Thread by @DrMarthaGulati

Features of #COVID19 @ACCinTouch #CCAACC
🔹fever predominant feature
🔹cough (less often productive)
🔹cough presents on discharge (Lancet paper)
🔹 more than pneumonia
🔹 abnormal coagulation: ⬆️ d-dimer so anticoag needed
@TheLancet @Drroxmehran @CMichaelGibson @hmkyale

Rapid deterioration seen quite often. Cases below demonstrate this: #COVID19

Discussion of this dilemma of ACEI and ARBs: question still remains. We don’t have evidence to stop these and shouldn’t yet.
🔹48% have HTN, less with HTN who survive (~20%)
🔹limited data to say stop anti-RAS
🔹 need studies
@ACCinTouch @hmkyale @DrJenniferCo_Vu

@hmkyale thanks the Chinese Teams for sharing the knowledge #WeAreAllInThisTogether and also for not just caring for patients but continuing the science and publishing this so we can better care for patients here ♥️ #oneworld #onefamily @ACCinTouch

Normal life is changing. It is a CoVID19 Life. It is a Pandemic life. Wear marks. Protect everyone. #COVID19

#COVID19 is a global issue:
♥️Threat to global health with it spreading across the world
♥️acute cardiac injury seen in at least 10%

Hypothesis of #cardiacInjury by #COVID19 ♥️
🔹ACE2 mediated damage
🔹hypoxia damage
🔹microvascular damage
🔹inflammation

Management of #COVID19 and #heartdysfunction
🔹questions persist about AntiRAS drugs but we don’t know
🔹antiplatelet drugs: continue but watch for bleeding
🔹statins: watch LFTs
🔹 watch for interaction of antiretrovirals and CVD drugs

Summary of Management of #COVID19 in those with #CVD
♥️ early management
♥️diagnosis in time
♥️therapy for those with severe cases
♥️ be aware of drug interaction

#COVID19 Pandemic but prior experience in China resulted in rapid response but 3.8% of Chinese healthcare workers infected
🔹 peak in healthcare worker deaths but steadily decreased

Treatment of #AMI during #COVID19 crisis shown from our Chinese colleagues:
♥️fever and respiratory inventory first
♥️ thrombocytopenia
♥️ remote consultation by cardiologists encouraged
♥️ instability: is it pneumonia or the AMI?

Safety of Cardiac patients:
♥️avoid unnecessary hospitalizations: there won’t be beds for all so stable disease stay home!!! For their safety
♥️remote consultations
♥️ reduce interaction
♥️ screen for fever: fever clinic, screen at entry of hospital
@athenapoppas @DickKovacs

As @hmkyale pointed out: this is not JUST a pulmonary disease. Cardiac patients at the highest risk.
Question: should we check troop one on all cases of #COVID19?
🔹 most will have elevated troponin
🔹 when critical it will be dramatically elevated
🔹 💔 injury common

@MinnowWalsh asks how you changed your approach to routine patients?
🔹 China closed routine clinics
🔹 used internet consultations
🔹 ER was open but encouraged patients not to be exposed in clinics
🔹 AMI treatment changed in #CoVID19: #thrombolytics not #PCI
#ChinaExperience

Patients with underlying Cardiac disease are at the greatest risk based on data we have from China #covid19 @ACCinTouch

Important to be aware that drugs we use can damage the ♥️
🔹 risk of complete heart block
🔹 risk of cardiomyopathy
With antiretroviral therapy #COVID19 so be aware of this @ACCinTouch @hmkyale

Thanks @hmkyale for asking my question about #NSAIDS given the warnings about using this and whether it increases risk. Seems that the Chinese experience doesn’t answer this. We just don’t know it seems. (If I understood this correctly-someone correct me if I didn’t understand)