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__NOTOC__
To go to the COVID-19 project topics list, click '''[[COVID-19 Project Topics|here]]'''.
== Methods of Pacing ==
{{COVID-19}}
Cardiac pacemakers consist of two parts: a '''pulse generator''' or simply generator which is the source of electric pulse, and a variable number of '''leads''' that convey the electric signal from the generator to the [[Myocardium|myocardium]]. Newer leadless pacemakers have been introduced reducing the risk of complications. There is no formal classification system for the pacemaker. Based upon their duration of use they can be divided into '''temporary pacing''' or emergency use pacing and '''permanent pacing'''.
{{CMG}}


=== Temporary pacing ===
Temporary pacing is indicated if permanent pacing is not instantly available, not required, or contraindicated. Unlike a permanent pacemaker, the generator is placed outside the body and not implanted in the [[Subcutaneous tissue|subcutaneous tissue]]. Different types of temporary pacing techniques (based upon the method used to consign the leads to the heart chambers) have been described in the table below.


<br />
==Complications==
{| class="wikitable"
===[[Anorexia associated with COVID-19]]===
! colspan=4 style="background: #4479BA; color: #FFFFFF; " align="center"|Types of temporary pacing
*According to a recent study by Pan et al, 48.5% presented with digestive symptoms as their chief complaint. [[Anorexia]] was the most common (83.8%) of digestive symptoms associated with SARS-Cov2 infection. With COVID-19 primarily being a respiratory disease, surprisingly around 3% cases had just the digestive symptoms but no respiratory symptoms.<ref name="pmid32287140">{{cite journal |vauthors=Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, Li P, Hu B, Wang J, Hu C, Jin Y, Niu X, Ping R, Du Y, Li T, Xu G, Hu Q, Tu L |title=Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study |journal=Am. J. Gastroenterol. |volume=115 |issue=5 |pages=766–773 |date=May 2020 |pmid=32287140 |pmc=7172492 |doi=10.14309/ajg.0000000000000620 |url=}}</ref>
|-
!style="background: #4479BA; color: #FFFFFF; " align="center" width="40"|Type
!style="background: #4479BA; color: #FFFFFF; " align="center" width="700"|Procedure
!style="background: #4479BA; color: #FFFFFF; " align="center" width="290"|Use
!style="background: #4479BA; color: #FFFFFF; " align="center" width="190"|Limitation/ Complication
|-valign="top"
|style="background: #DCDCDC; |'''Transvenous pacing'''
|{{main|Transvenous pacing}}Under sterile conditions, a pacemaker wire guided by [[Fluoroscopy|fluoroscopy]] or [[Echocardiography|echocardiography]] is placed into a vein. Internal jugular vein or subclavian vein are the most common access sites.<ref name="pmid17235372">{{cite journal |vauthors=McCann P |title=A review of temporary cardiac pacing wires |journal=Indian Pacing Electrophysiol J |volume=7 |issue=1 |pages=40–9 |date=January 2007 |pmid=17235372 |pmc=1764908 |doi= |url=}}</ref> It is then passed into either the right atrium or right ventricle. The pacing wire is then connected to an external pacemaker outside the body and appropriate mode is selected.
|1. Alternative to transcutaneous pacing and a bridge to permanent pacing.<br>2. Post-op injury/ trauma or temporary damage to conduction system or [[Sinoatrial node|SA node]].
|1. Infection<br>2. Thrombosis<br>3. Pneumothorax, hemothorax<br>4. Pericardial tamponade<ref name="MetkusSchulman2019">{{cite journal|last1=Metkus|first1=Thomas S.|last2=Schulman|first2=Steven P.|last3=Marine|first3=Joseph E.|last4=Eid|first4=Shaker M.|title=Complications and Outcomes of Temporary Transvenous Pacing|journal=Chest|volume=155|issue=4|year=2019|pages=749–757|issn=00123692|doi=10.1016/j.chest.2018.11.026}}</ref>
|-valign="top"
|style="background: #DCDCDC; |'''Transcutaneous pacing'''/ External pacing
|The procedure described in:{{main|Transcutaneous pacing}} External pacing should not be relied upon for an extended period of time.
|1.Emergencies: Hemodynamically significant [[bradycardia]]s, asystole, [[Third degree AV block|third-degree AV block]]<ref name="pmid30774278">{{cite journal |vauthors=Doukky R, Bargout R, Kelly RF, Calvin JE |title=Using transcutaneous cardiac pacing to best advantage: How to ensure successful capture and avoid complications |journal=J Crit Illn |volume=18 |issue=5 |pages=219–225 |date=May 2003 |pmid=30774278 |pmc=6376978 |doi= |url=}}</ref> <br>2. bridge to transvenous pacing
|1. Patient discomfort<br> 2. Risk of skin burns<br>3. Musculoskeletal stimulation
|-valign="top"
|style="background: #DCDCDC; |'''[[Epicardial]] Pacing'''
|Temporary epicardial pacing is used during open-heart surgery should the surgical procedure create [[Atrioventricular block|atrioventricular block]]. The electrodes are placed in contact with the [[Epicardium|outer wall]] of the ventricle to maintain satisfactory cardiac output until a temporary transvenous electrode has been inserted.
|
|
|-valign="top"
|style="background: #DCDCDC; |'''Transesophageal pacing'''
|Two types of leads are available; pill electrode with flexible wire that can be swallowed and a flexible catheter that is introduced via nares under local anesthesia. Transesophageal pacing requires special pacing devices. Being programed for burst pacing only, esophageal stimulators are intrinsically developed as triggering systems. The addition of a programmable stimulator is required to deliver extrastilumi.
|1. Evaluation of [[Sinoatrial node|SA node]], [[Supraventricular tachycardia|supraventricular tachycardias]] and palpitations.<br>2. Treatment: Atrial fibrillation<ref name="pmid16943920">{{cite journal |vauthors=Verbeet T, Castro J, Decoodt P |title=Transesophageal pacing: a versatile diagnostic and therapeutic tool |journal=Indian Pacing Electrophysiol J |volume=3 |issue=4 |pages=202–9 |date=October 2003 |pmid=16943920 |pmc=1502053 |doi= |url=}}</ref><br>3. Replacement of invasive atrial pacing (Atrial proximity and safer technique)
|1. No ventricular pacing<br>2. Heartburn<br>3. Phrenic nerve stimulation<ref name="pmid8780310">{{cite journal |vauthors=Roth JV |title=Phrenic nerve stimulation during transesophageal atrial pacing may cause apnea in spontaneously breathing patients |journal=Anesth. Analg. |volume=83 |issue=3 |pages=661 |date=September 1996 |pmid=8780310 |doi=10.1097/00000539-199609000-00054 |url=}}</ref>
|-valign="top"
|style="background: #DCDCDC; |'''Transthoracic pacing'''
|
|
|
|-valign="top"
|style="background: #DCDCDC; |'''Transthoracic mechanical pacing'''
|An old procedure, also known as percussive pacing involves the use of the closed fist, usually on the left lower edge of the sternum over the right ventricle. According to the British Journal of Anesthesia Striking from a distance of 20 - 30 cm to raise the ventricular pressure 10 - 15mmHg will induce electrical activity and hence ventricular beat.<ref>(Cite_Journal)Percussion pacing in a three-year-old girl with complete heart block during cardiac catheterization. C Eich, A Bleckmann and T. Paul, retrieved from http://bja.oxfordjournals.org/cgi/content/full/95/4/465</ref> It is a life-saving mean until an electrical pacemaker is available.
|1.Bradyarrhythmias with hemodynamic instability or asystole<ref name="EichBleckmann2007">{{cite journal|last1=Eich|first1=C.|last2=Bleckmann|first2=A.|last3=Schwarz|first3=S.K.W.|title=Percussion pacing—an almost forgotten procedure for haemodynamically unstable bradycardias? A report of three case studies and review of the literature|journal=British Journal of Anaesthesia|volume=98|issue=4|year=2007|pages=429–433|issn=00070912|doi=10.1093/bja/aem007}}</ref><br>2. Complete heart block with ventricular asystole
|Potential for injury due to mechanical nature and availability of better techniques limit the use.
|-valign="top"
|style="background: #DCDCDC; |'''Transmediastinal pacing'''
|Also available for permanent pacing, the technique is usually used for temporary pacing.
|
|
|}


====Natural history====
*


=== Permanent Pacing ===
====History of anorexia associated with COVID-19====
[[Image:Fluoroscopy pacemaker leads right atrium ventricle.png|thumb|left|Right atrial and right ventricular leads as visualized under X-ray during a pacemaker implant procedure. The atrial lead is the curved one making a U shape in the upper left part of the figure.]]
*
Permanent pacing with an implantable pacemaker involves the transvenous placement of one or more pacing electrodes within a chamber, or chambers, of the heart. The procedure is performed by the incision of a suitable vein into which the electrode lead is inserted and passed along the vein, through the valve of the heart, until positioned in the chamber. The procedure is facilitated by [[fluoroscopy]] which enables the physician or cardiologist to view the passage of the electrode lead. After satisfactory lodgment of the electrode is confirmed the opposite end of the electrode lead is connected to the pacemaker generator.
====Diagnosis====


The pacemaker generator is a hermetically sealed device containing a power source, usually a lithium battery, a sensing amplifier which processes the electrical manifestation of naturally occurring heartbeats as sensed by the heart electrodes, the computer logic for the pacemaker and the output circuitry which delivers the pacing impulse to the electrodes.
'''Laboratory Findings'''


Most commonly, the generator is placed below the subcutaneous fat of the chest wall, above the muscles and bones of the chest. However, the placement may vary on a case by case basis.
====Treatment====


The outer casing of pacemakers is so designed that it will rarely be rejected by the body's [[immune system]]. It is usually made of [[titanium]], which is inert in the body.
===[[Oral musical lesions associated with COVID-19]]===
*Recently, according to Carreras-Presas et al.  [[oral]] [[Vesicular and bullous lesions|vesiculobullous lesions]] associated with COVID-19 infection have been reported in three patients.<ref name="pmid32521067">{{cite journal |vauthors=Al-Khatib A |title=Oral manifestations in COVID-19 patients |journal=Oral Dis |volume= |issue= |pages= |date=June 2020 |pmid=32521067 |doi=10.1111/odi.13477 |url=}}</ref>
====Pathophysiology====
*An abundant Angiotensin-converting enzyme 2 ([[ACE2]]) receptor expression on epithelial cells of the [[oral cavity]] plays a pivotal role in allowing COVID-19 virus to enter the [[epithelial cells]] and cause infection. There is a  strong association between ACE-2 and 2019-nCoV S protein. The presence of coronavirus in human saliva is attributed to the same reason.<ref name="pmid32474389">{{cite journal |vauthors=Baghizadeh Fini M |title=Oral saliva and COVID-19 |journal=Oral Oncol. |volume=108 |issue= |pages=104821 |date=May 2020 |pmid=32474389 |pmc=7250788 |doi=10.1016/j.oraloncology.2020.104821 |url=}}</ref>
 
====Natural history====
*
 
====History of oral musical lesions associated with COVID-19====
*
====Diagnosis====
 
'''Laboratory Findings'''
 
====Treatment====
 
 
===Dysgeusia associated with COVID-19===
*[[Dysgeusia]]
 
===Hepatic injury associated with COVID-19===
*Several studies have reported the incidence of liver injury in [[COVID-19]] infected patients.
====Pathophysiology====
*The exact mechanism of liver injury is still unclear. There are a few proposed mechanisms by which the SARS-CoV2 virus can infect liver cells causing damage, leading to a rise in hepatic enzymes.
**Hepatic injury directly caused by the viral infection of the liver as the detection of SARS-CoV-2 RNA in stool gives rise to the notion of viral exposure in the liver. <ref name="pmid32145190">{{cite journal |vauthors=Zhang C, Shi L, Wang FS |title=Liver injury in COVID-19: management and challenges |journal=Lancet Gastroenterol Hepatol |volume=5 |issue=5 |pages=428–430 |date=May 2020 |pmid=32145190 |pmc=7129165 |doi=10.1016/S2468-1253(20)30057-1 |url=}}</ref>
**A preliminary study suggested that Angiotensin-converting enzyme 2 ([[ACE2]]) receptor expression is enriched in [[cholangiocytes]] and not in [[hepatocytes]], indicating that SARS-CoV-2 might directly bind to ACE2-positive cholangiocytes to dysregulate liver function. The studies have not yet answered about the specific mechanisms of [[cholangiocyte]] injury, and how [[hepatocyte]] injury occurs as it lacks ACE2 receptor.<ref name="pmid32243269">{{cite journal |vauthors=Lee IC, Huo TI, Huang YH |title=Gastrointestinal and liver manifestations in patients with COVID-19 |journal=J Chin Med Assoc |volume=83 |issue=6 |pages=521–523 |date=June 2020 |pmid=32243269 |pmc=7176263 |doi=10.1097/JCMA.0000000000000319 |url=}}</ref><ref name="KumarSharma2020">{{cite journal|last1=Kumar|first1=Pramod|last2=Sharma|first2=Mithun|last3=Kulkarni|first3=Anand|last4=Rao|first4=Padaki N.|title=Pathogenesis of Liver Injury in Coronavirus Disease 2019|journal=Journal of Clinical and Experimental Hepatology|year=2020|issn=09736883|doi=10.1016/j.jceh.2020.05.006}}</ref>
 
====Natural history====
* According to the data available to date, patients with severe disease had increased incidence of abnormal liver function. By Guan et al. of 1099 COVID-19 positive patients, 2.3% had a preexisting liver injury, but elevated levels of [[AST]] were observed in 18.2% of the patients with non-severe disease and 39·4% patients with severe disease. Other studies with a lesser sample size had similar findings reported.<ref name="pmid32145190">{{cite journal |vauthors=Zhang C, Shi L, Wang FS |title=Liver injury in COVID-19: management and challenges |journal=Lancet Gastroenterol Hepatol |volume=5 |issue=5 |pages=428–430 |date=May 2020 |pmid=32145190 |pmc=7129165 |doi=10.1016/S2468-1253(20)30057-1 |url=}}</ref>
 
*
====Diagnosis====
 
'''Laboratory Findings'''
 
====Treatment====
 
 
==References==
{{Reflist|2}}

Revision as of 06:57, 25 June 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Complications

Anorexia associated with COVID-19

  • According to a recent study by Pan et al, 48.5% presented with digestive symptoms as their chief complaint. Anorexia was the most common (83.8%) of digestive symptoms associated with SARS-Cov2 infection. With COVID-19 primarily being a respiratory disease, surprisingly around 3% cases had just the digestive symptoms but no respiratory symptoms.[1]

Natural history

History of anorexia associated with COVID-19

Diagnosis

Laboratory Findings

Treatment

Oral musical lesions associated with COVID-19

  • Recently, according to Carreras-Presas et al. oral vesiculobullous lesions associated with COVID-19 infection have been reported in three patients.[2]

Pathophysiology

  • An abundant Angiotensin-converting enzyme 2 (ACE2) receptor expression on epithelial cells of the oral cavity plays a pivotal role in allowing COVID-19 virus to enter the epithelial cells and cause infection. There is a strong association between ACE-2 and 2019-nCoV S protein. The presence of coronavirus in human saliva is attributed to the same reason.[3]

Natural history

History of oral musical lesions associated with COVID-19

Diagnosis

Laboratory Findings

Treatment

Dysgeusia associated with COVID-19

Hepatic injury associated with COVID-19

  • Several studies have reported the incidence of liver injury in COVID-19 infected patients.

Pathophysiology

  • The exact mechanism of liver injury is still unclear. There are a few proposed mechanisms by which the SARS-CoV2 virus can infect liver cells causing damage, leading to a rise in hepatic enzymes.
    • Hepatic injury directly caused by the viral infection of the liver as the detection of SARS-CoV-2 RNA in stool gives rise to the notion of viral exposure in the liver. [4]
    • A preliminary study suggested that Angiotensin-converting enzyme 2 (ACE2) receptor expression is enriched in cholangiocytes and not in hepatocytes, indicating that SARS-CoV-2 might directly bind to ACE2-positive cholangiocytes to dysregulate liver function. The studies have not yet answered about the specific mechanisms of cholangiocyte injury, and how hepatocyte injury occurs as it lacks ACE2 receptor.[5][6]

Natural history

  • According to the data available to date, patients with severe disease had increased incidence of abnormal liver function. By Guan et al. of 1099 COVID-19 positive patients, 2.3% had a preexisting liver injury, but elevated levels of AST were observed in 18.2% of the patients with non-severe disease and 39·4% patients with severe disease. Other studies with a lesser sample size had similar findings reported.[4]

Diagnosis

Laboratory Findings

Treatment

References

  1. ↑ Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, Li P, Hu B, Wang J, Hu C, Jin Y, Niu X, Ping R, Du Y, Li T, Xu G, Hu Q, Tu L (May 2020). "Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study". Am. J. Gastroenterol. 115 (5): 766–773. doi:10.14309/ajg.0000000000000620. PMC 7172492 Check |pmc= value (help). PMID 32287140 Check |pmid= value (help).
  2. ↑ Al-Khatib A (June 2020). "Oral manifestations in COVID-19 patients". Oral Dis. doi:10.1111/odi.13477. PMID 32521067 Check |pmid= value (help).
  3. ↑ Baghizadeh Fini M (May 2020). "Oral saliva and COVID-19". Oral Oncol. 108: 104821. doi:10.1016/j.oraloncology.2020.104821. PMC 7250788 Check |pmc= value (help). PMID 32474389 Check |pmid= value (help).
  4. ↑ 4.0 4.1 Zhang C, Shi L, Wang FS (May 2020). "Liver injury in COVID-19: management and challenges". Lancet Gastroenterol Hepatol. 5 (5): 428–430. doi:10.1016/S2468-1253(20)30057-1. PMC 7129165 Check |pmc= value (help). PMID 32145190 Check |pmid= value (help).
  5. ↑ Lee IC, Huo TI, Huang YH (June 2020). "Gastrointestinal and liver manifestations in patients with COVID-19". J Chin Med Assoc. 83 (6): 521–523. doi:10.1097/JCMA.0000000000000319. PMC 7176263 Check |pmc= value (help). PMID 32243269 Check |pmid= value (help).
  6. ↑ Kumar, Pramod; Sharma, Mithun; Kulkarni, Anand; Rao, Padaki N. (2020). "Pathogenesis of Liver Injury in Coronavirus Disease 2019". Journal of Clinical and Experimental Hepatology. doi:10.1016/j.jceh.2020.05.006. ISSN 0973-6883.
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