Thread by @AmitGoyalMD

Excited to join this @ACCinTouch Webinar.

Why pay attention⁉️

1. COVID19: worse w/ baseline CV Dz🥵
2. COVID19: apprears to *cause* CV Dz💔
3. @CardioNerds will need to step up💪👩‍⚕️🧑‍⚕️

https://twitter.com/ACCinTouch/status/1239654649566826501

Prof Bin Cao:

- SARS-CoV2 shares ~80% identity with SARS, 51.8% with MERS-CoV
- Not a "Wuhan" or "China" disease...but GLOBAL disease
- America will face ⬆️ cases
- Lung path: hyaline membrane formation, interstitial mononuclear inflammation, thrombus in arterioles

Prof Bin Cao:

- Electron microscopy: viral partical in alveolar type II cells
- Not limited to Lungs
- Damage also to: heart, liver, spleen, etc
- Lymphonea: cause? direct injury vs immune

Prof Bin Cao: Dx criteria

Prof Bin Cao:

- Asymptomatic patients are infectious
- Each affected patient transmits to ~2 other patients

- Disease spectrum...

NOTE: "mild" disease has a broad spectrum

Clinical Features:

- COVID19 starts more silently than Influenza
- NOTE: 12% Acute Cardiac Injury

Survivors vs Nonsurvivors

- Viral sheding for median 20 days, but up to 37 days!

- COVID19 is NOT just a pulmonary disease

MULTI-organ damage

"This condition is viral sepsis"

Abnormal coagulation in COVID-19

Extensive intravascular microthrombosis on autopsy

Role of anticoagulation?

"It is not a lung disease...

...it is a whole body disease"

Typical lung imaging

Progression of CT changes

Respiratory failure can progress very quickly

Isolation & Supportive Treatment

✅isolation
✅triage to icu
✅close monitoring
✅possible antivral Rx
✅

Remdesivir Trial ongoing in China...

Other possibilties...no solid evidence yet

Role of steroids uncertain.

Note connnnntraindications.

First do no harm.

Dilemma of ARB/ACEi

@cardionerds episode 19 with @cingolani_oscar on this: cardionerds.com/episodes/covid…

Q: How do we prepare?

Prof Bin Cao: The 1st answer is diagnosis...2nd is diagnosis...3rd is diagnosis.

Patients will present to the cardiac clinic, the diabetes clinic, etc, since these are the most frequent co-morbidites.

Must be very careful and TEST!

Q: How did you approach PPE?

Prof Bin Cao:

"if you are taking care of COVID+ patient, in the COVID ward --> wear N95."

Otherwise wear the surgical mask ALL THE TIME in the hospital.

Prof Bin Cao:

"I want to remind the American Dr: "normal life is changing"

"It's a COVID-19 life...it's a pandemic life now"

Prof Yundai Chen

On Mortality...

There are inflammatory changes in the heart
- mononuclear inflammatory infiltratews
- endothelial shedding
- Viral inclusions not yet seen in the heart

Cardiac injury is common

Mechanisms for COVID Cardiac Injury.

1) ACE2 --> direct
2) Hypoxia induced
3) Cardiac microvasc damage
4) Inflammatory milieu

Cardiac injury in severe cases.

Mortality in severe cases approaching ~50%

Management:
- Supportive care
- on ACE/ARB, Antiplt, sttins, BBs

❤️🤓NOTE ‼️‼️

📢Coronavirus Fulminant Myocarditis

Report of 2⃣ CASES💔

Thank you Prof Yundai Chen🙏

Prof Yawei Xu

Learning from SARS 2002-2003

Impact on Chinese Health Care Workers.
- 1,688 cases
- 247 severe or critical
- 5 dead

Our hearts go out to them all.

Be careful everyone.

#InThisTogether

5⃣Tips for AMI Rx

Consider thrombolysis💉

STEMI flowchart.

Every hospital 🏥 needs a defined pathway appropriate for their system.

5⃣ Tips to protect Provides 👩‍⚕️🧑‍⚕️🏥

Call for specialized "Fever Clinics"

Lessons from SARS 2002-2003

The duality of ACE2 in COVID-19:

- Facilitate viral entry
⚖️
- Protection against lung injury

The CV Implications of COVID-19

💔 Acute Cardiac Injury

💔 Chronic Cardiac Injury (from SARS-CoV)

💔 SARS-CoV2 in pre-existing CVD

💔 Drug-related heart damage

cardionerds.com/episodes/covid…

"We are connected"

"We are one family"

A great big THANKS to our Chinese colleagues for teaching us so much today 🙏

#FlattenTheCurve
#InThisTogether