COVID-19-associated heart failure: Difference between revisions

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===X-ray===
===X-ray===


*An x-ray may be helpful in the diagnosis of heart failure. Findings on an x-ray suggestive of heart failure include:
*An x-ray may be helpful in the diagnosis of [[heart failure]]. Findings on an x-ray suggestive of heart failure include:
**[[Cardiomegaly]]  
**[[Cardiomegaly]]  
**Pulmonary congestion
**Pulmonary congestion
**Increased pulmonary vascular markings.
**Increased pulmonary vascular markings.


*However, signs of pulmonary edema may be obscured by underlying respiratory involvement and ARDS due to COVID-19.
*However, signs of [[pulmonary edema]] may be obscured by underlying respiratory involvement and ARDS due to COVID-19.


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
Line 99: Line 99:
**Measurement of systolic pulmonary artery pressure
**Measurement of systolic pulmonary artery pressure
**Detection and quantification of pericardial effusion
**Detection and quantification of pericardial effusion
**Detection of regional wall motion abnormalities/reduced strain that would suggest underlying ischemia.
**Detection of [[regional wall motion abnormalities]]/reduced [[strain]] that would suggest underlying [[ischemia]].


===CT scan===
===CT scan===

Revision as of 14:23, 25 June 2020

WikiDoc Resources for COVID-19-associated heart failure

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

Synonyms and keywords:

Overview

  • 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.
  • Both de novo acute heart failure and acute decompensation of chronic heart failure can occur in patients with COVID-19.

Classification

Pathophysiology

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

Causes

Differentiating ((Page name)) from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

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)
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  2. PMID 32360242 (PMID 32360242)
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  3. PMID 32186331 (PMID 32186331)
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  4. PMID 30625066 (PMID 30625066)
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  5. PMID 32140732 (PMID 32140732)
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  6. PMID 20863950 (PMID 20863950)
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  7. PMID 28062628 (PMID 28062628)
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  8. PMID 32293449 (PMID 32293449)
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  9. PMID 32232979 (PMID 32232979)
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  10. PMID 18298480 (PMID 18298480)
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  11. PMID 16442916 (PMID 16442916)
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  12. PMID 28322314 (PMID 28322314)
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  13. PMID 23837838 (PMID 23837838)
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  14. PMID 21478812 (PMID 21478812)
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  15. PMID 32391912 (PMID 32391912)
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  16. PMID 24251454 (PMID 24251454)
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  17. PMID 12656651 (PMID 12656651)
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  18. PMID 31129923 (PMID 31129923)
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