COVID-19 Pandemic And Cardiac Imaging

Dr. Anshuman (He is Attending Consultant in Noninvasive Cardiology in a leading superspeciality hospital in New Delhi)

The coronavirus disease 2019 (COVID-19) pandemic has created new and unpredictable challenges for modern medicine and healthcare systems. Preliminary reports have demonstrated that older age, previous cardiovascular disease, diabetes, and hypertension are risk factors for increased mortality. Data on the cardiac affinity of the virus and its potential to harm the cardiovascular system and the mechanisms by which this occurs are sparse. A systemic infection generally increases demand on the heart, and can exacerbate underlying cardiac conditions.

When the lungs are heavily involved, as seen in COVID-19 patients, this may have a major impact on cardiac function, particularly that of the right ventricle. Finally, COVID-19 may have direct effects on the heart, as may some drugs being used in its treatment.

A study has been published in the European Heart Journal, which has made some important recommendations relating to the appropriate use of imaging modalities.

  1. According to this study, there should be two categories of patients:
  • Suspected COVID positive/highly infectious patients
  • Non COVID patients

Again, both groups are categorised in two headings on the basis of the fact that whether echo is needed or indicated to help in the clinical decision making or whether it is a routine echocardiography.

Routine echo should be postponed as far as possible.

  1. If echo is done, only important findings to be noted as follows
  • RWMA, LV function, LVEF
  • LVEDD
  • Gross valvular impression
  • RV function,PASP
  • Pericardium and pericardial effusion
  • Any other specific thing, that clinician want to know.

3.Adequate precaution for both machine and operator to avoid catching and spreading infection

4.Surgical mask is must for the patient and operator and PPE+N95 for suspected/confirmed COVID cases.

5.Hand disinfection and machine disinfection as per protocol

6.If possible, use disposable gloves which should be discarded after every examination

  1. Avoid TEE, as far as possible.
  2. Consider CT/MRI as alternate.
  3. Asymptomatic patients’ examination should be postponed as far as possible
  4. Cardiac indication for echo should overweigh the risk of infection to the operator and machine.

11. STEMI patients should not wait for echo and should be directly taken for cathlab until hemodynamic indication for an echo.

12. NSTEMI patients echo should be done,if murmur and other hemodynamic indication.

13. Routine Stress echo should be postponed.

14. If possible, machine and operator should cover themselves in a transparent cover which will minimise the risk of transmission of virus to the operator and machine.

15. Machine should be disinfected as per Vendor protocol.

16. In critical care setting, the purpose of 2d echo should be clear to complete the study in minimum time.

In Nutshell my conclusions are

Each order of echo should be with the note for the required clinical information needed from echo and level of risk of infection should be mentioned for appropriate precautions,r epeat 2nd echo should be discouraged until there is a change of clinical status of the patient.

Biomedical team to find innovative ways to apply a transparent cover for machine, and operator while doing echo and make a SOP for disinfection of the probe and machine.

Stay Safe Stay Healthy.

Source: European Society of Cardiology

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