concept image - COVID-19 cardiovascular updates April 02 to April 09, 2020

In response to the COVID-19/Coronavirus outbreak as it relates to treating patients with cardiovascular disease, many medical associations and organizations have released statements specifically related to treatment for cardiovascular patients.

As we have little to no clinical data at this time, position statements and articles from reliable sources are especially important.

These resources provide credible and trustworthy information. Many if not most, speak to the need for more detailed research and data, to help guide us as we develop new standards of practice to ensure optimal care based on clinical practice rather than speculation.

COVID-19 STEMI Registry Created to Study Acute Cardiovascular Effects of the Virus

April 03 - DAIC

The Society for Cardiovascular Angiography and Interventions (SCAI) and the Canadian Association of Interventional Cardiology (CAIC) announced the formation of the North American COVID-19 ST-Segment Elevation Myocardial Infarction Registry (NACMI). This will record data on novel coronavirus (COVID-19, SARS-CoV-2) patients who have STEMI. The purpose of the trial is to quickly gather information to understand the adverse cardiovascular effects being seen in COVID-19 patients.

 

"We believe that this registry has the potential to provide critically important time-sensitive data to inform the management and treatment guidelines applicable to COVID-19 patients," SCAI said in a statement on the study.

 

Any COVID-19 positive patients or persons under investigation (PUI) with ST-segment elevation or new-onset left bundle branch block (LBBB) with a clinical correlate of myocardial ischemia (including chest pain, dyspnea, cardiac arrest, hemodynamic instability) will be in enrolled.

 

The data will be compared to an age and gender-matched control population from the existing Midwest STEMI Consortium, which is a large (>15,000), prospective multi-center registry of consecutive STEMI patients.

FDA Approves ECMO to Treat COVID-19 Patients

April 07 - DAIC

The U.S. Food and Drug Administration (FDA) has issued guidance to provide a policy to help expand the availability of devices used in extracorporeal membrane oxygenation (ECMO) therapy to address the novel coronavirus (COVID-19, SARS-CoV-2) public health emergency.

ECMO systems are used for long-term respiratory/cardiopulmonary failure and provide assisted extracorporeal circulation and physiologic gas exchange of the patient’s blood for more than six hours. The technology can oxygenate a severely sick COVID-19 pneumonia patient's blood without the need to transfer the oxygen through fluid-filled lungs.

As a sudden acute respiratory syndrome, COVID-19 can trigger acute respiratory failure and/or acute cardiopulmonary failure. Under these conditions, the FDA states in the new policy extracorporeal oxygenation can now be used for greater than six hours as tool for treating patients. The FDA said it recognizes the importance and utility of increased availability of ECMO devices for patients during the COVID-19 emergency.

Joint Statement Issued on Reducing Arrhythmia Risk With COVID-19 Repurposed Drugs

April 09 - Cardiology Advisor
Cardiovascular complications should be considered when hydroxychloroquine and azithromycin are used to treat patients with coronavirus disease 2019 (COVID-19), according to new guidance jointly published by the American Heart Association (AHA), the American College of Cardiology (ACC) and the Heart Rhythm Society (HRS).
Although not approved by the Food and Drug Administration (FDA) for COVID-19, hydroxychloroquine and azithromycin have been gaining momentum as potential treatments based on results of small studies. However, these agents are associated with cardiac effects that could potentially be harmful to patients, especially those with existing cardiovascular disease.
Specifically, both drugs can prolong the QT interval, increasing the risk of arrhythmias and Torsades de Pointes. In addition, life-threatening and fatal cardiomyopathy has been reported with the use of hydroxychloroquine, as well as with chloroquine. In severely ill COVID-19 patients, comorbidities such as hypokalemia, hypomagnesemia, and fever can increase the risk of arrhythmia.

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About Jasdeep Dalawari MD

Experienced General and Specialist Physician with a demonstrated history of working in the medical practice industry. Skilled in Interventional, Endovascular, Vascular, and General Cardiovascular Medicine; Emergency Medicine; Healthcare Consulting, including Peer Review, Expert Witness, and Utilization Review; and Medical Education. Strong healthcare services professional with an MS focused in Health Administration from Virginia Commonwealth University.