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| __NOTOC__ | | __NOTOC__ |
| {{COVID-19 associated Heart Failure}} | | {{Xyz}} |
| '''For patient information, click [[Xyz (patient information)|here]]''' | | '''For patient information, click [[Xyz (patient information)|here]]''' |
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| {{CMG}}; {{AE}} {{Mitra}} | | {{CMG}}; {{AE}} |
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| {{SK}} | | {{SK}} |
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| ==[[Heart Failure overview|Overview]]== | | ==[[Xyz overview|Overview]]== |
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| *Patients with chronic heart failure (HF) may be at higher risk of developing severe COVID-19 infection due to the advanced age and the presence of multiple comorbidities.
| | ==[[Xyz historical perspective|Historical Perspective]]== |
| *Both de novo acute heart failure and acute decompensation of chronic heart failure can occur in patients with COVID-19.
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| ==[[Heart Failure historical perspective|Historical Perspective]]== | | ==[[Xyz classification|Classification]]== |
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| ==[[Heart Failure classification|Classification]]== | | ==[[Xyz pathophysiology|Pathophysiology]]== |
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| ==[[Heart Failure pathophysiology|Pathophysiology]]== | | ==[[Xyz causes|Causes]]== |
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| *Presumed pathophysiologic mechanisms for the development of new or worsening heart failure in patients with COVID-19 include:<ref name="pmid32219357">{{Cite pmid|32219357}}</ref> <ref name="pmid32360242">{{Cite pmid|32360242}}</ref> <ref name="pmid32186331">{{Cite pmid|32186331}}</ref> <ref name="pmid30625066">{{Cite pmid|30625066}}</ref> <ref name="pmid32140732">{{Cite pmid|32140732}}</ref>
| | ==[[Xyz differential diagnosis|Differentiating Xyz from other Diseases]]== |
| **Acute exacerbation of chronic heart failure
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| **Acute myocardial injury (which in turn can be caused by several mechanisms)
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| **Stress cardiomyopathy (i.e., Takotsubo cardiomyopathy)
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| **Impaired myocardial relaxation resulting in diastolic dysfunction [i.e., Heart failure with preserved ejection fraction (HFpEF)]
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| **Right-sided heart failure, secondary to pulmonary hypertension caused by hypoxia and acute respiratory distress syndrome (ARDS)
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| ==[[Heart Failure causes|Causes]]== | | ==[[Xyz epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==[[Heart Failure differential diagnosis|Differentiating Heart Failure from other Diseases]]== | | ==[[Xyz risk factors|Risk Factors]]== |
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| ==[[Heart Failure epidemiology and demographics|Epidemiology and Demographics]]== | | ==[[Xyz screening|Screening]]== |
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| ==[[Heart Failure risk factors|Risk Factors]]==
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| ==[[Heart Failure screening|Screening]]==
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| ==[[Heart Failure natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
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| | ==[[Xyz natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| [[COVID-19-associated heart failurediagnostic study of choice|Diagnostic study of choice]] | [[COVID-19-associated heart failure history and symptoms|History and Symptoms]] | [[COVID-19-associated heart failure physical examination|Physical Examination]] | [[COVID-19-associated heart failure laboratory findings|Laboratory Findings]] | [[COVID-19-associated heart failure electrocardiogram|Electrocardiogram]] | [[COVID-19-associated heart failure x ray|X-Ray Findings]] | [[COVID-19-associated heart failure echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[COVID-19-associated heart failure CT scan|CT-Scan Findings]] | [[COVID-19-associated heart failure MRI|MRI Findings]] | [[COVID-19-associated heart failure other imaging findings|Other Imaging Findings]] | [[COVID-19-associated heart failure other diagnostic studies|Other Diagnostic Studies]] | | [[Xyz diagnostic study of choice|Diagnostic study of choice]] | [[Xyz history and symptoms|History and Symptoms]] | [[Xyz physical examination|Physical Examination]] | [[Xyz laboratory findings|Laboratory Findings]] | [[Xyz electrocardiogram|Electrocardiogram]] | [[Xyz x ray|X-Ray Findings]] | [[Xyz echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Xyz CT scan|CT-Scan Findings]] | [[Xyz MRI|MRI Findings]] | [[Xyz other imaging findings|Other Imaging Findings]] | [[Xyz other diagnostic studies|Other Diagnostic Studies]] |
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| ====Electrocardiography (ECG)====
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| | [[Xyz x ray|X-Ray Findings]] | |
| ====Chest x-ray (CXR)====
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| *The Chest x-ray may show evidence of:
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| **Cardiomegaly
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| **Pulmonary congestion
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| **Increased pulmonary vascular markings.
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| *Signs of pulmonary edema may be obscured by underlying respiratory involvement and ARDS due to COVID-19.
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| | [[Heart Failure echocardiography and ultrasound|Echocardiography and Ultrasound]]
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| ====Echocardiography====
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| *A complete standard transthoracic (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.<ref name="pmid32391912">{{Cite pmid|32391912}}</ref>
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| *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.
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| *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:
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| **Cardiac point-of-care ultrasound (POCUS)
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| **Focused cardiac ultrasound study (FoCUS)
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| **Critical care echocardiography
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| *Cardiac ultrasound can help in assessing the following parameters:
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| **Left ventricular systolic function (ejection fraction) to distinguish systolic dysfunction with a reduced ejection fraction (<40%) from diastolic dysfunction with a preserved ejection fraction.
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| **Left ventricular diastolic function
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| **Left ventricular structural abnormalities, including LV size and LV wall thickness
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| **Left atrial size
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| **Right ventricular size and function
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| **Detection and quantification of valvular abnormalities
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| **Measurement of systolic pulmonary artery pressure
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| **Detection and quantification of pericardial effusion
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| **Detection of regional wall motion abnormalities/reduced strain that would suggest an underlying ischemia
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| | [[Heart Failure CT scan|CT-Scan Findings]] | [[Heart Failure MRI|MRI Findings]] | [[Heart Failure other imaging findings|Other Imaging Findings]] | [[Heart Failure other diagnostic studies|Other Diagnostic Studies]]
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| ====Cardiac biomarkers====
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| *Cardiac Troponins:
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| **Elevated cardiac troponin levels suggest the presence of myocardial cell injury or death.
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| **Cardiac troponin levels may increase in patients with chronic or acute decompensated HF.<ref name="pmid20863950">{{Cite pmid|20863950}}</ref>
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| *Natriuretic Peptides:
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| **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.<ref name="pmid28062628">{{Cite pmid|28062628}}</ref>
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| **Elevated BNP and NT-proBNP are of both diagnostic and prognostic significance in patients with heart failure.
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| **Increased BNP or NT-proBNP levels have been demonstrated in COVID-19 patients.
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| **Increased NT-proBNP level was associated with worse clinical outcomes in patients with severe COVID-19.<ref name="pmid32293449">{{Cite pmid|32293449}}</ref> <ref name="pmid32232979">{{Cite pmid|32232979}}</ref>
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| **However, increased natriuretic peptide levels are frequently seen among patients with severe inflammatory or respiratory diseases.<ref name="pmid18298480">{{Cite pmid|18298480}}</ref> <ref name="pmid16442916">{{Cite pmid|16442916}}</ref> <ref name="pmid28322314">{{Cite pmid|28322314}}</ref> <ref name="pmid23837838">{{Cite pmid|23837838}}</ref> <ref name="pmid21478812">{{Cite pmid|21478812}}</ref>
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| **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.
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| ==Treatment== | | ==Treatment== |
| [[Heart Failure medical therapy|Medical Therapy]] | | [[Xyz medical therapy|Medical Therapy]] | [[Xyz interventions|Interventions]] | [[Xyz surgery|Surgery]] | [[Xyz primary prevention|Primary Prevention]] | [[Xyz secondary prevention|Secondary Prevention]] | [[Xyz cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Xyz future or investigational therapies|Future or Investigational Therapies]] |
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| *Patients with chronic heart failure are recommended to continue their previous guideline-directed medical therapy, including beta-blockers, ACEI or ARB, and mineralocorticoid receptor antagonists. <ref name="pmid31129923">{{Cite pmid|31129923}}</ref>
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| *Acute heart failure in the setting of COVID-19 is generally treated similarly to acute heart failure in other settings. These may include:
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| **Fluid restriction
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| **Diuretic therapy
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| **Vasopressors and/or inotropes
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| **Ventricular assisted devices and extracorporeal membrane oxygenation (ECMO)
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| *Beta-blockers should not be initiated during the acute stage due to their negative inotropic effects.<ref name="pmid24251454">{{Cite pmid|24251454}}</ref>
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| *Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) should be used with caution in patients with acute heart failure due to their effect on fluid and sodium retention.<ref name="pmid12656651">{{Cite pmid|12656651}}</ref>
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| | [[Heart Failure interventions|Interventions]] | [[Heart Failure surgery|Surgery]] | [[Heart Failure primary prevention|Primary Prevention]] | [[Heart Failure secondary prevention|Secondary Prevention]] | [[Heart Failure cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Xyz future or investigational therapies|Future or Investigational Therapies]] | |
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| ==Case Studies== | | ==Case Studies== |