The SARS CoV-2 is transmitted by droplets, which enter the mucous membranes of the patients eyes, nose, and mouth. 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. strong class=”kwd-title” Keywords: cardiac involvement, COVID infection, echocardiography for cardiac evaluation Introduction The Coronavirus pandemic, which started in late 2019 and is still ongoing, has severely stretched and overwhelmed the healthcare infrastructure all over the world. The SARS CoV-2 is transmitted by droplets, which enter the mucous membranes of the patients eyes, nose, and mouth. ACE-2 receptors, predominantly present in the lungs, facilitate the entry of the virus into the cells. 1 Cardiac involvement in the coronavirus infection is relatively uncommon in low-risk, younger, asymptomatic patients ( 40 yrs). In middle age/elderly patients, the Rabbit polyclonal to KBTBD8 cardiac involvement progressively increases, and in patients requiring intensive care facilities, with or without ventilator therapy, the prevalence of heart involvement rises steeply and could be in the range of 50 to 60%. 1 2 3 4 Cardiac Involvement due to Coronavirus Infection can Occur in ( Table?1 ): Table 1 Cardiac involvement COVID-19 MyocarditisStress cardiomyopatdyArrytdmiasHeart failureMyocardial infarctionSeptic shockPulmonary embolismMyocardial ischemia due to demand-supply mismatchCytokine storm /multiorgan failure Open in a separate window Individuals with preexisting heart diseaseCcoronary artery disease, well-compensated congenital heart disease, valvular heart disease, as well while those in whom there is involvement of the heart in comorbid conditions such as hypertension, diabetes and chronic kidney disease. These individuals can undergo worsening and decompensation due to acute stress. Direct/indirect involvement of myocardium (myocarditis) is as follows: Direct involvement of the myocardium happens because Chondroitin sulfate of the viral RNA influencing the endothelium of the myocardial vessels, leading to launch of troponins (troponinCT and Chondroitin sulfate I), causing varying examples of myocardial dysfunction. Indirect involvement of the myocardium can occur as a result of a severe systemic swelling, causing launch of cytokines/chemokines. These proinflammatory cytokines like tumor necrosis element (TNF), interleukin (IL)-6, ferritin, C-reactive protein (CRP), and IL-1 are overproduced in response to cells injury. This phenomenon is called cytokine storm which leads to vascular hyperpermeability, plaque ruptures, and eventually multiorgan failure. This is mediated by activation of monocytes and macrophages. The presence of myocardial injury is an self-employed risk factor associated with improved mortality in COVID individuals. 5 6 7 8 Rupture of atherosclerotic plaque on a preexisting crucial/noncritical coronary artery disease, causing acute myocardial infarction (MI), usually ST elevated myocardial infarction (STEMI). The management of individuals with MI could either become using thrombolytic therapy (offered no C/I exist) or become directly referred to a percutaneous coronary treatment (PCI) center. The thrombolytic therapy routine has the Chondroitin sulfate advantage of becoming cost-effective, immediately available, and more importantly avoiding transmission of infections to the interventional team. However, the advantage of PCI approach avoids unneeded delays arising from changes in the appearance of classical findings of ECG in STEMI. 5-8 Myocardial ischemia precipitated by myocardial supply/demand mismatch due to tachycardia, hypoxia, pyrexia, and systemic swelling which could lead to severe remaining ventricle (LV) dysfunction. 9 10 Cardiac arrhythmias varying from benign atrial/ventricular ectopics to life-threatening ventricular arrhythmias like Torsades de pointes, which could occur as a result of the following: Myocardial swelling; use of cardiotoxic medications like chloroquine, hydroxychloroquine, azithromycin antiviral medicines; congenital disorders such as Brugada syndrome and long QT; electrolyte imbalance 11 12 ( Table?2 ). Table 2 Drugs linked to arrhythmias in COVID-19 individuals thead th align=”remaining” valign=”top” rowspan=”1″ colspan=”1″ Type of arrhythmia /th th align=”remaining” valign=”top” rowspan=”1″ colspan=”1″ Cautious use of medicines /th /thead Benign atrial/ventricular ectopicsCCongenital arrythmias: long QT interval, short QT interval, Brugada syndromeChloroquine br / Hydroxychloroquine br / Azithromycin br / Chondroitin sulfate Lopinavir/ritonavirCatecholaminergic polymorphic ventricular tachycardiaEpinephrine, dopamine and dobutamine Open in a separate windows Involvement of pericardium,.
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