Staying heart healthy facing COVID challenge

V.V.S.Manian

World Heart Day is celebrated on September 29 th every year. The theme for this year is “Use Heart to Beat Cardiovascular Disease”. The biggest task for doctors worldwide is how to save CDC patients.

With onset of corona virus, the challenge to combat CDC is still greater.

The basis for contracting the virus infection is the same for all individuals. Once the virus enters into the body, it causes direct damage to the lungs and triggers an inflammatory response which places stress on the cardiovascular system in two ways: First by infecting lungs, the blood oxygen levels drop and second, the inflammatory effect of the virus itself causes the blood pressure to drop as well. In such cases the heart must beat faster and harder to supply oxygen to major organs.

The recent finding is that SARS –Cov 2 causing corona virus disease has reached pandemic levels. Patients with CV risk factors and established CVD represent a vulnerable population suffering from COVID -19. Patients with cardiac injury have increased morbidity and mortality. The biggest challenge to doctors is diagnosis and management of CVD during the COVID-19 pandemic, especially very old patients with the presence of several comorbidities.

The European Society of Cardiology (ESC) has given a series of recommendation for treatment of patients with heart ailment plus corona virus infection.

Key points

*In HF patients suspected of COVID-29, routine clinical assessment, temperature measurement with non-contact devices. ECG (arrhymias, myocardial ischemia , myocarditis, chest X-ray , (cardiomegaly COVID-19 pneumonia) and laboratory findings can provide a diagnostic clue.

* Tran thoracic echocardiogram (TTE) can be used for further assessment.

* Ambulatory stable HF patients (with no cardiac) emergencies should refrain from hospital visits.

* Guidelines –directed medical therapy ( including beta-blocker,ACEI, ARB or sacubitril/valsartan and minerallocorticoid receptor or antoagonist) should be continued in chronic HF patients, irrespective of COVID -19.

* COV ID-19 patients may become hypotensive due to dehydration and haemodynamic deterioration, hence adjustment of medication doses should be considered.

* The more widespread use of telemedicine should be encouraged to minimize the risks of infection in both HF patients and HCP. Whenever possible, this technology should be utilized to provide medical advice and follow –up of stable HF patients and to reserve direct patient provider contact for the emergency situations. If feasible, home delivery and mailing of standard HF drugs to the patients is a viable option.

* Left Ventricular Assist Device and Heart Transplantation (LVAD) patients have a greater susceptibility to the infection and strict preventive measures should be applied to avoid it. If technically feasible tele- monitoring is preferable. Telemedicine and telephonic contact with doctors will suffice unless one has a severe infection that warrants hospital admission and supervision.

(Source: https://www.escardio.org/Education/COVID-19-and-Cardiology/ESC-COVID-19-Guidance#fig07)

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