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Cardiac Echocardiography in COVID-19 Infection
The 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.
Article published online:
24 July 2020
Thieme Medical and Scientific Publishers Private Ltd.
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- 1 Guzik TJ, Mohiddin SA, Dimarco A. et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res 2020; cvaa106
- 2 Kuster GM, Pfister O, Burkard T. et al. SARS-CoV2: should inhibitors of the renin-angiotensin system be withdrawn in patients with COVID-19?. Eur Heart J 2020; 41 (19) 1801-1803
- 3 Basu-Ray I, Soos MP. Cardiac Manifestations of Coronavirus (COVID-19). A service of the National Library of Medicine, National Institutes of Health. 2020
- 4 Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020; 17 (05) 259-260
- 5 Mahmud E, Dauerman HL, Welt FG. et al. Management of acute myocardial infarction during the COVID-19 pandemic. J Am Coll Cardiol 2020; S0735-1097 (20) 35026-35029
- 6 Mahmud E, Dauerman HL, Welt FGP, et al. Management of acute myocardial infarction during the COVID-19 pandemic: A Consensus Statement from the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP). Catheter Cardiovasc Interv 2020. Doi: 10.1002/ccd.28946. doi:10.1002/ccd.28946
- 7 Kwong JC, Schwartz KL, Campitelli MA. et al. Acute myocardial infarction after laboratory-confirmed influenza infection. N Engl J Med 2018; 378 (04) 345-353
- 8 Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med 2004; 351 (25) 2611-2618
- 9 Shi S, Qin M, Shen B. et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol 2020; (e-pub ahead of print) DOI: 10.1001/jamacardio.2020.0950.
- 10 Guo T, Fan Y, Chen M. et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020; (e-pub ahead of print) DOI: 10.1001/jamacardio.2020.1017.
- 11 Prutkin JM, Knight BP, et al. Coronavirus Disease (COVID-19): Arrhythmias and Conduction System Disease. Available at: https://www.uptodate.com/contents/coronavirus-disease-2019. Accessed May 24, 2020
- 12 Lakkireddy DR, Chung MK, Gopinathannair R, et al; Guidance for Cardiac Electrophysiology During the Coronavirus (COVID-19) Pandemic from the Heart Rhythm Society COVID-19 Task Force. Guidance for Cardiac Electrophysiology During the Coronavirus (COVID-19) Pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association. Circulation 2020;(e-pub ahead of print). doi:10.1161/ CIRCULATIONAHA.120.047063
- 13 Ezad S, McGee M, Boyle AJ. Takotsubo syndrome associated with ST elevation myocardial infarction. Case Rep Cardiol 2019; 2019: 1010243
- 14 Roca E, Lombardi C, et al. Takotsubo Syndrome Associated with COVID-19. Available at: https://www.ejcrim.com/index.php/EJCRIM/article/view/1665/2065. Accessed May 24, 2020
- 15 Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18 (04) 844-847
- 16 Danzi GB, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association?. Eur Heart J 2020; 41 (19) 1858
- 17 Wang Y, Zhang D, Du G. et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet 2020; 395 (10236) 1569-1578
- 18 Nakkazi E. Randomised controlled trial begins for Ebola therapeutics. Lancet 2018; 392 (10162) 2338
- 19 Liu J, Cao R, Xu M. et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov 2020; 6: 16
- 20 Maisch B, Alter P. Treatment options in myocarditis and inflammatory cardiomyopathy: focus on i. v. immunoglobulins. Herz 2018; 43 (05) 423-430
- 21 Chatre C, Roubille F, Vernhet H, Jorgensen C, Pers YM. Cardiac complications attributed to chloroquine and hydroxychloroquine: a systematic review of the literature. Drug Saf 2018; 41 (10) 919-931
- 22 Kirkpatrick J, Mitchell C, Taub C, et al. ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak. Available at: https://www.asecho.org/wp-content/uploads/2020/03/COVIDStatementFINAL4-1-2020_v2_website.pdf. Accessed April 13, 2020
- 23 Peng Q-Y, Wang X-T, Zhang LN. Chinese Critical Care Ultrasound Study Group (CCUSG). Using echocardiography to guide the treatment of novel coronavirus pneumonia. Crit Care 2020; 24 (01) 143