COVID-19-associated heart failure: Difference between revisions

Jump to navigation Jump to search
Line 102: Line 102:
===Physical Examination===
===Physical Examination===


 
*Physical examination of patients with acute heart failure is usually remarkable for:
**Crackles on auscultation
**Distended jugular veins
**Lower extremity edema


===Laboratory Findings===
===Laboratory Findings===

Revision as of 21:21, 29 June 2020

For COVID-19 frequently asked inpatient questions, click here
For COVID-19 frequently asked outpatient questions, click here

WikiDoc Resources for COVID-19-associated heart failure

Articles

Most recent articles on COVID-19-associated heart failure

Most cited articles on COVID-19-associated heart failure

Review articles on COVID-19-associated heart failure

Articles on COVID-19-associated heart failure in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on COVID-19-associated heart failure

Images of COVID-19-associated heart failure

Photos of COVID-19-associated heart failure

Podcasts & MP3s on COVID-19-associated heart failure

Videos on COVID-19-associated heart failure

Evidence Based Medicine

Cochrane Collaboration on COVID-19-associated heart failure

Bandolier on COVID-19-associated heart failure

TRIP on COVID-19-associated heart failure

Clinical Trials

Ongoing Trials on COVID-19-associated heart failure at Clinical Trials.gov

Trial results on COVID-19-associated heart failure

Clinical Trials on COVID-19-associated heart failure at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on COVID-19-associated heart failure

NICE Guidance on COVID-19-associated heart failure

NHS PRODIGY Guidance

FDA on COVID-19-associated heart failure

CDC on COVID-19-associated heart failure

Books

Books on COVID-19-associated heart failure

News

COVID-19-associated heart failure in the news

Be alerted to news on COVID-19-associated heart failure

News trends on COVID-19-associated heart failure

Commentary

Blogs on COVID-19-associated heart failure

Definitions

Definitions of COVID-19-associated heart failure

Patient Resources / Community

Patient resources on COVID-19-associated heart failure

Discussion groups on COVID-19-associated heart failure

Patient Handouts on COVID-19-associated heart failure

Directions to Hospitals Treating COVID-19-associated heart failure

Risk calculators and risk factors for COVID-19-associated heart failure

Healthcare Provider Resources

Symptoms of COVID-19-associated heart failure

Causes & Risk Factors for COVID-19-associated heart failure

Diagnostic studies for COVID-19-associated heart failure

Treatment of COVID-19-associated heart failure

Continuing Medical Education (CME)

CME Programs on COVID-19-associated heart failure

International

COVID-19-associated heart failure en Espanol

COVID-19-associated heart failure en Francais

Business

COVID-19-associated heart failure in the Marketplace

Patents on COVID-19-associated heart failure

Experimental / Informatics

List of terms related to COVID-19-associated heart failure

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mitra Chitsazan, M.D.[2]Mandana Chitsazan, M.D. [3]

Synonyms and keywords:

Overview

Historical perspective

Classification

  • Heart Failure in COVID-19 may be classified similarly to heart failure from other causes.
  • In general, HF can be classified based on:
    • The pathophysiology of heart failure:
      • systolic vs diastolic
      • left-sided vs right-sided
    • The duration of symptoms:
      • acute vs chronic
    • The underlying physiology based on left ventricular ejection fraction (LVEF):
      • Heart failure with reduced ejection fraction (HFrEF) vs heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF),
    • The severity of heart failure (i.e., the New York Heart Association Class I-IV)
    • The stage of congestive heart failure (i.e., AHA Class A,B,C,D)
  • Acute heart failure has two forms:
    • Newly-arisen (“de novo”) acute heart failure
    • Acutely decompensated chronic heart failure (ADCHF)

Pathophysiology

  • Presumed pathophysiologic mechanisms for the development of new or decompensated heart failure in patients with COVID-19 include:[1] [2] [3] [4] [5]

Causes

  • Acute myocardial injury
  • Acute coronary syndromes
  • Myocarditis
  • Hypertensive crisis
  • Arrhythmias: Tachycardia or severe bradycardia
  • Stress-induced cardiomyopathy
  • Circulatory failure:
    • Acute pulmonary embolism
    • Pericardial tamponade


Differentiating ((COVID-19 associated heart failure)) from other Diseases

In patients with COVID-19 infection, acute heart failure should be differentiated from other diseases presenting with dyspnea and/or tachypnea. The differentials include the following:

  • Pneumonia
  • ARDS
  • Myocarditis/pericarditis
  • Acute pulmonary embolism


Epidemiology and Demographics

  • In one study, acute heart failure was seen in 4.1% of patients with acute cardiac injury.
  • In a retrospective study on study 191 COVID-19 patients in Wuhan, China, the incidence of heart failure was 23% (52% in non-survivors vs 12% in survivors).

Risk Factors

Screening

  • There is insufficient evidence to recommend routine screening for heart failure in COVID-19 patients.
  • Routine measurement of natriuretic peptides and/or cardiac troponins have not been recommended in the absence of a high index of suspicion for HF on the clinical grounds.

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

  • The most common symptoms of acute heart failure in COVID-19 patients are:
    • New or worsening dyspnea: may overlap with dyspnea caused by concomitant respiratory involvement and ARDS due to COVID-19
    • Peripheral edema
    • Confusion and altered mentation
    • Orthopnea
    • Palpitations
    • Paroxysmal nocturnal dyspnea
    • Cool extremities
    • Cyanosis
    • Dizziness
    • Syncope
    • Fatigue
    • Hemoptysis

Physical Examination

  • Physical examination of patients with acute heart failure is usually remarkable for:
    • Crackles on auscultation
    • Distended jugular veins
    • Lower extremity edema

Laboratory Findings

  • Cardiac Troponins:
    • Elevated cardiac troponin levels suggest the presence of myocardial cell injury or death.
    • Cardiac troponin levels may increase in patients with chronic or acute decompensated HF.[6]
  • Natriuretic Peptides:
    • Natriuretic peptides (BNP/NT-proBNP) are released from the heart in response to increased myocardial stress and are quantitative markers of increased intracardiac filling pressure.[7]
    • Elevated BNP and NT-proBNP are of both diagnostic and prognostic significance in patients with heart failure.
    • Increased BNP or NT-proBNP levels have been demonstrated in COVID-19 patients.
    • Increased NT-proBNP level was associated with worse clinical outcomes in patients with severe COVID-19.[8] [9]
    • However, increased natriuretic peptide levels are frequently seen among patients with severe inflammatory or respiratory diseases.[10] [11] [12] [13] [14]
    • Therefore, routine measurement of BNP/NT-proBNP has not been recommended in COVID-19 patients, unless there is a high suspicion of HF based on clinical grounds.

Electrocardiogram

X-ray

  • An x-ray may be helpful in the diagnosis of heart failure. Findings on an x-ray suggestive of heart failure include:
    • Cardiomegaly
    • Pulmonary congestion
    • Increased pulmonary vascular markings.
  • However, signs of pulmonary edema may be obscured by underlying respiratory involvement and ARDS due to COVID-19.

Echocardiography or Ultrasound

  • A complete standard transthoracicechocardiography (TTE) has not been recommended in COVID-19 patients considering the limited personal protective equipment (PPE) and the risk of exposure of additional health care personnel.[15]
  • To deal with limited resources (both personal protective equipment and personnel) and reducing the exposure time of personnel, a focused TTE to find gross abnormalities in cardiac structure/function seems satisfactory.
  • In addition, bedside options, which may be performed by the trained personnel who might already be in the room with these patients, might also be considered. These include:
  • Cardiac ultrasound can help in assessing the following parameters:
    • Left ventricular systolic function (ejection fraction) to distinguish systolic dysfunction with a reduced ejection fraction (<40%) from diastolic dysfunction with a preserved ejection fraction.
    • Left ventricular diastolic function
    • Left ventricular structural abnormalities, including LV size and LV wall thickness
    • Left atrial size
    • Right ventricular size and function
    • Detection and quantification of valvular abnormalities
    • Measurement of systolic pulmonary artery pressure
    • Detection and quantification of pericardial effusion
    • Detection of regional wall motion abnormalities/reduced strain that would suggest underlying ischemia.

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

References

  1. PMID 32219357 (PMID 32219357)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  2. PMID 32360242 (PMID 32360242)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  3. PMID 32186331 (PMID 32186331)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  4. PMID 30625066 (PMID 30625066)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  5. PMID 32140732 (PMID 32140732)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  6. PMID 20863950 (PMID 20863950)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  7. PMID 28062628 (PMID 28062628)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  8. PMID 32293449 (PMID 32293449)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  9. PMID 32232979 (PMID 32232979)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  10. PMID 18298480 (PMID 18298480)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  11. PMID 16442916 (PMID 16442916)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  12. PMID 28322314 (PMID 28322314)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  13. PMID 23837838 (PMID 23837838)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  14. PMID 21478812 (PMID 21478812)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  15. PMID 32391912 (PMID 32391912)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  16. PMID 24251454 (PMID 24251454)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  17. PMID 12656651 (PMID 12656651)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  18. PMID 31129923 (PMID 31129923)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand


Template:WikiDoc Sources