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Description : Adult Congenital Heart Disease and The COVID-19 Pandemic

Tags : Adult Congenital Heart Disease, ACHD, COVID-19, Pandemic, cardiology

Published on : Oct 04, 2020 | Views : 1901 | Downloads : 5

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Adult Congenital Heart Disease and The COVID-19 Pandemic Robert M. Radke | Tim Frenzel | Helmut Baumgartner | Gerhard-Paul Diller Journal Reading divisi Kardiologi Pediatrik dan Penyakit Jantung Bawaan Oleh: Enggar Sari Kesumawardani Pembimbing: Prof. dr. A. Afif Siregar, Sp.A(K), Sp.JP(K)
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Introduction
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Virus Characteristics Large enveloped betacorona-virus targeting primarily the respiratory system but also affecting multiple other organs. Using its spike surface glycoproteins, binds to the cellular ACE-2 receptor facilitated by a specific cellular protease, internalised into target cells. Beyond airway epithelial cells, ACE-2 is expressed in multiple organs, including vascular endothelial cells, immune cell tissue, the heart and the intestine. Replicates quickly in the upper airways, generating high virus concentrations  facilitating transmission
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COVID-19 Disease Stages Respiratory presentation, Disease stages and General management
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General Cardiac Involvement ECG changes, elevated Troponin, CK, CKMB and NT Pro BNP Standard protocol for ACS including coronary angiography should be followed In critically ill patients with COVID-19, the likelihood of primary coronary occlusions is lower and other forms of myocardial injury have to be considered. Due to : pre-existing coronary disease mismatch of coronary flow increase demand stress cardiomyopathy systemic hyperinflammation Increased pulmonary capillary resistance and mechanical ventilation may represent a complication of ARDS Substantial number of critically ill patients with COVID-19, including SCD The risk increased by myocarditis, ventricular dysfunction, electrolyte imbalances, fever as well endogenous or exogenous inotrope related to: immobilization, hypoxia, hyperinflammation and diffuse intravascular coagulation
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Specific aspects of ACHD No solid data with regards to COVID-19 related morbidity and mortality in ACHD patients General population, severe death strongly linked to advanced patients age Non-Congenital patients with COVID-19 who died had one or more (mainly cardiovascular) comorbidities. It would be reasonable to expect pre-existing cardiac involvement to be a major risk factor for worse prognosis.
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Preventive measures Adhere to local regulations, practice physical distancing, meticulous hygiene and to wear face masks Guided in risk stratification by the anatomic complexity of the cardiac lesion but also consider physiological aspects modulating the risk of adverse outcome.
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Outpatient assessment and management Volume of ACHD outpatient visit reduced to essential visits only Senior ACHD specialist should review outpatient appointment and ensure that high-risk patients are prioritized Teleconsultation
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Specific considerations for severely affected ACHD patients Complex underlying lesions, and they should be admitted to a secondary or tertiary ACHD centres. Multidisciplinary approach involving intensivists and ACHD specialists. Right Heart Dilatation or dysfunction Increased risk of RHF PAH  higher risk developing ARDS Mechanical ventilation & ARDS  PAP ↑ Measurement of BP affected by common previous surgical procedures (Blalock-Taussig-Thomas shunts and subclavian flap) Central Venous Access Hampered by chronic vascular occlusion d/t previous critical care admissions, multiple surgeries and pacemaker leads Problems for large catheters i.e haemofiltration in PLSVC with small RSVC Down Syndrom Higher risk for pulmonary infection and ARDS Fontan-type circulation Pulmonary blood flow sensitive to increase in PVR Increased risk of pulmonary arterial thrombosis Cyanotic heart disease No venesection Deteriorate with even milder degree of pulmonary involvement
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How to manage
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Conclusion The COVID-19 pandemic represents a significant challenge for the care of patients with severe chronic conditions, including ACHD. Despite the fact that ACHD patients have underlying cardiovascular disease, we contend that due to their younger age and the anatomical and physiological heterogeneity present across the ACHD spectrum, We propose a pragmatic approach to categorizing patients into low-risk, intermediate-risk and high-risk groups. This classification—while in need of refinement as new data emerge
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Thank You
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Diakses melalui: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293495/pdf/main.pdf
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In conclusion, the results of the meta-analysis suggest that use of ACEI/ARB in patients with COVID-19 does not increase the risk of COVID-19 infection, severity, or mortality. However, a lower risk of mortality was observed among those patients who were taking ACEI/ ARB for the treatment of hypertension. The findings suggest that ACEI/ ARB treatment should be continued in COVID-19 patients who are taking these medications for antihypertensive treatment.
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PH pada ARDS