Thread by @athakkarMD

1/6 #Cardiotwitter - check out this #Tweetorial

"CV considerations & #COVID19"

💥Viral cell entry using ACE2
💥ACEi/ARB - don't stop - no evidence of harm/benefit

#ACCFIT #MedEd #Medtwitter #HMHFellow @HMHCardioFellow @HMethodistCV #StayHomeSaveLives #FlattenTheCurveTogether

2/6

💥Increased #COVID19 mortality with CVD
💥Association between elevated troponin and mortality
💥#COVID19 + elevated troponin -> older patients, more co-morbidities, higher acuity

3/6

💥ACC: Measure troponin & BNP if considering ACS / HF clinically
💥Based on studies, ?consider using troponin as prognostic marker
💥ACS: GDMT, consider cath lab staff exposure, ?fibrinolytics in low risk ACS

#COVID19

4/6

💥Reports of new onset cardiomyopathy - may contribute to #COVID19 mortality
💥Steroids or no steroids?
💥Cautious volume resuscitation
💥Consider RV failure with ARDS
💥Define hemodynamics, imp if considering ECMO
💥Malignant tachy-arrhythmia + ⬆️troponin -> ?Myocarditis

5/6

💥Hydroxychloroquine / Azithromycin - no strong evidence for benefit
💥Does ⬆️QTc
💥Can use Tisdale score to risk stratify
💥Repeat ECG 2-3 hours post dose on day 3

#COVID19

6/6

💥ISHLT: Stratify OHTxp by #COVID19 severity
💥Mild -> #StayHome, continue immunosuppression
💥Mod -> Admit, avoid non-invasive vent, consider early intubation
💥Severe -> Consider interrupting antimetabolite, local ECMO guidelines

#echofirst #radialfirst #yesCCT #whyCMR