Infectious Disease

Algorithm developed for treating suspected ACS in patients admitted to hospital with COVID-19

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Khera A. Ischemic Heart Disease. Presented at: American Society for Preventive Cardiology Congress for the Prevention of Cardiovascular Disease; 23-25 July 2021 (virtual meeting).

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Khera does not report any relevant financial information.

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Diagnosing ACS with simultaneous COVID-19 infection can be made difficult due to an overlap in symptoms, fewer patients presenting to the hospital, and lack of guidance on diagnosing hospitalized patients, a spokesman reported.

Amit Chera

At the American Society for Preventive Cardiology’s virtual congress for the prevention of cardiovascular disease Amit Khera, MD, MSc, FACC, FAHA, FASPC, former ASPC President and Professor of Medicine, Director of Preventive Cardiology and the Dallas Heart Ball Chair of Hypertension and Heart Disease at UT Southwestern Medical Center, discussed the etiologies of ACS and COVID-19 infections and the importance of patient education and an algorithm for the diagnosis of ACS in the COVID-19 population.

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“In every patient visit I have made over the past year, I have always reminded people that the hospital is safe when you have a symptom. You have to submit. Hopefully we’re at the end of all of this, but there are variations and other teachings that may come up in the future, ”Khera said. “But communication with our patients is the key. How can we avoid this surge in ACS-related COVID-19? Vaccination. People know that very well. We have all seen clinical trial data. This is data from the real world. “

According to a study published in the American Journal of Preventive Cardiology, patients with atherosclerotic CVD who contracted COVID-19 had a higher relative risk of COVID-19-associated ACS compared to those without ASCVD (RR = 5.9). Researchers reported an even higher relative risk in patients with COVID-19 and familial hypercholesterolemia compared to patients without FH (RR = 14.3).

In addition to a more complicated diagnosis when patients with COVID-19 present with potential ACS, a comment in the NEJM Catalyst went into why some experiencing ACS in the COVID-19 era might not choose to present at all. The researchers found that some people view hospitals as reservoirs for infectious diseases and are unaware of hospital staff’s efforts to reduce risk. According to the study, patients need confirmation from doctors in their community health systems when to go to the emergency room.

Khera explained that diagnosing ACS in patients with COVID-19 can be difficult for several reasons. Chest pain, a symptom of ACS, is also commonly seen with a COVID-19 respiratory infection. ST segment changes in connection with a COVID-19 infection can “fake” clinicians who later cannot find any obstructive CHD. About a third of patients with COVID-19 may experience an increase in troponin, a finding that the presentation suggests could represent several potential etiologies.

Therefore, Khera presented an algorithm for the management of a potential ACS in patients with simultaneous COVID-19 illness.

For patients with COVID-19 who are suspected of having ACS, Khera said the point-of-care ultrasound may rule out other explanations such as myocarditis, congestive HF, pulmonary embolism, right ventricular dysfunction, and stress cardiomyopathy. Should doctors discover other characteristics of ACS during the ultrasound, Khera recommended patients at higher risk and poor COVID-19 prognosis to receive more conservative treatment and a shared decision-making process between doctors, patients and their families. Invasive coronary angiography may be considered for patients at higher risk and with a better COVID-19 prognosis. For those with moderate or low risk of ACS with COVID-19, clinicians might consider non-invasive testing for ACS such as cardiac CT or MRI, he said.

“Point-of-care ultrasound has been a godsend in our and many other facilities because we get quick data and avoid exposure,” said Khera.

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American Society for Preventive Cardiology

American Society for Preventive Cardiology

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