrhythmias in COVID-19 patients. This novel Coronavirus enters into the cells of the human body by binding to ACE-2 receptors which are predominantly present on pneumocytes and cardiomyocytes. The damage to myocardium is manifested by the increase in cardiac enzymes such as troponin-I, CK-MB, and NT pro-BNP. Although echocardiogram is an important tool in the cardiac evaluation of COVID-19 patients, its indiscriminate use is discouraged, owing to the risk of transmission to echocardiography service providers, as well as possible risk of contaminating echocardiography equipment. In this article, we discuss the different mechanisms and cardiac manifestations of COVID-19. We also review the current guidelines for echocardiography evaluation of COVID-19 patients as well as current recommendations on safety of echocardiography personnel and equipment against contamination. We also include our experience of two cases in which COVID-19 affliction of heart was strongly suspected, and echocardiography clinched the diagnosis.

Author(s):  
Soraya Shadmanfar ◽  
Maryam Masoumi ◽  
Fereydoun Davatchi ◽  
Massoomeh Akhlaghi ◽  
Seyedeh Tahereh Faezi ◽  
...  

Background: Behcet’s disease (BD) is a vasculitis with multisystem and multiorgan involvement. Cardiac involvement in BD is a rare complication with a poor outcome that manifests itself in different forms. In this study, we aimed to investigate cardiac involvement in BD.  Methods: This is a retrospective study based on cardiac manifestations in BD according to the data of the Behçet’s Disease Unit, the Rheumatology Research Center, Tehran University of Medical Sciences, from registered patients from 1975 until June 2017. Cardiac manifestations consisted of pericarditis, myocardiopathy, myocardial infarction, stable ischemic heart disease, endomyocardial fibrosis, thrombosis, and valvular and coronary involvement. All the patients’ baseline and demographic data were recorded in a designed questionnaire. The laboratory workups, imaging, and pathological tests were also performed.      Results: We studied 7650 patients with BD, of whom 51% were male. In the entire study population, 47 patients manifested cardiac involvement: valvular involvement in 6.1%, myocardial infarction in 23.4%, stable ischemic heart disease in 20%, pericarditis in 21.3%, intracardiac thrombosis in 2.1%, coronary aneurysm in 2.1%, heart failure in 12.8%, and dilated cardiomyopathy in 4.3%. Conclusion: The prevalence of cardiac involvement in our patients with BD was 0.6%. A multidisciplinary approach can reduce mortality and morbidity rates. Consequently, we suggest that echocardiography and other cardiac diagnostic tests be routinely considered for early diagnosis and subsequent treatment.


2020 ◽  
Vol 63 (7) ◽  
pp. 239-250 ◽  
Author(s):  
Kyung-Yil Lee ◽  
Jung-Woo Rhim ◽  
Jin-Han Kang

The novel coronavirus disease 2019 (COVID-19) is spreading globally. Although its etiologic agent is discovered as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), there are many unsolved issues in COVID-19 and other infectious diseases. The causes of different clinical phenotypes and incubation periods among individuals, species specificity, and cytokine storm with lymphopenia as well as the mechanism of damage to organ cells are unknown. It has been suggested that in viral pneumonia, virus itself is not a direct cause of acute lung injury; rather, aberrant immune reactions of the host to the insults from viral infection are responsible. According to its epidemiological and clinical characteristics, SARS-CoV-2 may be a virus with low virulence in nature that has adapted to the human species. Current immunological concepts have limited ability to explain such unsolved issues, and a presumed immunopathogenesis of COVID-19 is presented under the proteinhomeostasis-system hypothesis. Every disease, including COVID-19, has etiological substances controlled by the host immune system according to size and biochemical properties. Patients with severe pneumonia caused by SARS-CoV-2 show more severe hypercytokinemia with corresponding lymphocytopenia than patients with mild pneumonia; thus, early immunomodulator treatment, including corticosteroids, has been considered. However, current guidelines recommend their use only for patients with advanced pneumonia or acute respiratory distress syndrome. Since the immunopathogenesis of pneumonia may be the same for all patients regardless of age or severity and the critical immune-mediated lung injury may begin in the early stage of the disease, early immunomodulator treatment, including corticosteroids and intravenous immunoglobulin, can help reduce morbidity and possibly mortality rates of older patients with underlying conditions.


Kardiologiia ◽  
2021 ◽  
Vol 61 (10) ◽  
pp. 26-35
Author(s):  
I. V. Kovtyukh ◽  
G. E. Gendlin ◽  
I. G. Nikitin ◽  
A. M. Baymukanov ◽  
A. E. Nikitin ◽  
...  

Background     Heart damage is one of complications of the novel coronavirus infection. Searching for available predictors for in-hospital death and survival that determine the tactic of managing patients with COVID-19, is a challenge of the present time.Aim      To determine the role echocardiographic (EchoCG) parameters in evaluation of the in-hospital prognosis for patients with the novel coronavirus infection, COVID-19.Material and methods  The study included 158 patients admitted for COVID-19. EchoCG was performed for all patients. The role of left ventricular (LV) ejection fraction (EF) was analyzed in various age groups. EchoCG data were compared with the clinical picture, including the severity of respiratory failure (RF), blood oxygen saturation (SрО2), data of computed tomography (CT) of the lungs, and blood concentration of troponin. Comorbidity was analyzed, and the highest significance of individual pathologies was determined.Results LV EF ≤40 % determined the worst prognosis of patients with COVID-19 (p<0.0001), including the age group older than 70 years (р=0.013). LV EF did not correlate with the degree of lung tissue damage determined by CT upon admission (р=0.54) and over time (р=0.23). The indexes that determined an adverse in-hospital prognosis to a considerable degree were pericardial effusion (p<0.0001) and pulmonary hypertension (p<0.0001). RV end-diastolic dimension and LV end-diastolic volume did not determine the in-hospital mortality and survival. Blood serum concentration of troponin I higher than 165.13 µg/l was an important predictor for in-hospital death with a high degree of significance (р<0.0001). Th degree of RF considerably influenced the in-hospital mortality (р<0.0001). RF severity was associated with LV EF (р=0.024). The SpO2 value determined an adverse immediate prognosis with a high degree of significance (р=0.0009). This parameter weakly correlated with LV EF (r=0.26; p=0.0009). Patients who required artificial ventilation (AV) constituted a group with the worst survival rate (р<0.0001). LV EF was associated with a need for AV with a high degree of significance (р=0.0006). Comorbidities, such as chronic kidney disease, postinfarction cardiosclerosis and oncologic diseases, to the greatest extent determined the risk of fatal outcome.Conclusion      EchoCG can be recommended for patients with COVID-19 at the hospital stage to determine the tactics of management and for the in-hospital prognosis.


Author(s):  
Usung Isaac Akpan

Following the novel coronavirus disease 2019 (COVID-2019) pandemic, both public and private sectors have put in place a number of measures, including those affecting workplaces, to fight the spread of the disease. The world of work is severely affected during this crisis, therefore, all sections of society including businesses, employers and social partners must play a role in order to protect workers, their families and society at large. The nature and extent of the restrictions and lockdown milestones, such as on suspension of non-essential activities, differ between service providers and different sectors , but a substantial proportion of workers either have to work from home, or if their work cannot be performed at a distance, they stay at home often under an income replacement arrangement. Drawing from this experience, various organisations have decided to restructure their workforce work routine which necessitate my curiosity to ponder and its application in the Nigerian context as it affects working from home philosophy. KEYWORDS: pandemic, employees, social distance, working from home, corona virus, workforce.


2021 ◽  
Vol 13 (1) ◽  
pp. 251-258
Author(s):  
Davide Roberto Donno ◽  
Ignazio Grattagliano ◽  
Alessandro Rossi ◽  
Pierangelo Lora Aprile ◽  
Gerardo Medea ◽  
...  

The impact of the coronavirus disease (COVID-19), caused by the novel coronavirus SARS-CoV-2, continues to be widespread, with more than 100 million cases diagnosed in more than 220 countries since the virus was first identified in January 2020. Although patients with mild to moderate forms of COVID-19 could be efficiently managed at home, thus reducing the pressure on the healthcare system and minimizing socio-psychological impact on patients, no trial has been proposed, conducted, or even published on COVID-19 home therapy to date. These expert opinions provide indications on the therapeutical at home management of COVID-19 patients, based on the evidence from the literature and on current guidelines.


2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e97-e98
Author(s):  
Sarah Gander ◽  
Kate Flood ◽  
Sarah Campbell ◽  
Katie Bonner

Abstract Primary Subject area Social Paediatrics Background The novel coronavirus (COVID-19) pandemic is a major global threat that emerged in 2020. Many countries have enacted policies such as mandatory school closures, business closures, and self-quarantining to keep people at home and prevent further spread of the virus. Previous research has shown that pandemics and subsequent disease containment measures negatively affect children and families, both psychosocially and economically. Objectives The current study explores the potential psychosocial impacts of the COVID-19 pandemic and subsequent disease containment measures on a number of domains (employment/business, education, finances, medical care, access to medication, technology, children/family, access to community services) through an online survey. The current abstract focuses on the emotional well-being of children and how families have been affected by the restrictions and changes related to the COVID-19 pandemic. Design/Methods Participants were asked to complete an online survey through a secure portal. The survey consisted of questions about household demographics and socio-economic status (SES), as well as five psychometric scales measuring satisfaction with life, psychological well-being, anxiety, depression, and substance use, and specific questions about how the COVID-19 pandemic has impacted respondents’ daily lives in the previously identified domains. This is the first of four longitudinal surveys that will be conducted throughout this study. Results A total of 571 participants completed the survey. Of these participants, 41.3% identified as being a parent or guardian with children under 18. The focus of this abstract is the subset of respondents with children. Roughly three quarters of participants identified that their children were emotionally impacted by COVID-19, the school closures, or missing friends or family (Yes = 46.6%; Somewhat = 30.5%). Parents also reported loss of access to childcare, disruptions to their visits with their children living outside the home, and feeling like they could not access timely medical care for their children. Demographic information and other relevant responses and information can be found in Tables 1 and 2, respectively. Conclusion The impacts of the COVID-19 pandemic will be felt for years to come and will shape an entire generation of children. Even in the current sample, which consisted largely of individuals from medium-high SES households, most reported that children had been impacted emotionally. Understanding and mitigating the impact on children and adapting resources in the short term and the long-term to meet the growing needs of our communities must be top priorities for pediatricians and community service providers.


2018 ◽  
Vol 64 (9) ◽  
pp. 1347-1360 ◽  
Author(s):  
Jasper Boeddinghaus ◽  
Raphael Twerenbold ◽  
Thomas Nestelberger ◽  
Patrick Badertscher ◽  
Karin Wildi ◽  
...  

Abstract BACKGROUND Clinical performance of the novel high-sensitivity cardiac troponin I (Siemens-hs-cTnI-Centaur) assay is unknown. We aimed to clinically validate the Siemens-hs-cTnI-Centaur assay and develop 0/1-h and 0/2-h algorithms. METHODS We enrolled patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction (AMI). Final diagnoses were centrally adjudicated by 2 independent cardiologists including all clinical information twice: first, using serial hs-cTnT (Roche-Elecsys, primary analysis); second, using hs-cTnI (Abbott-Architect, secondary analysis) measurements in addition to the clinically applied (hs)-cTn. Siemens-hs-cTnI-Centaur was measured at presentation, 1 h, and 2 h. The primary objective was a direct comparison of diagnostic accuracy, quantified by the area under the ROC curve (AUC), of Siemens-hs-cTnI-Centaur vs the 2 established hs-cTn assays (Roche-hs-cTnT-Elecsys, Abbott-hs-cTnI-Architect). Secondary objectives included the development of Siemens-hs-cTnI-Centaur-specific 0/1-h and 0/2-h algorithms. RESULTS AMI was the final diagnosis in 318 of 1755 (18%) patients (using Roche-hs-cTnT-Elecsys for adjudication). The AUC at presentation for Siemens-hs-cTnI-Centaur was 0.94 (95% CI, 0.92–0.96) and comparable with 0.95 (95% CI, 0.93–0.97) for Roche-hs-cTnT-Elecsys and 0.93 (95% CI, 0.90–0.96) for Abbott-hs-cTnI-Architect. Applying the derived Siemens-hs-cTnI-Centaur 0/1-h algorithm to the validation cohort, 46% of patients were ruled out (sensitivity, 99.1%; 95% CI, 95.3–100), and 18% of patients were ruled in (specificity, 94.1%; 95% CI, 91.8–95.9). The Siemens-hs-cTnI-Centaur 0/2-h algorithm ruled out 55% of patients (sensitivity, 100%; 95% CI, 94.1–100), and ruled in 18% of patients (specificity, 96.0%; 95% CI, 93.1–97.9). Findings were confirmed in the secondary analyses using serial measurements of Abbott-hs-cTnI-Architect for adjudication. CONCLUSIONS Diagnostic accuracy and clinical utility of the novel Siemens-hs-cTnI-Centaur assay are high and comparable with the established hs-cTn assays. ClinicalTrials.gov Identifier: NCT00470587


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Boeddinghaus ◽  
T Nestelberger ◽  
R Twerenbold ◽  
L Koechlin ◽  
D Wussler ◽  
...  

Abstract Background Lately, the novel high-sensitivity cardiac troponin I (hs-cTnI) Access assay was developed. Its clinical performance in patients presenting with chest pain to the emergency department (ED) is unknown. Purpose To clinically validate the novel hs-cTnI-Access assay and to derive and validate an assay specific 0/1h-algorithm accordingly to the European Society of Cardiology (ESC) recommendations. Methods In a prospective international multicentre study we enrolled patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction (AMI). Final diagnoses were centrally adjudicated by two independent cardiologists including all clinical information including cardiac imaging twice: first, using serial hs-cTnT (Elecsys, primary analysis) and second, using hs-cTnI (Architect, secondary analysis) measurements in addition to the clinically used (hs)-cTn. Hs-cTnI-Access was measured at presentation and at 1h. Primary objective was a direct comparison of diagnostic accuracy as quantified by the area under the receiver-operating-characteristic curve (AUC) of hs-cTnI-Access versus the two established hs-cTn assays (hs-cTnT-Elecsys, hs-cTnI-Architect). Secondary objectives included the derivation and internal validation of an hs-cTnI-Access specific 0/1h-algorithm. Results AMI was the adjudicated final diagnosis in 243/1579 (15.4%) patients. The AUC at presentation for hs-cTnI-Access was 0.95 (95% CI, 0.94–0.96), significantly higher as hs-cTnI-Architect (0.92 [95% CI, 0.91–0.94; p<0.001]), and comparable to hs-cTnT-Elecsys (0.94 [95% CI, 0.93–0.95; p=0.12]) Applying the derived hs-cTnI-Access 0/1h-algorithm (derivation cohort n=686) to the internal validation cohort (n=680), 60% of patients were ruled-out (sensitivity 98.9% [95% CI, 94.3–99.8]), and 15% of patients were ruled-in (specificity 95.9% [95% CI, 94.0–97.2]). Patients ruled-out by the 0/1h-algorithm had a survival rate of of 100% after 30-days and 98.4% after two years of follow up. Findings were confirmed in the secondary analyses using the adjudication including serial measurements of hs-cTnI (Architect). Performance of the 0/1h-algorithm Conclusions Diagnostic accuracy of the novel hs-cTnI-Access assay is excellent and at least comparable to the two established hs-cTn assays. The assay-specific 0/1h-algorithm allows a safe rule-out and accurate rule-in of MI in about 75% of patients within 1-hour after presentation to the ED. Survival of patients ruled-out by the 0/1h-algorithm was very high. Acknowledgement/Funding Swiss National Science Foundation, the Swiss Heart Foundation, the KTI, the European Union, the Stiftung für kardiovaskuläre Forschung Basel


2020 ◽  
Vol 14 (3) ◽  
pp. 384-386 ◽  
Author(s):  
Yun-Jung Kang

ABSTRACTOn December 31, 2019 the China National Health Commission (NHC) reported that an unknown cause of pneumonia had been detected in Wuhan in Hubei province. On February 12, the disease caused by the novel coronavirus (2019-nCoV) was given a formal name, COVID-19. On January 20, 2020, the first case of COVID-19 was confirmed in Korea. The age-specific death rate was the highest among patients over 70 years of age, with underlying diseases in their circulatory system, such as myocardial infarction, cerebral infraction, arrythmia, and hypertension. Patients with underlying disease who are 70 years of age or older should recognize that there is a high possibility of developing a serious disease in case of viral infection and follow strict precautions.


2010 ◽  
Vol 30 (7) ◽  
pp. 782-785 ◽  
Author(s):  
Chun-Chi Lin ◽  
Dong-Haur Phua ◽  
Jou-Fang Deng ◽  
Chen-Chang Yang

Introduction: Cardiotoxicity in acute aconitine intoxication is well known; however, elevation of troponin I level and abnormal scintigraphy findings had not previously been reported. Case report: A 60-year-old man developed chest tightness, syncope and convulsion after ingesting processed Aconitum carmichaeli (Chuanwu) extract for treatment of headache. Electrocardiogram showed first degree atrioventricular (AV) block. Troponin I level was elevated at 14.8 ng/mL 13 hours post-ingestion. Creatine kinase was also increased to 414 U/L. However, echocardiography did not show any abnormal cardiac wall motion. Tc-99m-PYP scintigraphy revealed diffusely increased uptake in the myocardium, suggesting the presence of myocardial necrosis or myocarditis. Discussion: Aconitine poisoning can mimic acute myocardial infarction with chest tightness and elevated cardiac enzymes. Increased cardiac markers and myocardial insult seen in this patient were likely to be related to the toxicity of aconitine. Care should be taken in making the diagnosis in such instances. Management is primarily supportive.


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