The Utility of Handheld Cardiac and Lung Ultrasound in Predicting Outcomes of Hospitalised Patients With COVID-19
Strict isolation precautions limit formal echocardiography use in the setting of COVID-19 infection. Information on the importance of handheld focused ultrasound for cardiac evaluation in these patients is scarce. This study investigated the utility of a handheld echocardiography device in hospitalised patients with COVID-19 in diagnosing cardiac pathologies and predicting the composite end point of in-hospital death, mechanical ventilation, shock, and acute decompensated heart failure.Digital Technology Application for Improved Responses to Health Care Challenges: Lessons Learned From COVID-19
While COVID-19 is still ongoing and associated with more than 5 million deaths, the scope and speed of advances over the past year in terms of scientific discovery, data dissemination, and technology have been staggering. It is not a matter of “if” but “when” we will face the next pandemic, and how we leverage technology and data management effectively to create flexible ecosystems that facilitate collaboration, equitable care, and innovation will determine its severity and scale. The aim of this review is to address emerging challenges that came to light during the pandemic in health care and innovations that enabled us to adapt and continue to care for patients.Myocarditis and Pericarditis After COVID-19 mRNA Vaccination: Practical Considerations for Care Providers
The mRNA vaccines against COVID-19 infection have been effective in reducing the number of symptomatic cases worldwide. With widespread uptake, case series of vaccine-related myocarditis/pericarditis have been reported, particularly in adolescents and young adults. Men tend to be affected with greater frequency, and symptom onset is usually within 1 week after vaccination. Clinical course appears to be mild in most cases. On the basis of the available evidence, we highlight a clinical framework to guide providers on how to assess, investigate, diagnose, and report suspected and confirmed cases.Myocarditis After SARS-CoV-2 Vaccination: A Vaccine-Induced Reaction?
Vaccination plays an important role in the fight against SARS-CoV-2 to minimie the spread of coronavirus disease 2019 (COVID-19) and its life-threatening complications. Myocarditis has been reported as a possible and rare adverse consequence of different vaccines, and its clinical presentation can range from influenza-like symptoms to acute heart failure. We report a case of a 30-year-old man who presented progressive dyspnea and constrictive retrosternal pain after receiving SARS-CoV-2 vaccine.Long COVID-19: A Primer for Cardiovascular Health Professionals, on Behalf of the CCS Rapid Response Team
It is now widely recognized that COVID-19 illness can be associated with significant intermediate and potentially longer-term physical limitations. The term, “long COVID-19” is used to define any patient with persistent symptoms after acute COVID-19 infection (ie, after 4 weeks). It is postulated that cardiac injury might be linked to symptoms that persist after resolution of acute infection, as part of this syndrome. The Canadian Cardiovascular Society Rapid Response Team has generated this document to provide guidance to health care providers on the optimal management of patients with suspected cardiac complications of long COVID-19.Kawasaki Disease Shock Syndrome vs Classical Kawasaki Disease: A Meta-analysis and Comparison With SARS-CoV-2 Multisystem Inflammatory Syndrome
The emergence of increasing reports worldwide of a severe inflammatory process and shock in pediatric patients resembling Kawasaki disease (KD)—and, more specifically, Kawasaki disease shock syndrome (KDSS)—prompted us to explore KDSS in a preamble of a systematic comparison between the 2 conditions.Challenges and Lessons Learned From COVID-19 Trials: Should We Be Doing Clinical Trials Differently?
The COVID-19 crisis led to a flurry of clinical trials activity. The COVID-evidence database shows 2814 COVID-19 randomized trials registered as of February 16, 2021. Most were small (only 18% have a planned sample size > 500) and the rare completed ones have not provided published results promptly (only 283 trial publications as of February 2021). Small randomized trials and observational, nonrandomized analyses have not had a successful track record and have generated misleading expectations. Different large trials on the same intervention have generally been far more efficient in producing timely and consistent evidence.Influenza Vaccination in Patients With Congenital Heart Disease in the Pre-COVID-19 Era: Coverage Rate, Patient Characteristics, and Outcomes
Influenza vaccination is the most commonly recommended immune prevention strategy. However, data on influenza vaccination in patients with congenital heart disease (CHD) are scarce. In this study, our goals were to: (1) measure vaccination coverage rates (VCRs) for influenza in a large cohort of children, adolescents, and adults with CHD; (2) identify patient characteristics as predictors for vaccination; and (3) investigate the effect of influenza vaccination on hospitalization.COVID-19 Vaccination Prioritization on the Basis of Cardiovascular Risk Factors and Number Needed to Vaccinate to Prevent Death
The supply limitations of COVID-19 vaccines have led to the need to prioritize vaccine distribution. Obesity, diabetes, and hypertension have been associated with an increased risk of severe COVID-19 infection. Approximately half as many individuals with a cardiovascular risk factor need to be vaccinated against COVID-19 to prevent related death compared with individuals without a risk factor. Adults with body mass index ≥ 30, diabetes, or hypertension should be of a similar priority for COVID-19 vaccination to adults 10 years older with a body mass index of 20 to < 30, no diabetes, and no hypertension.The Global Effect of the COVID-19 Pandemic on STEMI Care: A Systematic Review and Meta-analysis
The COVID-19 pandemic has affected patients with ST-segment elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI) worldwide. In this review we examine the global effect of the COVID-19 pandemic on incidence of STEMI admissions, and relationship between the pandemic and door to balloon time (D2B), all-cause mortality, and other secondary STEMI outcomes.Use of Simulation-Based Medical Education for Advanced Resuscitation of In-Hospital Cardiac Arrest Patients With Suspected or Confirmed COVID-19
Cardiac arrest is common in critically ill patients with coronavirus disease 2019 (COVID-19) and is associated with poor survival. Simulation is frequently used to evaluate and train code teams with the goal of improving outcomes. All participants engaged in training on donning and doffing of personal protective equipment for suspected or confirmed COVID-19 cases. Thereafter, simulations of in-hospital cardiac arrest of patients with COVID-19, so-called protected code blue, were conducted at a quaternary academic centre.The Transformation of Cardiology Training in Response to the COVID-19 Pandemic: Enhancing Current and Future Standards to Deliver Optimal Patient Care
The COVID-19 pandemic has had an unprecedented impact on cardiology training. Novel opportunities have been identified in several domains: patient exposure, procedural experience, didactic education, research and development, advocacy and well-being, and career advancement. Lessons learned from COVID-19 should be used to further improve fellowship training such as, for example, through the development of a competency-based training and evaluation system. Multimodality teaching that incorporates telelearning provides creative solutions for trainee and continuing medical education.A Multiprofessional Face-to-Face and Remote Real-Time Hybrid Mode of Exercise-Based Cardiac Rehabilitation: An Innovative Proposal During the COVID-19 Pandemic
Exercise-based cardiac rehabilitation is largely recognized as a cost-effective therapeutic strategy for several clinical conditions and formally recommended and endorsed by a number of institutional guidelines.1 Since 1994, in our medically supervised exercise program, more than 2500 patients have completed over 450,000 patient-hours in exercise sessions. However, during the COVID-19 pandemic, as happened worldwide, our on-site exercise sessions were suspended, and we had to quickly implement alternative options of home-based programs, using recent advances in telecommunications and health-monitoring technology.Reply to Čulić et al—COVID-19 Pandemic and Possible Rebound Phenomenon in Incidence of Acute Myocardial Infarction
We agree with Čulić et al1 regarding to the fact that the observed ST-segment elevation myocardial infarction (STEMI) hospitalisation rebound phenomenon is not entirely unexpected. Nonetheless, our report2 is indeed the first description of this worrisome trend. Israel saw its first confirmed COVID-19 patient on February 21. The first documented in-state transmission of the virus subsequently occurred on February 22. New government regulations calling for social distancing; limiting gatherings; and restrictions on public transportation, schools, universities, and businesses were announced on March 10.Cardiovascular Care Delivery During the Second Wave of COVID-19 in Canada
Hospitals and ambulatory facilities significantly reduced cardiac care delivery in response to the first wave of the COVID-19 pandemic. The deferral of elective cardiovascular procedures led to a marked reduction in health care delivery with a significant impact on optimal cardiovascular care. International and Canadian data have reported dramatically increased wait times for diagnostic tests and cardiovascular procedures, as well as associated increased cardiovascular morbidity and mortality. In the wake of the demonstrated ability to rapidly create critical care and hospital ward capacity, we advocate a different approach during the second and possible subsequent COVID-19 pandemic waves.COVID-19–Myocarditis and Return to Play: Reflections and Recommendations From a Canadian Working Group
The COVID-19–related pandemic has resulted in profound health, financial, and societal impacts. Organized sporting events, from recreational to the Olympic level, have been cancelled to both mitigate the spread of COVID-19 and protect athletes and highly active individuals from potential acute and long-term infection-associated harms. COVID-19 infection has been associated with increased cardiac morbidity and mortality. Myocarditis and late gadolinium enhancement as a result of COVID-19 infection have been confirmed.Implications of the COVID-19 Pandemic for Cardiovascular Disease and Risk-Factor Management
COVID-19 and our public health responses to the pandemic may have far-reaching implications for cardiovascular (CV) risk, affecting the general population and not only survivors of COVID-19. In this narrative review, we discuss how the pandemic may affect general CV risk for years to come and explore the mitigating potential of telehealth interventions. From a health care perspective, the shift away from in-person office visits may have led many to defer routine risk- factor management and may have had unforeseen effects on continuity of care and adherence.Bioprosthetic Valve Thrombosis and Obstruction Secondary to COVID-19
Patients with COVID-19 may present a hypercoagulable state, with an important impact on morbidity and mortality. Because of this situation pulmonary embolism is a frequent complication during the course of infection. We present the case of a patient recently discharged, after admission with confirmed COVID-19, who developed a pulmonary embolism and thrombosis of a biological mitral valve prosthesis, producing valve obstruction and stenosis. After 15 days of anticoagulant treatment, resolution of the thrombus and normalisation of prosthetic valve function was observed.Post COVID-19 Acute Myocardial Infarction Rebound
As the first wave of COVID-19 came to a relative trough during May 2020 in parts of Europe and some states in the United States, for example Vermont, New York, and New Jersey, we are now beginning to observe a resurgence in acute myocardial infarction (AMI) admissions in Israel.1A Novel Protocol for Very Early Hospital Discharge After STEMI
Although the incidence of ST-elevation myocardial infarction (STEMI) is on the decline, management of patients who present with STEMI continues to require significant health care resources. Earlier hospital discharge in low-risk patients who present with STEMI has been an area of focus in an attempt to reduce health care costs. As a result, discharge within 48-72 hours after successful primary percutaneous coronary intervention has increasingly become routine practice. Moreover, the current COVID-19 pandemic has led to enormous pressure on health care systems to find ways to increase bed capacity, preserve resources, and reduce the risk of exposure to patients and health care workers.The Multiple Effects of SGLT2 Inhibitors Suggest Potential Benefit in COVID-19 Patients
Recent evidence has shown that inflammation is a potential contributor to the progression and exacerbation of COVID-19.1 Indeed, SARS-CoV-2 often induces a robust immune response and releases cytokines, which might contribute to multiorgan dysfunction and mortality.1 Growing evidence suggests that COVID-19 is not solely a respiratory illness, and that the infection can directly or indirectly infect organs or vascular endothelial cells causing endotheliitis. Because of the urgent need for additional therapies and because COVID-19 disproportionately affects individuals with cardiovascular/cardiometabolic comorbidities, herein we discuss the rationale for using the antidiabetic sodium-glucose cotransporter 2 (SGLT2) inhibitors, namely dapagliflozin and empagliflozin, as a unique approach to potentially treat severe COVID-19 symptoms.The Basics of ARDS Mechanical Ventilatory Care for Cardiovascular Specialists
The ongoing COVID-19 pandemic has placed pressure on health care systems and intensive care unit capacity worldwide. Respiratory insufficiency is the most common reason for hospital admission in patients with COVID-19. The most severe form of respiratory failure is acute respiratory distress syndrome (ARDS), which is associated with significant morbidity and mortality. Patients with ARDS are often treated with invasive mechanical ventilation according to established evidence-based and guideline recommended management strategies.Reduced Rate of Hospital Presentations for Heart Failure During the COVID-19 Pandemic in Toronto, Canada
Coronavirus disease 2019 (COVID-19) has resulted in public health measures and health care reconfigurations likely to have impact on chronic disease care. We aimed to assess the volume and characteristics of patients presenting to hospitals with acute decompensated heart failure (ADHF) during the 2020 COVID-19 pandemic compared with a time-matched 2019 cohort. Patients presenting to hospitals with ADHF from March 1, to April 19, 2020 and 2019 in an urban hospital were examined. Multivariable logistic-regression models were used to evaluate the difference in probability of ADHF-related hospitalization between the 2 years.Transfusion Thresholds for Adult Respiratory Extracorporeal Life Support: An Expert Consensus Document
Severe acute respiratory distress syndrome (ARDS) can complicate novel pandemic coronavirus disease (COVID-19). Extracorporeal life support (ECLS) represents the final possible rescue strategy. Variations in practice, combined with a paucity of rigourous guidelines, may complicate blood-product resource availability and allocation during a pandemic. We conducted a literature review around venovenous extracorporeal membrane oxygenation (VV-ECMO) transfusion practices for platelets, packed red blood cells, fresh frozen plasma, prothrombin complex concentrate, and antithrombin.Biventricular Thrombi Associated With Myocardial Infarction in a Patient With COVID-19
A wide spectrum of cardiovascular manifestations has been documented in patients suffering from coronavirus disease-2019 (COVID-19). Usually associated with a poor prognoses, these manifestations include thromboembolic events, acute coronary syndrome, heart failure, and cardiogenic shock. We describe a patient with COVID-19 who presented with subacute myocardial infarction, biventricular thrombi, and bilateral pulmonary emboli. Biventricular thrombi are rare, and their presence raises concern for an underlying prothrombotic condition.Cardiovascular Collateral Damages at the Time of COVID-19
On March 13th, 2020, the Québec provincial government announced an extended lockdown over all sectors of the economy to face the COVID-19 pandemic.1 Supportive programs were instituted to insure implementation of effective social-distancing measures.2 Hospitals were asked to postpone elective and semielective procedures to spare personal protective equipment.3 The general population respected the request for confinement and stayed home.Cardiac Rehabilitation During the COVID-19 Era: Guidance on Implementing Virtual Care
Cardiac rehabilitation programs across Canada have suspended in-person services as a result of large-scale physical distancing recommendations designed to flatten the COVID-19 pandemic curve. Virtual cardiac rehabilitation (VCR) offers an alternate mechanism of care delivery, capable of providing similar patient outcomes and safety profiles compared with centre-based programs. To minimize care gaps, all centres should consider developing and implementing a VCR program. The process of this rapid implementation, however, can be daunting.First Documentation of Persistent SARS-Cov-2 Infection Presenting With Late Acute Severe Myocarditis
A 64-year-old man presented with severe myocarditis 6 weeks after an initial almost asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) infection. He was found to have a persistent positive swab. Mechanisms explaining myocardial injury in patients with COVID-19 remains unclear, but this case suggests that severe acute myocarditis can develop in the late phase of COVID-19 infection, even after a symptom-free interval.The Next Wave of Health Care Strain Related to COVID-19: Heart Failure Patients Coming Back in Force—We Must Not Fail Them
In preparation for the expected wave of critically ill patients, the initial COVID-19 response focused on minimizing in-person healthcare encounters and reallocating resources to patients with COVID-19. Strict physical distancing to flatten the curve, coupled with dramatic downscaling of services, have thus far been successful in avoiding a calamitous surge of COVID-19 in most Canadian jurisdictions. As we recalibrate our approach to healthcare delivery, recognizing that COVID-19 will have a drawn out and sustained impact on healthcare, attention is turning towards addressing the backlog of procedures and surgeries.Strategic Cardiac Catheterization Lab Staffing in the Era of COVID-19: The Pod Initiative
The COVID-19 pandemic affected cardiovascular programs across Canada, with multiple professional organizations recommending deferral of all elective and semielective procedures to reduce exposures in the hospital setting and to save critical care capacity. Few recommendations directly addressed health care unit integrity.Guiding Cardiac Care During the COVID-19 Pandemic: How Ethics Shapes Our Health System Response
The COVID-19 pandemic has raised ethical questions for the cardiovascular leader and practitioner. Attention has been redirected from a system that focuses on individual patient benefit toward one that focuses on protecting society as a whole. Challenging resource allocation questions highlight the need for a clearly articulated ethics framework that integrates principled decision making into how different cardiovascular care services are prioritized. A practical application of the principles of harm minimisation, fairness, proportionality, respect, reciprocity, flexibility, and procedural justice is provided, and a model for prioritisation of the restoration of cardiovascular services is outlined.Use of Renin-Angiotensin System Blockers During the COVID-19 Pandemic: Early Guidance and Evolving Evidence
The COVID-19 pandemic invoked the need for prompt guidance and rapid research to address emerging clinical questions. In response to early theoretical concerns regarding the use of renin-angiotensin system (RAS) blockers, including angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and angiotensin receptor–neprilysin inhibitors (ARNIs) during the COVID-19 pandemic, the Canadian Cardiovascular Society (CCS) and Canadian Heart Failure Society (CHFS) issued guidance to continue these therapies among patients with heart failure and hypertension.Echocardiographic Findings in Patients With COVID-19 Pneumonia
The aim of this study was to characterize the echocardiographic phenotype of patients with COVID-19 pneumonia and its relation to biomarkers. Seventy-four patients (59 ± 13 years old, 78% male) admitted with COVID-19 were included after referral for transthoracic echocardiography as part of routine care. A level 1 British Society of Echocardiography transthoracic echocardiography was used to assess chamber size and function, valvular disease, and likelihood of pulmonary hypertension. The chief abnormalities were right ventricle (RV) dilatation (41%) and RV dysfunction (27%).Surveillance for COVID-19 in Cardiac Inpatients: Containing COVID-19 in a Specialized Cardiac Centre
We read with interest the article by Cosentino et al., who described a triage pathway for patients with acute coronary syndrome (ACS) during a COVID-19 outbreak.1 However, although COVID-19 might manifest as ACS, other cardiac complications can also be associated with SARS-CoV-2 infection2; for instance, respiratory viruses can cause heart failure or myocarditis. Because a small percentage might be presymptomatic,3 this makes detection even more challenging. Some form of risk stratification is necessary to prioritize patients for COVID-19 testing.Family Engagement in the Cardiovascular Intensive Care Unit in the COVID-19 Era
The COVID-19 pandemic has caused an abrupt shift in the way care is delivered in cardiovascular intensive care units (CICUs). One example of this drastic change has been the limitations placed on family visitation. In many hospitals across Canada and beyond, a strict "no visitor" policy has been implemented. Governments and hospital administrators have instituted this policy to prevent the spread of infection and preserve protective equipment. However, physical distancing may lead to social isolation and emotional distress for both patients and their families.Decrease and Delay in Hospitalization for Acute Coronary Syndromes During the 2020 SARS-CoV-2 Pandemic
The diffusion of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) forced the Italian population to restrictive measures that modified patients’ responses to non-SARS-CoV-2 medical conditions. We evaluated all patients with acute coronary syndromes admitted in 3 high-volume hospitals during the first month of SARS-CoV-2 Italian-outbreak and compared them with patients with ACS admitted during the same period 1 year before. Hospitalization for ACS decreased from 162 patients in 2019 to 84 patients in 2020.The Use of Decision Modelling to Inform Timely Policy Decisions on Cardiac Resource Capacity During the COVID-19 Pandemic
In Ontario on March 16, 2020, a directive was issued to all acute care hospitals to halt nonessential procedures in anticipation of a potential surge in COVID-19 patients. This included scheduled outpatient cardiac surgical and interventional procedures that required the use of intensive care units, ventilators, and skilled critical care personnel, given that these procedures would draw from the same pool of resources required for critically ill COVID-19 patients. We adapted the COVID-19 Resource Estimator (CORE) decision analytic model by adding a cardiac component to determine the impact of various policy decisions on the incremental waitlist growth and estimated waitlist mortality for 3 key groups of cardiovascular disease patients: coronary artery disease, valvular heart disease, and arrhythmias.Optimizing Access to Heart Failure Care in Canada During the COVID-19 Pandemic
The traditional model of heart failure (HF) care in Canada, which relies upon a multidisciplinary team and clinic-based care processes, has been undermined as a result of the COVID-19 pandemic. As the pandemic continues, we will be challenged to improve or maintain the health status of those with HF by optimizing guideline-directed care despite physical distancing constraints and a reduction in the health care workforce. This will require development of new strategies specifically targeted at decreasing the risk of decompensation and resultant HF hospitalization.Cardiovascular Implications of the COVID-19 Pandemic: A Global Perspective
The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), represents the pandemic of the century, with approximately 3.5 million cases and 250,000 deaths worldwide as of May 2020. Although respiratory symptoms usually dominate the clinical presentation, COVID-19 is now known to also have potentially serious cardiovascular consequences, including myocardial injury, myocarditis, acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure, and cardiogenic shock.Lung Ultrasound for Cardiologists in the Time of COVID-19
Lung ultrasound (LUS) is a point-of-care ultrasound technique used for its portability, widespread availability, and ability to provide real-time diagnostic information and procedural guidance. LUS outperforms lung auscultation and chest X-ray, and it is an alternative to chest computed tomography in selected cases. Cardiologists may enhance their physical and echocardiographic examination with the addition of LUS. We present a practical guide to LUS, including device selection, scanning, findings, and interpretation.Late STEMI and NSTEMI Patients’ Emergency Calling in COVID-19 Outbreak
The highly contagious coronavirus that causes COVID-19 disease is affecting daily clinical practice. The anticipated fast growth in cases has led to development of a regional restructuring model to preserve time-sensitive pathologies in northern Italy. On this way, the Lombardy Region Government built up a big hub-and-spoke model to converge treatment of acute coronary syndrome (ACS) in 13 dedicated centres active 24/7 in the region, implementing availability of intensive care unit beds in general hospitals converted to COVID-19 treatment.Reduced Physical Activity During COVID-19 Pandemic in Children With Congenital Heart Disease
Children with congenital heart disease (CHD) are at risk for both COVID-19 and secondary cardiovascular outcomes. Their increased cardiovascular risk may be mitigated through physical activity, but public health measures implemented for COVID-19 can make physical activity challenging. We objectively measured the impact of the COVID-19 pandemic on physical activity, continuously measured by Fitbit step counts, in children with CHD. Step counts were markedly lower in late March and early April 2020, compared with 2019 and early March 2020.Safe Reintroduction of Cardiovascular Services During the COVID-19 Pandemic: From the North American Society Leadership
The coronavirus disease-2019 (COVID-19) pandemic has led to marked global morbidity and mortality (1–3). There have been appropriate but significant restrictions on routine medical care to comply with public health guidance on physical distancing and to help preserve or redirect limited resources. Most invasive cardiovascular (CV) procedures and diagnostic tests have been deferred with North American CV societies advocating for intensified triage and management of patients on waiting lists (4). Unfortunately, patients with untreated CV disease are at increased risk of adverse outcomes (5).COVID-19—Where Have All the STEMIs Gone?
The COVID-19 pandemic has required acute and long-term services to accommodate surges in hospital admissions. Cardiovascular care has experienced challenges to primary percutaneous coronary intervention (PPCI) from safety (personal protective equipment), staffing (health care worker infection rates), and patient welfare perspectives. Recently, an approximately 40% reduction in ST-segment-elevation myocardial infarction (STEMI) presentations for PPCI has been reported during the COVID-19 crisis.1 Reduced STEMI admissions could relate to altered patient behaviour, disrupted care pathways, or altered cardiovascular risk factors pertaining to partial or complete lockdown conditions during the pandemic (Fig. 1).Ramping Up the Delivery of Cardiac Surgery During the COVID-19 Pandemic: A Guidance Statement From the Canadian Society of Cardiac Surgeons
The coronavirus disease 2019 (COVID-19) has had a profound global effect. Its rapid transmissibility has forced whole countries to adopt strict measures to contain its spread. As part of necessary pandemic planning, most Canadian cardiac surgical programs have prioritized and delayed elective procedures in an effort to reduce the burden on the health care system and to mobilize resources in the event of a pandemic surge. While the number of COVID-19 cases continue to increase worldwide, new cases have begun to decline in many jurisdictions.COVID-19: A Time for Alternate Models in Cardiac Rehabilitation to Take Centre Stage
The coronavirus disease 2019 (COVID-19) pandemic has resulted in large-scale social distancing, working from home, prohibiting large group gatherings,1 and staying at home.2 These public health measures have been shown to be effective in the influenza pandemic of 19183 and continue to hold a place in today’s scenario. Social distancing requires one to maintain a distance of at least 2 m or 6 feet between individuals in public spaces4 whereas stay at home orders require an individual to remain confined to one’s home with the provision to leave for essential errands (ie, groceries, medicine, and health care).A Focus on COVID-19: Fast and Accurate Information to Guide Management for Pandemic-Related Issues in Cardiac Patients
The COVID-19 pandemic is in “full flower,” causing the shedding of many tears for the innocents who have suffered and died, despair over incomes lost and businesses endangered, and spilling of much ink (some of it useful). This new reality has set in much faster than we have been able to absorb it and adjust.Considerations for Scaling Down Fetal Echocardiography During the COVID-19 Pandemic
In the context of the COVID-19 pandemic, institutions performing fetal echocardiography (FE) are weighing the risks and benefits of reducing the number of FE to free up resources and limit nonessential visits to hospitals and clinics. These decisions must be made rapidly, often without a solid knowledge base. As of the first week of April 2020, strategies adopted by Canadian institutions varied considerably, with some significantly scaling down the rate of FE and others maintaining the pace as before the pandemic.Management and Treatment of COVID-19: The Chinese Experience
With more than 1,800,000 cases and 110,000 deaths globally, COVID-19 is one of worst infectious disease outbreaks in history. This paper provides a critical review of the available evidence regarding the lessons learned from the Chinese experience with COVID-19 prevention and management. The steps that have led to a near disappearance of new cases in China included rapid sequencing of the virus to establish testing kits, which allowed tracking of infected persons in and out of Wuhan. In addition, aggressive quarantine measures included the complete isolation of Wuhan and then later Hubei Province and the rest of the country, as well as closure of all schools and nonessential businesses.An In-hospital Pathway for Acute Coronary Syndrome Patients During the COVID-19 Outbreak: Initial Experience Under Real-World Suboptimal Conditions
Owing to the COVID-19 outbreak in Lombardy, Italy) there is an urgent need to manage cardiovascular emergencies, including acute coronary syndrome (ACS), with appropriate standards of care and dedicated preventive measures and pathways against the risk of SARS-CoV-2 infection. For this reason, the Government of Lombardy decided to centralize the treatment of ACS patients in a limited number of centers, including our university cardiology institute, which in the past 4 weeks became a cardiovascular emergency referral center in a regional hub-and-spoke system.Feel Better, Work Better: The COVID-19 Perspective
The world appears to many to be a scary place at the moment. News outlets and social media are full of the latest horror stories of exponential increases in COVID-19 patients, dwindling medical supplies, heartbreaking decisions due to rationing of care, and infected health care workers. And, of course, there are tales of individuals who are not taking this pandemic seriously, who are defying physical distancing recommendations and even quarantine and putting others at risk as a result.Post-Discharge Cardiac Care in the Era of Coronavirus 2019: How Should We Prepare?
The novel coronavirus 2019 disease (COVID-19) pandemic has placed intense pressure on health care organizations around the world. Among other concerns, there has been an increasing recognition of common and deleterious cardiovascular effects of COVID-19 based on preliminary studies. Furthermore, patients with preexisting cardiac disease are likely to experience a more severe disease course with COVID-19. As case numbers continue to increase exponentially, a surge in the number of patients with new or comorbid cardiovascular disease will translate into more frequent and, in some cases, prolonged rehabilitation needs after acute hospitalization.What Is the Role of Angiotensin-Converting Enzyme 2 (ACE2) in COVID-19 Infection in Hypertensive Patients With Diabetes?
The recent publication by Bombardini et al. suggests an important role of the renin angiotensin aldosterone system (RAAS) in the development of acute respiratory distress syndrome (ARDS) in patients with underlying infection with the novel coronavirus, SARS-CoV-2.1Cardiac Surgery in Canada During the COVID-19 Pandemic: A Guidance Statement From the Canadian Society of Cardiac Surgeons
On March 11, 2020, the World Health Organization declared that COVID-19 was a pandemic.1 At that time, only 118,000 cases had been reported globally, 90% of which had occurred in 4 countries.1 Since then, the world landscape has changed dramatically. As of March 31, 2020, there are now nearly 800,000 cases, with truly global involvement.2 Countries that were previously unaffected are currently experiencing mounting rates of the novel coronavirus infection with associated increases in COVID-19–related deaths.Guidance on Minimizing Risk of Drug-Induced Ventricular Arrhythmia During Treatment of COVID-19: A Statement from the Canadian Heart Rhythm Society
The COVID-19 pandemic has led to efforts at rapid investigation and application of drugs which may improve prognosis but for which safety and efficacy are not yet established. This document attempts to provide reasonable guidance for the use of antimicrobials which have uncertain benefit but may increase risk of QT interval prolongation and ventricular proarrhythmia, notably, chloroquine, hydroxychloroquine, azithromycin, and lopinavir/ritonavir. During the pandemic, efforts to reduce spread and minimize effects on health care resources mandate minimization of unnecessary medical procedures and testing.Rapid Scholarly Dissemination and Cardiovascular Community Engagement to Combat the Infodemic of the COVID-19 Pandemic
While the body of literature on the novel coronavirus disease 2019 (COVID-19)-related cardiac complications rapidly expands alongside the exponential surge of confirmed cases,1 print and social media pose significant challenges and opportunities in propagating an infodemic during the COVID-19 pandemic.Characteristic Electrocardiographic Manifestations in Patients With COVID-19
Cardiac involvement has been reported in patients with COVID-19, which may be reflected by electrocardiographic (ECG) changes. Two COVID-19 cases in our report exhibited different ECG manifestations as the disease caused deterioration. The first case presented temporary SIQIIITIII morphology followed by reversible nearly complete atrioventricular block, and the second demonstrated ST-segment elevation accompanied by multifocal ventricular tachycardia. The underlying mechanisms of these ECG abnormalities in the severe stage of COVID-19 may be attributed to hypoxia and inflammatory damage incurred by the virus.Angiotensin-Converting Enzyme 2 as the Molecular Bridge Between Epidemiologic and Clinical Features of COVID-19
Pre-existent cardiovascular disease is a recognized risk factor for COVID-19 infection.1 COVID-19 spike protein uses the angiotensin-converting enzyme 2 (ACE2) as the binding site to enter the host cell in tongue, bronchi, and lungs. Any condition enhancing the expression of ACE2 would increase the vulnerability to infection. Heart failure, coronary artery disease, hypertension, diabetes, ACE inhibitors (ACEi), or angiotensin receptor blockers (ARBs) increase the expression of ACE2, which can be considered nature's endogenous ACEi at the cellular level.Precautions and Procedures for Coronary and Structural Cardiac Interventions During the COVID-19 Pandemic: Guidance from Canadian Association of Interventional Cardiology
The globe is currently in the midst of a COVID-19 pandemic, resulting in significant morbidity and mortality. This pandemic has placed considerable stress on health care resources and providers. This document from the Canadian Association of Interventional Cardiology- Association Canadienne de Cardiologie d'intervention, specifically addresses the implications for the care of patients in the cardiac catheterization laboratory (CCL) in Canada during the COVID-19 pandemic. The key principles of this document are to maintain essential interventional cardiovascular care while minimizing risks of COVID-19 to patients and staff and maintaining the overall health care resources.
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