1/ Great #ASPC2021 session by @dramitkhera on ACS in Patients with COVID-19
Follow this🧵on pts w/ COVID
🔷Prevention of ACS events
🔷Identification of ACS
🔷Management of ACS
@ASPCardio @CardioNerds
Follow this🧵on pts w/ COVID
🔷Prevention of ACS events
🔷Identification of ACS
🔷Management of ACS
@ASPCardio @CardioNerds
2/ 8 fold📈in AMI w/ COVID even in pts with no ASCVD/FH
Absolute risk for AMI📈in pts with ASCVD. Even higher for FH +ASCVD bit.ly/3eJ2csW
Based on NHANES, 75% of US pop has risk factors (CKD, obesity, smoking, T2DM) for severe COVID
bit.ly/3xYxpQn
#ASPC2021
Absolute risk for AMI📈in pts with ASCVD. Even higher for FH +ASCVD bit.ly/3eJ2csW
Based on NHANES, 75% of US pop has risk factors (CKD, obesity, smoking, T2DM) for severe COVID
bit.ly/3xYxpQn
#ASPC2021
3/ 🌟Prevention of ACS🌟
🗝️Address barriers to medication adherence and access
🗝️Team-based approach
🗝️Regular physical activity and nutrition
🗝️Cardiac rehab
🗝️Utilize telehealth
🗝️Counsel on promptly reporting new symptoms
#ASPC2021
🗝️Address barriers to medication adherence and access
🗝️Team-based approach
🗝️Regular physical activity and nutrition
🗝️Cardiac rehab
🗝️Utilize telehealth
🗝️Counsel on promptly reporting new symptoms
#ASPC2021
4/ During 1st wave, decline in ED visits for heart attack (23%) & stroke (20%)➡️delayed/deferred care➡️ repercussions including chronic & debilitating CVD
Study from NC, re-opening phase showed rebound in AMI & ADHF in urban & rural areas
bit.ly/3zoseJM
#ASPC2021
Study from NC, re-opening phase showed rebound in AMI & ADHF in urban & rural areas
bit.ly/3zoseJM
#ASPC2021
5/🌟 Identification of ACS 🌟
Challenging due to overlapping symptoms & ST changes/troponin elevation also seen in COVID
1/3 of COVID pts had positive troponin from study at Mt. Sinai from earlier in pandemic bit.ly/3rrS4tH
Troponin ➡️ prognostic marker
#ASPC2021
Challenging due to overlapping symptoms & ST changes/troponin elevation also seen in COVID
1/3 of COVID pts had positive troponin from study at Mt. Sinai from earlier in pandemic bit.ly/3rrS4tH
Troponin ➡️ prognostic marker
#ASPC2021
6/ Causes of Troponin Elevation related to COVID-19
♦️ACS
♦️Myocarditis
♦️Arrhythmias
♦️HF
♦️Thromboembolic complications
Also consider other non-direct CV causes leading to📈myocardial demand:
♦️Hypoxia (ARDS)
♦️Sepsis
bit.ly/3kPWk4O
#ASPC2021
♦️ACS
♦️Myocarditis
♦️Arrhythmias
♦️HF
♦️Thromboembolic complications
Also consider other non-direct CV causes leading to📈myocardial demand:
♦️Hypoxia (ARDS)
♦️Sepsis
bit.ly/3kPWk4O
#ASPC2021
7/ Aside on vaccine associated myocarditis…rare
Case series showed:
🔸Usually young males
🔸mRNA vaccines
🔸3-7 day range
🔸Chest pain
🔸Markedly elevated troponin
🔸CMR – late gadolinium enhancement
#ASPC2021
Case series showed:
🔸Usually young males
🔸mRNA vaccines
🔸3-7 day range
🔸Chest pain
🔸Markedly elevated troponin
🔸CMR – late gadolinium enhancement
#ASPC2021
8/ Pathophysiology of ACS
🔹⬆️ thrombosis
🔹Endothelial injury
🔹Cytokine storm
🔹⬆️catecholamines
🔹Microvascular dysfunction
Outcomes of ACS in pts with COVID ➡️delay to admission & door to balloon time, higher cardiogenic shock & mortality
bit.ly/3i1dACB
#ASPC2021
🔹⬆️ thrombosis
🔹Endothelial injury
🔹Cytokine storm
🔹⬆️catecholamines
🔹Microvascular dysfunction
Outcomes of ACS in pts with COVID ➡️delay to admission & door to balloon time, higher cardiogenic shock & mortality
bit.ly/3i1dACB
#ASPC2021
9/ NSTE-ACS & very high risk patient➡️cath
Guidelines: bit.ly/3hWYCxk
Risk stratification tool: POCUS
LV - Myocarditis, ACS, shock
RV - PE, cardiomyopathy
Other: Tamponade, valve disease
CCTA=⬆️neg predictive value in NSTEMI pts (VERDICT trial)
#ASPC2021
Guidelines: bit.ly/3hWYCxk
Risk stratification tool: POCUS
LV - Myocarditis, ACS, shock
RV - PE, cardiomyopathy
Other: Tamponade, valve disease
CCTA=⬆️neg predictive value in NSTEMI pts (VERDICT trial)
#ASPC2021
10/ Consider ACS risk features & COVID severity
Intermediate/Low risk➡️non-invasive tests (CCTA, CMR)
Poor prognosis➡️conserv. approach
No diff in thrombotic events/death w/ therapeutic AC vs. prophylactic in pts w/ high d-dimer (ACTION trial)
bit.ly/3eDTL27
#ASPC2021
Intermediate/Low risk➡️non-invasive tests (CCTA, CMR)
Poor prognosis➡️conserv. approach
No diff in thrombotic events/death w/ therapeutic AC vs. prophylactic in pts w/ high d-dimer (ACTION trial)
bit.ly/3eDTL27
#ASPC2021
11/ Summary for ACS in COVID
🗝️Prevent ACS w/ aggressive risk factor management, encourage timely care, & VACCINATE!
🗝️ACS can be challenging diagnosis in this population: use POCUS early (think of alternate causes)
#ASPC2021
🗝️Prevent ACS w/ aggressive risk factor management, encourage timely care, & VACCINATE!
🗝️ACS can be challenging diagnosis in this population: use POCUS early (think of alternate causes)
#ASPC2021
12/ More on cardiovascular implications of COVID-19 on @CardioNerds website: cardionerds.com/covid19/
#ASPC2021
#ASPC2021
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