Thread by @DrMarthaGulati

@ACCinTouch program #CAAACC starting now. Yesterday over 10,000 watched the first session #COVID19 Today they will discuss cases and their management @hmkyale
celebration: no new case in China 🇨🇳 today!

Case1: #COVID19
🔹 diabetic male age 31 from Wuhan
🔹 febrile on admission, +SOB

🔹ECG On admission
🔹 elevates troponin and elevates CRP, D Dimer
🔹 ground glass CT lungs
#COVID19

♥️echo normal
🔹treatment began as below

See lab trends:
♥️ peaked troponin
♥️ elevated BNP that reduced over time
♥️abnormal LFTs that resolves

Very elevated BNP with normal LV function and yet not such an elevated troponin (not as high as seen in MI)
🔹 typical pattern seen in #COVID19: inflammation evident, multi-organ dysfunction
🔹in this case heart seems okay by echo

Is the elevated BNP reflecting long period of hypoxia? This is what the discussant suggests but interesting troponin wasn’t all that ⬆️. Or when echo was done (& normal) was it done early or just technically difficult. Clinically the patient in Heart failure #CCAACC @ACCinTouch

Per @hmkyale: treated patient with everything they had with patient with multi organ failure with low grade myocarditis- supportive care in this inflammatory storm is what is needed. Keep them alive and supported to defeat #COVID19 @ACCinTouch #CCAACC

Case 2 presented by Dr. Zhou from Wuhan #COVID19
🔹 20% patients developed into severe or critically severe type
🔹 shock
🔹 respiratory failure
🔹 multiorgan failure

Case below is a 50 year old male with fever and SOB with #COVID19
♥️⬆️BNP and ⬆️troponin
♥️LVEF 45%

Ultimately patient placed on ECMO #COVID19 @ACCinTouch #CCAACC

Patient starts getting better as you can see by CXR with ECMO... and look at patient today! There is hope. Remember this! #COVID19 @ACCinTouch #chineseExperience #WeAreAllInThisTogether

Lessons Learned:
🔹 ECMO for severe hypoxia in the right patients: start before they are dying

🔹 remember where ECMO is contraindicated:
🔺>70
🔺irreversible brain injury

🔹Using ECMO: earlier the better to help patients survive

🔹Consider choice of ECMO depending on if heart failure present

Breaking with tradition lesson 5:
🔹 does the patient need to be intubated first? What about ECMO first??? #COVID19 @ACCinTouch @HeartOTXHeartMD @AnastasiaSMihai

Beautiful ending by this cardiologist. Told us about his patients who are alive and called them the heroes of this fight for fighting everyday to live. And he thanked his family for doing without him. #grateful #humbled #thankful #WeAreAllInThisTogether #COVID19

@hmkyale asks about using data that China 🇨🇳 has to create risk scores to help us with decision making and treatment. Hopefully this comes! @ACCinTouch #CCAACC This is why it is so good we are connected! #WeAreAllInThisTogether ♥️♥️♥️♥️♥️♥️🦠♥️♥️♥️♥️♥️

Q: inflammatory Marker- were you checking it every day? What was your testing strategy? @hmkyale #COVID19
A: severe patient check inflammatory markers 1x/week! Interesting because we do labs 🧪 a lot more frequently in USA

Others report they did these inflammatory tests every other day. #COVID19

Q: Age & Risk: very dramatic in #COVID19. What are your lessons about this
A: Older=sicker & more often hospitalized and highest mortality. More susceptible but also underlying comorbidities also existed
@ACCinTouch @MinnowWalsh @hmkyale @CaraCarahendry @mmamas1973

Q: did you keep older doctors away from the patients with #COVID19
A: yes. In China 🇨🇳 the front lines were more often younger doctors
#WeAreInThisTogether #CCAACC @ACCinTouch @HeartOTXHeartMD @hvanspall @saraceciliamtz @AnumSaeedMD @atunuguntla1 @MaasAngela

Is there Sex Differences in #COVID19 ? Asks @hmkyale
A: more frequent in men. Few are female. Disproportionately affecting men based on IRL & data we have seen @ACCinTouch @WilliamZoghbi @jct_ucb @hvanspall @AnastasiaSMihai @saraceciliamtz @iamritu @thaiscoutinhoCV