This document discusses the management of cardiovascular disease (CVD) during the COVID-19 pandemic. It notes that CVD patients have a higher risk of severe COVID-19 and complications. While the symptoms of CVD and COVID-19 can be similar, timely management of CVD emergencies is important. The document recommends a pharmacoinvasive strategy over primary PCI for STEMI patients when possible. It also provides guidance on managing other conditions like NSTEMI, heart failure and arrhythmias during the pandemic. Telemedicine is encouraged for stable patients to reduce hospital visits and risk of COVID-19 exposure.

1. Dr. Nagula Praveen, MD, DM
Assistant Professor of Cardiology,
Osmania General Hospital,
Hyderabad
drpraveennagula@gmail.com
twitter: @kizashipraveen

2. Agenda
Introduction
COVID pandemic
Management of CVD
Prevention

4. COronaVIrusDisease 2019 (COVID)
Closely related to SARS
NOVEL CORONA VIRUS

5. Corona virus family
 Latin for crown, greek for garland
 Enveloped, positive sense, single stranded RNA viruses
 Peplomers or spikes on the surface
 Usually mild infections – common cold
 SARS, MERS, COVID 19 – lethal

8. Indian Perspective

9. Why CVD to be worried in COVID
times?
10.8% IN MORTALITY (3.4% USUALLY)

10.  Both have similar symptoms
 CV diseases usually are emergencies when presented to ED
 Appropriate effective timely management is important to combat the
consequences if not treated (TIME IS MUSCLE, TIME IS LIFE)
 HCP and patients are at risk of COVID
 CVD and its risk factors – complications are more
 All CV Patients to be deemed to be positive for COVID and managed.

17. Issues
Patient aspects
 Fear of COVID infection
 Unable to meet the expenses of admission
 Neglecting the symptoms, in background of COVID fear
 Denied access in absence of report - alarm raised
 Loss of daily wages
 Poverty

21. HCP Aspects
 Patient to be treated on an emergency basis.
 Aerosol production can be there when doing procedures – more
precautions
 Limited personnel at hand in view of social distancing.
 Lot of stress in managing the patients
 Primary PCI < Pharmacoinvasive strategy

27.  Donning and doffing strict precautions to be taken - 30 minutes
 Not 100% effective ( usually when not followed the steps)
 Takes ten to fifteen minutes to donn/doff
 Cumbersome after an hour
 Cant move around
 Mind is not stable
 Procedure time delayed
 Touch sensation lost

30. HOSPITAL aspects
 Increased staff
 1:1 ratio of nurse to patients
 Use of PPE Kits
 Shortage of HCP
 Decontamination
 Three times the usual expenses
 Shortage of PPE kits
 Salaries ?

31.  Disposables
 Sterilization
 Expenses

32. ESC guidance (not guidelines, not consensus)

33. Triaging of patients is important

34. STEMI

36.  Pharmacoinvasive strategy is better than Primary PCI.
 It is evidence based
 STREAM Trial ( fibrinolytic therapy vs PPCI)
 MORTALITY < 5%
 Increased ICH in FT
 Beneficial in Present times
 TIME OF REPERFUSION is MORE IMPORTANT THAN MODE OF
REPERFUSION

39. PUI = person under investigation

40. PI = pharmacoinvasive strategy;

42. ICU admission

43. NSTEMI

44. Acute Heart Failure
 Acute myocardial injury (defined as serum hs-cTn I elevation > 99th percentile of the
ULN or new abnormalities in ECG or echocardiography) occurs in 8% of COVID-19
patients.
 Ischemia, Infarction, Inflammation (Myocarditis)
 Severe COVID 22-31%
 Higher troponin values more poor prognosis
 Elevate NT BNP
 ARDS, Hypoxia, Acute Kidney Injury, hypervolemia, stress induced cardiomyopathy
 Arrhythmias

47. Cardiogenic
Shock

48. Chronic Heart Failure
 Risk of COVID is higher
 TTE and chest CT scan can be used for further assessment.
 Attention should be given to the prevention of viral transmission to healthcare providers and
contamination of the equipment;
 Patients with chronic HF should closely follow protective measures to prevent infection;
 Ambulatory stable HF patients (with no cardiac emergencies) should refrain from hospital
visits;
 Guideline-directed medical therapy (including beta-blocker, ACEI, ARB or sacubitril/valsartan
and mineralocorticoid receptor antagonist), should be continued in chronic HF patients,
irrespective of COVID-19;
 Telemedicine should be considered whenever possible to provide medical advice and follow
up of stable HF patients.

49. CSA

50. arrhythmias

54. QT management

55. Hypertension

61. Interaction of drugs

66. NATURE CURES ITSELF
COVID IS NO EXCEPTION
But after every eclipse
there is sunshine

70. FAKE NEWS
SOCIAL MEDIA

77. Take Home Message
 All patients with CVD are at high risk of severeCOVID.
 COVID mimics CVD – similar symptoms
 Type 2 MI
 All patients requiring emergency care should be deemed as COVID positive.
 Pharmacoinvasive therapy is better than Primary PCI
 Elective procedures to be avoided
 Telemedicine to be encouraged for effective bonding with patients.
 Patient should restrict to home and access hospital only in an emergency
 Follow SMS.