A comprehensive protocol-based triaging and decision making at the point of care in patients with COVID-19 presenting with acute myocardial injury is necessary to reduce provider anxiety and confusion, offer a pathway for streamlined management of these challenging patients, while simultaneously minimizing the exposure of medical personnel to this highly contagious virus, according to a report published in Atherosclerosis.
COVID-19 has forced the healthcare system to reconsider its approach to even the most basic practices. Recent reports show that acute myocardial injury and subsequent troponin and/or ST-segment elevation are common findings and risk predictors among patients with COVID-19.
Consequently, a comprehensive protocol which incorporates recommendations by the American College of Cardiology and the Society for Cardiovascular Angiography and Interventions for the management of acute coronary syndromes in patients with COVID-19, was developed.
Patients with suspected and confirmed COVID-19 and acute myocardial injury are treated similarly. Whenever possible, the cardiovascular team does the initial evaluation and triaging through teleconsult. Patients with definite or probable regional wall motion abnormalities in a coronary distribution are treated as myocardial infarction, and those with wall motion abnormalities outside of a coronary artery distribution are considered as noncoronary myocardial injury.
Type 2 myocardial infarction and stable non-ST-elevation myocardial infarction are treated conservatively, and patients with unstable non-ST-elevation myocardial infarction are treated with an early invasive strategy, on condition that that the benefit from revascularization surpasses the risk for respiratory failure, adverse outcomes and COVID-19 exposure.
For ST-elevation myocardial infarction, the reperfusion approach is grounded on patients clinical, electrical, and hemodynamic stability, bleeding risk, time delays, and severity of pneumonia. Rescue percutaneous coronary intervention may be an option if thrombolysis fails, after taking into account the patients respiratory status and prognosis. Thrombolysis should be considered only in patients with high likelihood for ST-elevation myocardial infarction.
Institutions caring for [patients with] COVID-19 would benefit from a heart team-like approach developing a combined cardiology/critical care team that meets daily to optimize diagnostic and therapeutic strategies, concluded the study authors.
Reference
Chatzizisis YS, Gajanan G, Bhatt DL, Dangas G, Porter T. Management of acute myocardial injury in patients with confirmed or suspected COVID-19 (published online June 11, 2020). Atherosclerosis. doi.org/10.1016/j.atherosclerosis.2020.06.008
Original post:
Recommendations for the Management of ACS in COVID-19 - The Cardiology Advisor
- ST-Segment Elevation Myocardial Infarction - verywell.com - May 12th, 2018 [May 12th, 2018]
- Myocardial infarction (Heart Attack) - Health Facts - June 21st, 2018 [June 21st, 2018]
- Heart Attack and Acute Coronary Syndrome - Lab Tests Online - June 21st, 2018 [June 21st, 2018]
- Myocardial Infarction - ECGpedia - September 21st, 2018 [September 21st, 2018]
- Myocardial Infarction Clinical Presentation: History ... - September 25th, 2018 [September 25th, 2018]
- Myocardial infarction diagnosis - Wikipedia - September 25th, 2018 [September 25th, 2018]
- Myocardial Infarction Treatment & Management: Approach ... - October 9th, 2018 [October 9th, 2018]
- Myocardial infarction - Simple English Wikipedia, the free ... - October 18th, 2018 [October 18th, 2018]
- ST-Segment Elevation Myocardial Infarction - October 18th, 2018 [October 18th, 2018]
- ECG localization of myocardial infarction / ischemia and ... - October 18th, 2018 [October 18th, 2018]
- Heart Attack (Myocardial Infarction) Symptoms | Cleveland Clinic - November 15th, 2018 [November 15th, 2018]
- Myocardial Infarction (Heart Attack) Ischemia Pathophysiology, ECG, Nursing, Signs, Symptoms Part 1 - November 15th, 2018 [November 15th, 2018]
- Myocardial Infarction (MI) NCLEX Questions - November 30th, 2018 [November 30th, 2018]
- Myocardial Infarction NCLEX Review (Part 1) - December 3rd, 2018 [December 3rd, 2018]
- Acute Myocardial Infarction, Myocardial infection. Patient - December 4th, 2018 [December 4th, 2018]
- Heart Attack | Myocardial Infarction | MedlinePlus - December 16th, 2018 [December 16th, 2018]
- Heart Attack (Myocardial Infarction) - medicinenet.com - December 17th, 2018 [December 17th, 2018]
- Myocardial infarction (acute): Early rule out using high ... - December 20th, 2018 [December 20th, 2018]
- Conditions We Treat: Myocardial Infarction | Johns Hopkins ... - December 23rd, 2018 [December 23rd, 2018]
- Myocardial Infarction - Heart Home Page - December 25th, 2018 [December 25th, 2018]
- Myocardial infarction: signs symptoms and treatment ... - December 25th, 2018 [December 25th, 2018]
- ECGs in Acute Myocardial Infarction - ACLS Medical Training - December 25th, 2018 [December 25th, 2018]
- Myocardial Infarction - Eccles Health Sciences Library - December 27th, 2018 [December 27th, 2018]
- Myocardial Infarction: Practice Essentials, Background ... - December 27th, 2018 [December 27th, 2018]
- Myocardial infarction - Wikipedia - December 27th, 2018 [December 27th, 2018]
- Nursing Care Plan for Myocardial Infarction | NRSNG - December 29th, 2018 [December 29th, 2018]
- Cardiovascular disease - Myocardial infarction | Britannica.com - January 11th, 2019 [January 11th, 2019]
- Heart Attack (Myocardial Infarction) - Cedars-Sinai - January 11th, 2019 [January 11th, 2019]
- Top 5 MI ECG Patterns You Must Know | LearntheHeart.com - January 11th, 2019 [January 11th, 2019]
- Anterior Myocardial Infarction LITFL ECG Library Diagnosis - January 11th, 2019 [January 11th, 2019]
- Electrocardiography in myocardial infarction - Wikipedia - January 11th, 2019 [January 11th, 2019]
- Myocardial Infarction Therapeutics Market, Share, Growth ... - March 13th, 2019 [March 13th, 2019]
- Heart Attack (Myocardial Infarction) - Drugs.com - April 20th, 2019 [April 20th, 2019]
- STEMI (ST Elevation Myocardial Infarction): diagnosis ... - April 20th, 2019 [April 20th, 2019]
- Heart attack - Symptoms and causes - Mayo Clinic - April 20th, 2019 [April 20th, 2019]
- Cardiovascular models including myocardial infarction ... - April 27th, 2019 [April 27th, 2019]
- Myocardial infarction - Osmosis Video Library - May 1st, 2019 [May 1st, 2019]
- Myocardial Infarction - September 17th, 2019 [September 17th, 2019]
- Creatinine Rises After RAS Inhibitor Initiation Tied to Worse Outcomes - Renal and Urology News - September 19th, 2019 [September 19th, 2019]
- Ventricular Tachycardia Treatment Market Growth in Technological Innovation, Competitive Landscape Mapping the Trends and Outlook - NewsVarsity - September 19th, 2019 [September 19th, 2019]
- FDA Action Alert: Merck and Amarin - BioSpace - September 19th, 2019 [September 19th, 2019]
- Resverlogix Provides Update on BETonMACE Phase 3 Trial Toronto Stock Exchange:RVX - GlobeNewswire - September 19th, 2019 [September 19th, 2019]
- Marijuana Use Linked to Improved Acute-HF Hospital Survival - Medscape - September 19th, 2019 [September 19th, 2019]
- Population Health vs. Personalized Medicine: Lost in Translation? - American Council on Science and Health - September 19th, 2019 [September 19th, 2019]
- Bariatric Surgery Tied to Less MACE in Obesity, Diabetes - Medscape - September 19th, 2019 [September 19th, 2019]
- A Novel Algorithm for Improving the Diagnostic Accuracy of Prehospital ST-Elevation Myocardial Infarction - DocWire News - September 19th, 2019 [September 19th, 2019]
- Shock and Awe: ARNI for Acute HF May Be Safely Started in ICU - Medscape - September 19th, 2019 [September 19th, 2019]
- Global Myocardial Infarction Treatment Market Will Reach USD 1726.3 million by end of 2022 - Market News Store - September 19th, 2019 [September 19th, 2019]
- Frequency and Factors Related to Not Receiving Acute Reperfusion Therapy in Patients with ST Elevation Myocardial Infarction; A Single Specialty... - September 19th, 2019 [September 19th, 2019]
- Research Offers 10-Year Forecast on Myocardial Infarction Treatment Market - Rapid News Network - September 19th, 2019 [September 19th, 2019]
- University of Colorado study suggests Cannabis aids in surviving heart... - Communities Digital News - September 19th, 2019 [September 19th, 2019]
- SRH part of regional system award recognizing care for heart attacks - Index-Journal - September 19th, 2019 [September 19th, 2019]
- TherOx Announces Key SuperSaturated Oxygen Therapy Presentations at TCT 2019 - Yahoo Finance - September 19th, 2019 [September 19th, 2019]
- Incidence, Characteristics and Outcomes in Very Young Patients with ST Segment Elevation Myocardial Infarction - DocWire News - September 19th, 2019 [September 19th, 2019]
- Health Recovery After Acute MI Similar in Young Adults With and Without Diabetes - The Cardiology Advisor - September 19th, 2019 [September 19th, 2019]
- Rapid Diagnosis Protocol for Chest Pain Does Not Improve Outcomes - Diagnostic and Interventional Cardiology - September 19th, 2019 [September 19th, 2019]
- Diagnosis of Myocardial Infarction At Autopsy: AECVP Reappraisal in the Light of the Current Clinical Classification - DocWire News - September 19th, 2019 [September 19th, 2019]
- Global Myocardial Infarction Drug Market 2019 BioCardia, Inc., Biscayne Pharmaceuticals, Inc., Capricor Therapeutics, Inc., Cell - Market News Times - September 19th, 2019 [September 19th, 2019]
- Abiomed to Highlight Importance of Optimal PCI Treatment to Improve Outcomes for High-Risk Patients at TCT 2019 - Yahoo Finance - September 19th, 2019 [September 19th, 2019]
- ENTRUST-AF PCI Supports Safety of Dual Therapy With Edoxaban - Medscape - September 19th, 2019 [September 19th, 2019]
- Preoperative opioid use leads to perioperative consequences in foot and ankle surgery - Healio - September 19th, 2019 [September 19th, 2019]
- CV, General Safety of Long-Term PPI Use Examined - The Cardiology Advisor - September 19th, 2019 [September 19th, 2019]
- Effect of Delayed vs Immediate Interventions in Transient STEMI - The Cardiology Advisor - September 19th, 2019 [September 19th, 2019]
- Cardiorenal Disease Is the Most Common CVD Manifestation in Patients With T2D - Endocrinology Advisor - September 19th, 2019 [September 19th, 2019]
- DAPA-HF Published: 'Stunning Consistent Benefit With Dapagliflozin' - Medscape - September 19th, 2019 [September 19th, 2019]
- Geomagnetic Disturbances and Cardiovascular Mortality Risk - On Health - BMC Blogs Network - September 19th, 2019 [September 19th, 2019]
- Reconsidering the Safety of Intravenous Thrombolysis for Ischemic Stroke After Recent Myocardial Infarction - Neurology Advisor - September 19th, 2019 [September 19th, 2019]
- The Lowdown on Lipoprotein(a) - Medscape - October 9th, 2019 [October 9th, 2019]
- Protamine use found to significantly reduce reoperations for patients who undergo carotid endarterectomy - Vascular News - October 9th, 2019 [October 9th, 2019]
- Left Main Treated With PCI or CABG Have Similar Outcomes at Five Years - Diagnostic and Interventional Cardiology - October 9th, 2019 [October 9th, 2019]
- Sen. Sanders released from the hospital after heart attack - WXYZ - October 9th, 2019 [October 9th, 2019]
- E-Selectin Gene Haplotypes are Associated with the Risk of Myocardial Infarction - DocWire News - October 9th, 2019 [October 9th, 2019]
- BioVentrix Enrolls and Treats First Patient in REVIVE-HF European RCT for Ischemic Heart Failure Patients - P&T Community - October 9th, 2019 [October 9th, 2019]
- Quantitative Flow Ratio guided Residual Functional SYNTAX Score for Risk Assessment in Patients with ST-Segment Elevation Myocardial Infarction... - October 9th, 2019 [October 9th, 2019]
- Coronary Calcium Scan: The Role of Calcium Scoring in Preventing a First Myocardial Infarction - Consultant360 - October 9th, 2019 [October 9th, 2019]
- Sanders plans to 'change the nature' of campaign after heart attack - New York Post - October 9th, 2019 [October 9th, 2019]
- Early MI Linked to High Recurrent Events, Mortality - Medscape - October 9th, 2019 [October 9th, 2019]
- Sudden Cardiac Arrest and Ventricular Arrhythmias following first type I Myocardial Infarction in the Contemporary Era - DocWire News - October 9th, 2019 [October 9th, 2019]
- E-Cigarette Use and Myocardial Infarction - Physician's Weekly - October 9th, 2019 [October 9th, 2019]
- Sen. Bernie Sanders had heart attack; chest pains diagnosed as myocardial infarction - KIRO Seattle - October 9th, 2019 [October 9th, 2019]