A cardiologists perspective to current scenario in light of corona pandemic in india and world wide. cardiac procedures , heart disease , aceinhibitors , arni , heart failure , troponin, nt probnp
COVID 19 and The Heart - Lessons Learnt from this Pandemicahvc0858
COVID 19 and The Heart - Lessons Learnt from this Pandemic
Presentation by Dr Jeremy Chow
Cardiologist, Electrophysiologist
Asian Heart & Vascular Centre
www.ahvc.com.sg
COVID 19 and The Heart - Lessons Learnt from this Pandemicahvc0858
COVID 19 and The Heart - Lessons Learnt from this Pandemic
Presentation by Dr Jeremy Chow
Cardiologist, Electrophysiologist
Asian Heart & Vascular Centre
www.ahvc.com.sg
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
What is a SCAD (spontaneous coronary artery dissection)?Laura Haywood-Cory
PPT presentation I created to educate people about how SCAD survivors use social media to support each other and organize. Katherine Leon had input on this as well, and the two of us presented a slightly different version of this in the WomenHeart "Champions Educating Champions" webinar series back in November of 2011.
IVUS may not be clinically warranted in all interventions, and should be seen as an adjunct to angiography. IVUS provides information about vessel morphology, plaque topography, and therapeutic outcomes that is often either equivocal or unavailable in angiographic images.
There are 3 situations in which IVUS has the most clinical utility:
Small vessel stenting: Studies have shown that post-stent restenosis rates are higher in small vessels. This is particularly true for vessels with diameters of 3.0mm or less, wherein small increases in stent diameter have been shown to significantly decrease the rate of restenosis. A study by Moussa et al showed that, as measured by IVUS, the incidence of restenosis has an inverse relationship to the post-procedure in-stent lumen CSA1.
In-Stent restenosis: In these cases, IVUS helps to determine whether the restenosis is due to inadequate stent deployment (underexpansion or incomplete apposition) due to intimal hyperplasia. IVUS will also help you select the proper device size for treatment of the stented area.
Difficult to assess lesions: At times, images of a lesion and the adjacent reference segment are often hazy. IVUS should be used to identify whether the angiographic appearance is due to dissection, thrombus, residual plaque, or is benign.
A coronary bifurcation consists of a flow divider (carina) and three vessel segments:
The proximal main vessel (PMV)
The distal main vessel (DMV) and
The side branch (SB).
A bifurcation lesion is a major epicardial coronary artery stenosis next to and/or including the ostium of a significant side branch
A significant SB is a branch whose severe narrowing or acute occlusion before or during intervention can cause considerable ischemia or a new infarction area that will worsen the clinical course of a particular patient.
Other important elements to consider that are not inherent in the bifurcation classifications include:
Extent of disease on the SB (limited to the ostium or involving the vessel beyond the ostium)
Its size (over 2.5mm in reference diameter)
Bifurcation angle, and
Disease distribution
La Dra. Ainara Lozano Bahamonde repasa las novedades incluidas en las últimas guías europeas en insuficiencia cardiaca presentadas en ESC Congress 2021.
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
What is a SCAD (spontaneous coronary artery dissection)?Laura Haywood-Cory
PPT presentation I created to educate people about how SCAD survivors use social media to support each other and organize. Katherine Leon had input on this as well, and the two of us presented a slightly different version of this in the WomenHeart "Champions Educating Champions" webinar series back in November of 2011.
IVUS may not be clinically warranted in all interventions, and should be seen as an adjunct to angiography. IVUS provides information about vessel morphology, plaque topography, and therapeutic outcomes that is often either equivocal or unavailable in angiographic images.
There are 3 situations in which IVUS has the most clinical utility:
Small vessel stenting: Studies have shown that post-stent restenosis rates are higher in small vessels. This is particularly true for vessels with diameters of 3.0mm or less, wherein small increases in stent diameter have been shown to significantly decrease the rate of restenosis. A study by Moussa et al showed that, as measured by IVUS, the incidence of restenosis has an inverse relationship to the post-procedure in-stent lumen CSA1.
In-Stent restenosis: In these cases, IVUS helps to determine whether the restenosis is due to inadequate stent deployment (underexpansion or incomplete apposition) due to intimal hyperplasia. IVUS will also help you select the proper device size for treatment of the stented area.
Difficult to assess lesions: At times, images of a lesion and the adjacent reference segment are often hazy. IVUS should be used to identify whether the angiographic appearance is due to dissection, thrombus, residual plaque, or is benign.
A coronary bifurcation consists of a flow divider (carina) and three vessel segments:
The proximal main vessel (PMV)
The distal main vessel (DMV) and
The side branch (SB).
A bifurcation lesion is a major epicardial coronary artery stenosis next to and/or including the ostium of a significant side branch
A significant SB is a branch whose severe narrowing or acute occlusion before or during intervention can cause considerable ischemia or a new infarction area that will worsen the clinical course of a particular patient.
Other important elements to consider that are not inherent in the bifurcation classifications include:
Extent of disease on the SB (limited to the ostium or involving the vessel beyond the ostium)
Its size (over 2.5mm in reference diameter)
Bifurcation angle, and
Disease distribution
La Dra. Ainara Lozano Bahamonde repasa las novedades incluidas en las últimas guías europeas en insuficiencia cardiaca presentadas en ESC Congress 2021.
Pneumonia - Community Acquired Pneumonia (CAP)Arshia Nozari
An overview to Community Acquired Pneumonia; It's Pathophysiology, Etiology, Epidemiology, Diagnosis and Treatment according to Harrison's Internal Medicine, 20th Edition (2018).
PERIOPERATIVE MANAGEMENT OF COVID 19 SUSPECT/ CONFIRMED PATIENTBhagwatiPrasad18
These recommendations are based on recent guidelines and protocols followed in major hospitals in India and also from recent articles published online. This cannot be taken as final. Guidelines will be updated from time to time.
Watch this presentation in laptop/ pc as slideshow for beautiful animations.
Similar to Covid 19 a cardiologists perspective (20)
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. • Introduction to corona virus
• Impact of corona Virus on Cardiologist
• Impact of Corona Virus on patients
• Safety of Doctors
• Guidelines and Position statement
• Treating Patients in the OPD
• How Corona infection can mimic ACS
• Treating Patients with ACS in times of COVID /Interventions in present times
• Should ARBs and ACEI be stopped
• Use of Asprin and NSAIDs
• Use of Anti coagulation in patients suffering from Cardiac manifestations
• Drugs for treatment of Corona , where do we stand
A Brief Overview
3. EFFECT OF COVID PANDEMIC ON
HEALTHCARE
• COVID-19 has dramatically altered our world, health care systems and supply chains.
• Older adults with cardiovascular disease especially those over 60 years suffer
disproportionately.
• Stressed the capacity of the hospital infrastructure, ICU beds and ventilatory support, post-
acute and community care resources, hospital personnel and personal protection equipment.
• Change in the way we practice medicine and also the treatment protocols have been modified
• Risk stratification based on clinical and laboratory data may assist in the process of
prognostication and shared decision-making
4. DRY COUGH (76%)HIGH FEVER (98%)
Irritation and constant
coughing without expelling
any mucus
The body feels completely
tired and without energy to
perform normal tasks
The body temperature can
exceed 37.3 Celsius degrees
or 99 Fahrenheit degrees
SYMPTOMS OF COVID-19
TIREDNESS (44%)
Other: Sputum production (28%) and Diarrhoea (3%)
5. More than half of the patients developed shortness of breath roughly eight days
from the onset of illness
6. Clinical Features
• Mild: no symptoms, mild caughing and fever.
• Severe: dyspnea, hypoxia or > 50% lung involvement on imaging.
• Critical: respiratory failure, shock, multi-organ failure. A PATIENT WHO IS IN
EMINENT DANGER
A PATIENT WHO IS IN EMINENT DANGER
• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face
• Low Oxygen Saturation
7. PCR-test
• Very specific
• Lower sensitivity of 65-95%, which means that the test can be
negative even when the patient is infected.
• Waiting time 24 hours, while CT results are available right away.
• Common laboratory findings in COVID-19 are a decreased lymphocyte
count and an increased CRP and high-sensitivity C-reactive
protein level.
9. X Ray Features
1. Picture not like lobar pneumonia- Bilateral , mimics Viral pneumonia
2. Poorly demarcated , bilateral , peripheral consolidation
3. Uncommon to have pleural effusion. which is late
4. May mimic features of volume overload
CT Scan Features – more specific
1. GROUND GLASSING and peripheral areas of consolidation , but nit well demarcated as
lobar pneumonia
2. No lymphadenopathy
Radiological features of corona infection
10. CT findings - hallmark
• Ground glass pattern is the most common finding in COVID-19 infections.
They are usually multifocal, bilateral and peripheral, but in the early may present
as a unifocal lesion, most commonly in inferior lobe of the right lung
• Other are – Crazy paving , Vascular dilatation , Traction bronchiectasis , Sub
pleural bands and architecture
11. • COVID-19 might enter the human body via angiotensin-converting enzyme 2 (ACE2)
on the surfaces of type II alveolar cells.
• ↓
• The virus may exhibit pathogenic activity by attacking type II alveolar epithelial cells
expressing ACE2.
• ↓
• ACE2 is likely to be the cellular receptor of COVID-19, but whether it is the only
cellular receptor remains to be further investigated
Interplay between SARS-CoV-2 and ACE2 receptor
Hypertension Research. 2020. March 3:1-3
16. • Physician should wear white coats, paper
caps and surgical masks (PPE)
• High Risk and more than 60 should avoid
• Strictly perform hand hygiene in
outpatient clinic (before/after patient
contact)
• Avoid use of stethoscope
Physician in OPD
17. Personal Protection Equipment
• Integrated protective clothing
• Goggles (protective face screen or
protective hood)
• Infrared thermometer
• N95 masks
• Disposable shoe covers (long style
recommended)
• Sterile instrument sets
• Air sterilizers
• Disposable sheets, etc.
18. a) Give suspect patient a triple layer surgical mask and
b) Direct patient to separate area, an isolation room if available.
c) Keep at least 1meter distance between suspected patients and other
patients.
d) Instruct all patients to cover nose and mouth during coughing or sneezing
with tissue or flexed elbow for others.
e) Perform hand hygiene after contact with respiratory secretions.
At Triage: In Hospital
19. a) Droplet precautions prevent large droplet transmission of respiratory viruses.
b) Use a triple layer surgical mask if working within 1-2 metres of the patient.
c) Place patients in single rooms, or group together those with the same etiological
diagnosis.
d) If possible, use either disposable or dedicated equipment (e.g. stethoscopes, blood
pressure cuffs and thermometers).
e) If equipment needs to be shared among patients, clean and disinfect between each
patient use.
f) Avoid contaminating environmental surfaces that are not directly related to patient
care (e.g. door handles and light switches).
g) Ensure adequate room ventilation.
Apply droplet precautions all through the care:
21. Management strategy of COVID-19 combined with CVD
• Induce COVID-19 infection
• Avoid acute cardiac events
(heart failure,ACS)
• Potential proarrhythmia
• Vasoactive agent induced acute
events such as vasospasm
• Drug interaction induced liver
injury
• ECG、BP monitoring
• Early intervention
•Diagnosis of COVID-19
in time
•Respiratory support: rectifying
hypoxia
•Circulation support:maintain
volume balance
•Immunotherapy
Early self-
management
Diagnosis
in time
drug
interactions
Therapy
for severe
cases
22. Common Co-morbid conditions with COVID-19
other than age alone
Hypertension 23.7%
Diabetes mellitus 16.2%
Coronary heart diseases 5.8%
Cerebrovascular disease 2.3 %
N Engl J Med 2020; published online Feb 28. DOI:10.1056/NEJMoa2002032.
23. Association of hypertension with COVID-19 mortality
Pol Arch Intern Med. 2020 Mar 31. doi: 10.20452/pamw.15272.
24. Hypertension comprised 20–30% of all COVID-19 patients
58.3% of hypertensive patients in the intensive care unit due to COVID-19.
Hypertension have been responsible for 60.9% of deaths caused by COVID-19.
Hypertension may be associated with an up to 2.5-fold higher risk of severe
and fatal COVID-19, especially among older individuals.
Hypertension should be considered as a clinical predictor of COVID-19 severity
in older patients
Hypertension–COVID-19 Link
Hypertension Research. 2020. March 3:1-3
Pol Arch Intern Med. 2020 Mar 31. doi: 10.20452/pamw.15272.
25. 1. People with diabetes are more likely to experience severe symptoms and
complications when infected with a virus
2. If diabetes is well-managed, the risk of getting severely sick from COVID-19 is
about the same as the general population
3. Having heart disease or other complications in addition to diabetes could worsen
the chance of getting seriously ill from COVID-19
4. If glucose control is poor, severity of viral illness and risk of complications will
increase because of impairment of immunity.
5. People with diabetes do face an increased risk of DKA (diabetic ketoacidosis) and
or Hypoglycemia, Specialy pts with type 1 diabetes.
COVID-19 and Diabetic patients
26. People with diabetes do face a
higher chance of experiencing
serious complications from
COVID-19
27. • Patients with diabetes, particularly those with poor glycaemic control, as they
are at increased risk of complications, they should be instructed about
warning symptoms and need for hospitalization if they develop such
symptoms.
• Always to be in touch with your personal doctor in such situations
Precautions to be taken in diabetics:
30. Symptomatic treatment
• Supportive Treatment- anti tussevies,paracetamol,Hydration
• Oxygen supplementation to maintain SpO2>94Conservative fluid management if
there is no evidence of shock.
• Tab Hydroxychloroquine, 400mgBD for1dayfollowedby200mgBDfor4days
• Tab Azithromycin,500 OD for 5 days
• Tab Oseltamivir,150 mg BD for 5 days
• Tab Vitamin C,500mgBDfor5days
• If Hydroxychloroquine or,Chloroquine contraindicated
• then:Lopinavir/Ritonavir(200/50) 2 tab BD for 10 days
• Caution: Do not co-administer Lopinavir/ritonavir and Hydroxychloroquine
(eg.QTprolongation,hypoglycemia).
31. How HCQS works
• Not clearly
known, changes
the pH of
endosomes and
believed to
prevents viral
entry, transport
and post-entry
event
33. The National Taskforce for COVID-19 recommends
,ICMR -use of hydroxy-chloroquine for prophylaxis
of SARS-CoV-2
• Asymptomatic healthcare workers involved in the care of suspected or
confirmed cases of COVID-19
• Asymptomatic household contacts of laboratory confirmed cases
• Dose for HCW:400 mg twice a day on Day 1, followed by 400 mg once
weekly for next 7 weeks; to be taken with meals.
• Dose for Asymptomatic household contacts of laboratory confirmed cases:
400 mg twice a day on Day 1, followed by 400 mg once weekly for next 3
weeks; to be taken with meals .
• Note - It is reiterated that the intake of above medicine should not in still sense of
false secuirity. The hydroxy-chloroquine may not be replaced by any other
compound.
34. DRUG TREATMENT:
Other drugs which are being tested on an experimental basis
and are not available in India as of now.
Remdesivir -Several randomized trials , used for Ebola
Favipiravir- Japanese molecule
Kaletra- Anti HIV drug
Tocilizumab – Treatment guidelines from China's National
Health Commission include the IL-6 inhibitor tocilizumab for
patients with severe COVID-19 and elevated IL-6 levels
Ivermectin
35. Cardiac Symptoms in patients with Covid
infections – ACS or COVID Infection?
36. • Interactions between antiviral drugs and cardiovascular drugs: Lopinavir and
Ritonavir may increase the liver injury and cause the elevation of muscle
enzyme if taken with some kinds of statins at the same time.
• Be alert to the direct or indirect damaging effects of antiviral drugs on heart:
Chloroquine may induce sudden cardiac death, while Lopinavir and Ritonavir
may lower the heart rate
• HCQS and Cholroquin can prolong the QT interval
Potential interactions between antiviral drugs and
cardiovascular drugs
Yundai Chen. Chinese Journal of Interventional Cardiology; 2020; 28(2):107-109
38. How covid effects heart
• In addition to lung damage, many COVID-19 patients are also
developing heart problems—and dying of cardiac arrest.
• As more data comes in from China and Italy, as well as Washington
state and New York, more cardiac experts are coming to believe the
COVID-19 virus can infect the heart muscle.
• An initial study found cardiac damage in as many as 1 in 5 patients,
leading to heart failure and death even among those who show no
signs of respiratory distress
39. Acute Cardiac Complications of COVID-19
• Anecdotal reports of acute heart failure, myocardial infarction,
myocarditis, and cardiac arrest; as with any acute illness, higher
cardiometabolic demand can precipitate cardiac complications
• Raised Cardiac enzymes – troponin I suggesting Cardiac injury
• Some patients also have myocarditis with global LV Hypokinesia , some
patients have RWMA also.
• Ecg changes also seen mimicking Acute MI and NSTEMI.
• Chest Xray , ECG, CT Chest , Cardiac Enzymes and Echocardiography etcare
required .
• Some patients develop arrhythmias , which may be worsened by HCQS etc.
40. Acute Cardiac Complications of COVID-19
• In a recent case report on 138 hospitalized COVID-19 patients,
16.7% of patients developed arrhythmia and 7.2% experienced
acute cardiac injury.
• Cardiologists should be prepared to assist other clinical specialties in
managing cardiac complications in severe cases of COVID-19
• Critical care and cardiology teams should confer to guide care for
patients requiring extracorporeal circulatory support with veno-
venous (V-V) versus veno-arterial (V-A) ECMO
• Patients demonstrating heart failure, arrhythmia, ECG changes or
cardiomegaly should have echocardiography
41. COVID-19 Implications For Patients With
Underlying Cardiovascular Conditions
• Make plans for quickly identifying and isolating cardiovascular
patients with COVID19 symptoms
• Patients with underlying cardiovascular disease are at higher risk of
contracting COVID-19 and have a worse prognosis
• CVD pts to remain current with vaccinations, including the
pneumococcal and influenza.
• Triage COVID-19 patients according to underlying cardiovascular,
diabetic, respiratory, renal, oncological, or other comorbid conditions
for prioritized treatment.
42. Cardiac-specific Preparedness Recommendations
For COVID-19 –General guidelines
• Protocols for the diagnosis, triage, isolation, and management of COVID-19
patients with cardiovascular complications and/or cardiovascular patients
with COVID-19 should be developed in detail and rehearsed.
•
Cardiovascular care team members protective equipment (PPE) donning,
usage, and doffing should be trained now in accordance with CDC guidance
• Specific protocols should be developed for the management of AMI in the
context of a COVID-19 outbreak, both for patients with and without a
COVID-19 diagnosis
• Particular emphasis should be placed on acute PCI and CABG, including
protocols to limit catheterization lab and OR personnel to a required
minimum.
44. Management of ACS incl. AMI in times of
Corona- key points
• For AMI patients with COVID-19, a safe and efficient medical
environment should be ensured in parallel with effective reperfusion
therapy.
• Many medical centers do not have professionally protected cardiac
catheterization rooms and cardiac care units for respiratory infectious
diseases.
• Coordination of hospital administrators and the collaboration of
multidisciplinary teams including the cardiology , emergency ,
respiratory , radiology and the medical laboratory .
• Emergency intravenous thrombolysis is the first choice for acute ST-
segment elevation myocardial infarction (STEMI).
46. STEMI patients with confirmed COVID-19
• Strict isolation should start immediately, and thrombolytic
contraindications should be evaluated. Patients with thrombolytic
contraindications should be transferred to the local designated COVID
treatment.
• Patients without thrombolytic contraindications should first start
intravenous thrombolysis and then transfer to the local designated
medical institution of infectious disease for further treatment
49. AMI with non-STEMI (NSTEMI),
• For treatment strategy should be based on the GRACE risk stratification
while waiting for the results of novel coronavirus nucleic acid detection.
• Confirmed patients with COVID-19 should be transferred to the designated
medical institution immediately for further optimal medical treatment.
• If COVID-19 cannot be excluded by chest CT, routine medical treatment of
NSTEMI should be given and risk stratification should be conducted while
waiting for the results of nucleic acid detection.
• For NSTEMI patients excluded from COVID-19, early or time-limited
intervention strategies as per risk stratification of NSTE–acute coronary
syndrome.
51. Non Coronary Interventions during present
times
• Avoid all non essential Interventions – EP procedures ,
Radiofrerquency abalation , balloon valvotomies ,etc
• Pacemakers implants are usually emergency procedures, which have
to be done with precautions .
52.
53. Cardiac Drug options for patients with COVID-19
combined with CVD
• ACEI/ARB: Patients should continue taking these medication
• Antiplatelet drugs:For CVD patients, continue taking the same medication, and
hemorrhage should be observed strictly.
• Nsaids- Data equivocal , no clear harm or benefit , some data from Italy suggested
harm from ibuprofen , but not proven .
• Statins:monitoring the liver function closely.
• β-receptor blockers:if there is no hypoxia and airway spasms, selective β1-receptor
blockers are recommended, and observe the pulmonary lesions.Yundai Chen. Chinese Journal of Interventional Cardiology; 2020; 28(2):107-109