COVID-19-associated cardiac arrest: Difference between revisions
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!Inherited causes of cardiac arrest and malignant arrhythmia associated covid-19 | !Inherited causes of cardiac arrest and malignant arrhythmia associated covid-19 | ||
![[long QT syndrome]] | ![[long QT syndrome]] | ||
![[ | ![[Brugada]] syndrome | ||
![[short QT syndrome]] | ![[short QT syndrome]] | ||
![[cathecolaminergic polymorphic ventricular tachaycardia]] | ![[cathecolaminergic polymorphic ventricular tachaycardia]] | ||
|- | |- | ||
| | |Mechanism of arrhythmia | ||
|Mutation in ''[[KCNQ1]]'', ''[[KCNH2]]'', and ''[[SCN5A]]'') | |Mutation in ''[[KCNQ1]]'', ''[[KCNH2]]'', and ''[[SCN5A]]''), | ||
block potassium current and prolongation of ventricular repolarization | block potassium current and prolongation of ventricular repolarization and [[EAD]] <ref name="pmid16412861">{{cite journal |vauthors=Straus SM, Kors JA, De Bruin ML, van der Hooft CS, Hofman A, Heeringa J, Deckers JW, Kingma JH, Sturkenboom MC, Stricker BH, Witteman JC |title=Prolonged QTc interval and risk of sudden cardiac death in a population of older adults |journal=J. Am. Coll. Cardiol. |volume=47 |issue=2 |pages=362–7 |date=January 2006 |pmid=16412861 |doi=10.1016/j.jacc.2005.08.067 |url=}}</ref>'''PMID:''' '''16412861''' | ||
|PMID: <ref name="pmid27423412">{{cite journal |vauthors=Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AA |title=J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge |journal=Heart Rhythm |volume=13 |issue=10 |pages=e295–324 |date=October 2016 |pmid=27423412 |pmc=5035208 |doi=10.1016/j.hrthm.2016.05.024 |url=}}</ref>'''27423412''' | |PMID: <ref name="pmid27423412">{{cite journal |vauthors=Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AA |title=J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge |journal=Heart Rhythm |volume=13 |issue=10 |pages=e295–324 |date=October 2016 |pmid=27423412 |pmc=5035208 |doi=10.1016/j.hrthm.2016.05.024 |url=}}</ref>'''27423412''' | ||
loss of function in SCN5A in %30 of patients | loss of function in [[SCN5A]] in %30 of patients | ||
|Mutation in potassium channel genes ''KCNH2'', ''KCNQ1'', and ''KCNJ2'' and SLC4A3 | |Mutation in potassium channel genes ''[[KCNH2]]'', ''[[KCNQ1]]'', and ''[[KCNJ2]]'' and [[SLC4A3]] | ||
|Mutation in RYR2 | |Mutation in [[RYR2]] | ||
<ref name="pmid23390049">{{cite journal |vauthors=van der Werf C, Wilde AA |title=Catecholaminergic polymorphic ventricular tachycardia: from bench to bedside |journal=Heart |volume=99 |issue=7 |pages=497–504 |date=April 2013 |pmid=23390049 |doi=10.1136/heartjnl-2012-302033 |url=}}</ref>'''PMID''': '''23390049''' | <ref name="pmid23390049">{{cite journal |vauthors=van der Werf C, Wilde AA |title=Catecholaminergic polymorphic ventricular tachycardia: from bench to bedside |journal=Heart |volume=99 |issue=7 |pages=497–504 |date=April 2013 |pmid=23390049 |doi=10.1136/heartjnl-2012-302033 |url=}}</ref>'''PMID''': '''23390049''' | ||
|- | |- | ||
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|- | |- | ||
|risk factors related to covid-19 | |risk factors related to covid-19 | ||
|1.Using | |1.Using [[hydroxychloroquine]] and chloroquine 2. using CYP3a4 inhibitore that increases | ||
hydroxychloroquine level include;lupinavir,ritonavir . | [[hydroxychloroquine]] level include;lupinavir,ritonavir . | ||
azithromycin | azithromycin | ||
3. hydroxychloquine does not result'''PMID: 17646028''' | 3. [[hydroxychloquine]] does not result'''PMID: 17646028''' | ||
significant prolonged | significant prolonged QTinterval in cases without [[LQTS]] | ||
<ref name="pmid17646028">{{cite journal |vauthors=White NJ |title=Cardiotoxicity of antimalarial drugs |journal=Lancet Infect Dis |volume=7 |issue=8 |pages=549–58 |date=August 2007 |pmid=17646028 |doi=10.1016/S1473-3099(07)70187-1 |url=}}</ref> | <ref name="pmid17646028">{{cite journal |vauthors=White NJ |title=Cardiotoxicity of antimalarial drugs |journal=Lancet Infect Dis |volume=7 |issue=8 |pages=549–58 |date=August 2007 |pmid=17646028 |doi=10.1016/S1473-3099(07)70187-1 |url=}}</ref> | ||
3. fever:'''PMID: 18551196''' | 3. fever:'''PMID: 18551196''' | ||
| Line 143: | Line 143: | ||
2. fever increases the risk of cardiac arrest in BrS | 2. fever increases the risk of cardiac arrest in BrS | ||
3. Risk of life threatening arrythmia in BrS related to fever was (65%)higher in young patients less than 5 year old (%65)PMID: '''29649615''' and %25 in patients older than 70 year old.<ref name="pmid29649615">{{cite journal |vauthors=Michowitz Y, Milman A, Sarquella-Brugada G, Andorin A, Champagne J, Postema PG, Casado-Arroyo R, Leshem E, Juang JJM, Giustetto C, Tfelt-Hansen J, Wijeyeratne YD, Veltmann C, Corrado D, Kim SH, Delise P, Maeda S, Gourraud JB, Sacher F, Mabo P, Takahashi Y, Kamakura T, Aiba T, Conte G, Hochstadt A, Mizusawa Y, Rahkovich M, Arbelo E, Huang Z, Denjoy I, Napolitano C, Brugada R, Calo L, Priori SG, Takagi M, Behr ER, Gaita F, Yan GX, Brugada J, Leenhardt A, Wilde AAM, Brugada P, Kusano KF, Hirao K, Nam GB, Probst V, Belhassen B |title=Fever-related arrhythmic events in the multicenter Survey on Arrhythmic Events in Brugada Syndrome |journal=Heart Rhythm |volume=15 |issue=9 |pages=1394–1401 |date=September 2018 |pmid=29649615 |doi=10.1016/j.hrthm.2018.04.007 |url=}}</ref> | 3. Risk of life threatening [[arrythmia]] in BrS related to [[fever]] was (65%)higher in young patients less than 5 year old (%65)PMID: '''29649615''' and %25 in patients older than 70 year old.<ref name="pmid29649615">{{cite journal |vauthors=Michowitz Y, Milman A, Sarquella-Brugada G, Andorin A, Champagne J, Postema PG, Casado-Arroyo R, Leshem E, Juang JJM, Giustetto C, Tfelt-Hansen J, Wijeyeratne YD, Veltmann C, Corrado D, Kim SH, Delise P, Maeda S, Gourraud JB, Sacher F, Mabo P, Takahashi Y, Kamakura T, Aiba T, Conte G, Hochstadt A, Mizusawa Y, Rahkovich M, Arbelo E, Huang Z, Denjoy I, Napolitano C, Brugada R, Calo L, Priori SG, Takagi M, Behr ER, Gaita F, Yan GX, Brugada J, Leenhardt A, Wilde AAM, Brugada P, Kusano KF, Hirao K, Nam GB, Probst V, Belhassen B |title=Fever-related arrhythmic events in the multicenter Survey on Arrhythmic Events in Brugada Syndrome |journal=Heart Rhythm |volume=15 |issue=9 |pages=1394–1401 |date=September 2018 |pmid=29649615 |doi=10.1016/j.hrthm.2018.04.007 |url=}}</ref> | ||
|1.There is no risk of arrhythmia when patients affected by covid19. | |1.There is no risk of arrhythmia when patients affected by covid19. | ||
| | | | ||
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|torsade de pointes and fatal ventricular arrhythmia | |torsade de pointes and fatal ventricular arrhythmia | ||
|ventricular fibrilation and sudden cardiac death | |ventricular fibrilation and sudden cardiac death | ||
|syncope,ventricular fibrillation, sudden cardiac death | |[[syncope]],[[ventricular fibrillation]], sudden cardiac death | ||
|ventricular arrhythmia during exercise and stress related to covid-19 | |ventricular arrhythmia during exercise and stress related to covid-19 | ||
|- | |- | ||
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3. self isolation | 3. self isolation | ||
|2. hydroxychloroquine may prolonge QTinterval and useful in treatment of SQTS type 1 (''KCNH2''-related) and type 3 (''KCNJ2'' related<ref name="pmid30441573">{{cite journal |vauthors=Luo C, Wang K, Liu T, Zhang H |title=Computational Analysis of the Action of Chloroquine on Short QT Syndrome Variant 1 and Variant 3 in Human Ventricles |journal=Conf Proc IEEE Eng Med Biol Soc |volume=2018 |issue= |pages=5462–5465 |date=July 2018 |pmid=30441573 |doi=10.1109/EMBC.2018.8513572 |url=}}</ref> PMID: '''30441573''' | |2. [[hydroxychloroquine]] may prolonge QTinterval and useful in treatment of SQTS type 1 (''KCNH2''-related) and type 3 (''KCNJ2'' related<ref name="pmid30441573">{{cite journal |vauthors=Luo C, Wang K, Liu T, Zhang H |title=Computational Analysis of the Action of Chloroquine on Short QT Syndrome Variant 1 and Variant 3 in Human Ventricles |journal=Conf Proc IEEE Eng Med Biol Soc |volume=2018 |issue= |pages=5462–5465 |date=July 2018 |pmid=30441573 |doi=10.1109/EMBC.2018.8513572 |url=}}</ref> PMID: '''30441573''' | ||
|1.do not use epinephrine in the setting of ventricular arrhythmia | |1.do not use epinephrine in the setting of ventricular arrhythmia | ||
2. flecainide is treatment of choice without any interaction with lopinavir, ritonavir and chloroquine. | 2. flecainide is treatment of choice without any interaction with lopinavir, ritonavir and chloroquine. | ||
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==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
** The proportion of patients developed out of hospital cardiac arrest (OHCA) increased during covid-19 pandemic.<ref name="PfefferbaumNorth2020">{{cite journal|last1=Pfefferbaum|first1=Betty|last2=North|first2=Carol S.|title=Mental Health and the Covid-19 Pandemic|journal=New England Journal of Medicine|year=2020|issn=0028-4793|doi=10.1056/NEJMp2008017}}</ref> | ** The proportion of patients developed [[out of hospital cardiac arrest]] (OHCA) increased during [[covid-19]] pandemic.<ref name="PfefferbaumNorth2020">{{cite journal|last1=Pfefferbaum|first1=Betty|last2=North|first2=Carol S.|title=Mental Health and the Covid-19 Pandemic|journal=New England Journal of Medicine|year=2020|issn=0028-4793|doi=10.1056/NEJMp2008017}}</ref> | ||
'''DOI: 10.1056/NEJMp2008017''' | '''DOI: 10.1056/NEJMp2008017''' | ||
** | ** Common causes of OHCA durig covid-19 pandemic include:1.acute cardiac events ( coronary syndrome, heart failure,arrhythmia,) 2.'''<nowiki>http://dx.doi.org/10.1016/j.thromres.2020.04.013</nowiki>''' thromboembolic events related to [[covid19]] ([[pulmonary embolism]], acute coronary syndrome)<ref name="KlokKruip2020">{{cite journal|last1=Klok|first1=F.A.|last2=Kruip|first2=M.J.H.A.|last3=van der Meer|first3=N.J.M.|last4=Arbous|first4=M.S.|last5=Gommers|first5=D.A.M.P.J.|last6=Kant|first6=K.M.|last7=Kaptein|first7=F.H.J.|last8=van Paassen|first8=J.|last9=Stals|first9=M.A.M.|last10=Huisman|first10=M.V.|last11=Endeman|first11=H.|title=Incidence of thrombotic complications in critically ill ICU patients with COVID-19|journal=Thrombosis Research|volume=191|year=2020|pages=145–147|issn=00493848|doi=10.1016/j.thromres.2020.04.013}}</ref> | ||
3.Acute respiratory distress and hypoxia related to covid19 4. late presentation for example acute MI in hospital due to lockdown and movement restriction 4. Overwelming of medical service 5. Myocarditis | |||
** Prognosis of patients with severe | 5. Letal arrhythmia by using azithromycin and <nowiki>https://doi.org/10.1016/S0140-6736(20)31180-6</nowiki> 6.Myocardial injury and [[myocarditis]] | ||
*** | |||
** Prognosis of patients with severe [[COVID-19]] pneumonia with [[in hospital cardiac arrest]] (IHCA) was poor in wohan '''.<ref name="pmid32283117">{{cite journal |vauthors=Shao F, Xu S, Ma X, Xu Z, Lyu J, Ng M, Cui H, Yu C, Zhang Q, Sun P, Tang Z |title=In-hospital cardiac arrest outcomes among patients with COVID-19 pneumonia in Wuhan, China |journal=Resuscitation |volume=151 |issue= |pages=18–23 |date=June 2020 |pmid=32283117 |pmc=7151543 |doi=10.1016/j.resuscitation.2020.04.005 |url=}}</ref>: 3228311'''7 | |||
*** Mortality rate of patients with [[COVID-19]] is approximately 1-2%'''<ref name="pmid32109013">{{cite journal |vauthors=Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS |title=Clinical Characteristics of Coronavirus Disease 2019 in China |journal=N. Engl. J. Med. |volume=382 |issue=18 |pages=1708–1720 |date=April 2020 |pmid=32109013 |pmc=7092819 |doi=10.1056/NEJMoa2002032 |url=}}</ref>:''' '''32109013''' | |||
==Diagnosis== | ==Diagnosis== | ||
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* The diagnosis of sudden cardiac death is made when the following diagnostic criteria are met: | * The diagnosis of sudden cardiac death is made when the following diagnostic criteria are met: | ||
:* Prodromes phase occuring weeks or months before an event includes: new or worsening cardiovascular symptoms(chest pain, dyspnea, palpitations, fatigability) | :* Prodromes phase occuring weeks or months before an event includes: new or worsening cardiovascular symptoms([[chest pain]], [[dyspnea]], [[palpitations]], fatigability) | ||
:* Onset of terminal event occuring one hour before cardiac arrest includes:abrupt change in clinical status( arrhythmia, hypotension, chest pain, dyspnea,lightheadness) | :* Onset of terminal event occuring one hour before cardiac arrest includes:abrupt change in clinical status( [[arrhythmia]], hypotension, [[chest pain]], [[dyspnea]],lightheadness) | ||
:* Cardiac arrest includes: sudden collapse, loss of effective circulation, loss of consciousness | :* Cardiac arrest includes: sudden collapse, loss of effective [[circulation]], loss of consciousness | ||
:*[[Biologic death]]: failure of | :*[[Biologic death]]: failure of [[resuscitatio]]<nowiki/>n or failure of electerical, mechanical or CNS function after initial [[resuscitation]] | ||
<br /> | <br /> | ||
Revision as of 19:03, 19 July 2020
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COVID-19 Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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COVID-19-associated cardiac arrest On the Web |
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American Roentgen Ray Society Images of COVID-19-associated cardiac arrest |
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Risk calculators and risk factors for COVID-19-associated cardiac arrest |
For COVID-19 frequently asked inpatient questions, click here
For COVID-19 frequently asked outpatient questions, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayesha Javid, MBBS[2]
Overview
The sudden cardiac death is defined as the natural death from cardiac causes developed by abrupt loss of consciousness within one hour of onset of acute change in cardiovascular status. Preexisting heart disease may or may not present at the time of cardiac arrest. Prodromes signs and symptoms of deterioration of cardiovascular status may occur weeks or months before an events. Sudden onset of chest pain, dyspnea or palpitations and other symptoms of arrhythmia may precede the onset of cardiac arrest. If cardiopulmonary resuscitation fails to restore the circulation, biologic death may occur within minutes to weeks.
Historical Perspective
- In December 2019, the COVID-19 outbreak first appeared in China, Wuhan.[1]
- On February 20, 2020, the first case of COVID-19 was documented in Lodi Province of Italy.[2]
- In April 2020, An increase in out of hospital cardiac arrest was reported during the COVID-19 pandemic.
- In January 2020, the first COVID-19 case was documented in the United States.[3]
Classification
Cardiac arrest associated COVID19 may be classified into three subtypes:
1.Pulseless electerical activity
2. Bradyarrhythmia and asystolic arrest
3.letal tachyarrhythmia
Pathophysiology
- The pathogenesis of cardiac arrest associated COVID-19 is characterized by cytokine storm, especially elevation of IL-6.[4]
doi: 10.1038/s41577-018-0098-z
- IL-6 directely blocks hERG/Kv11.1 potassium channels and causes action potential depolarization(APD) prolongation and ventricular repolarization.
- IL-6 induces hyperactivity of cardiac sympathetic nerve[5]
.doi: 10.1093/eurheartj/ehw208MedlineGoogle Sch
doi: 10.1016/j.jacc.2020.03.031
- Hydroxychloroquine and lopinavir/ritonavir inhibit HERG-K+ channel and induce both ventriculat repolarization and the level of other QTc prolongation drugs[6]
- 10.1016/j.jacc.2020.03.031
- Hydroxychloroquine inhibit CYP2D6 (cytochrome P450 2D6) ,then the level of antipsychotics,antidepressants and antihistamins increase[6]
.doi: 10.1016/j.jacc.2020.03.031
- Ritonavir inhibits CYP3A4 (cytochrome P450 3A4), then the level of azols antifungals, macrolides (particulary azithromycin),antidepressants,antihistamines,fluoroquinolones increase.[6]
- 10.1016/j.jacc.2020.03.031
- intrinsic genetic susceptibility (Ser1103Tyr-SCN5A) in african americans COVID-19 patients has been associated with increased risk of torsade points arrhythmia.[7]PMID: 32359771
Causes
The causes of ventricular tachyarrhythmia and sudden cardiac death in covid-19 are caracterized by:[8]PMID: 32380288
1.Environmental risk factors include:
- COVID-19 directed QTc prolongation drugs( hydroxychloroquin ± azithromycin and lupinavir/ritonavir)
- Concurrent use of QT prolongation drug (anti -emetics,floroquinolones,SSRIs)
- Electrolitise abnormalities(hypokelemia and hypomagnesemia)
2. Internistics risk factors includes:
- High risk comorbidity condition(CHF,CKD,DM,COPD)
- Ages≥65,male gender
- Inherited arrhythmia syndromes
3. Other mechanisms include:
- Hypoxia causes ventricular arrhythmia and sudden cardiac death by myocardial injuries and increased in late I /NA
- Exaggerated immune response ( IL-6 increased the proportion of action potential duration/ QTc)
- Increased sympathetic activity
- Inhition of CYP450
- Direct myocardial injury(SARS-COV-2 myocarditis)
Differentiating [disease name] from other Diseases[edit | edit source]
- differentiation diagnosis of inherited cardiac arrest in covid19 patients include:
| Inherited causes of cardiac arrest and malignant arrhythmia associated covid-19 | long QT syndrome | Brugada syndrome | short QT syndrome | cathecolaminergic polymorphic ventricular tachaycardia |
|---|---|---|---|---|
| Mechanism of arrhythmia | Mutation in KCNQ1, KCNH2, and SCN5A),
block potassium current and prolongation of ventricular repolarization and EAD [9]PMID: 16412861 |
PMID: [10]27423412
loss of function in SCN5A in %30 of patients |
Mutation in potassium channel genes KCNH2, KCNQ1, and KCNJ2 and SLC4A3 | Mutation in RYR2
[11]PMID: 23390049 |
| EKG finding | QTc>450ms in men
QTc>470ms in women [12]: 20642543 |
Coved-type ST-segment elevation
and T-wave inversion in lead V1 and/or V2) |
QTc<360 msec | |
| risk factors related to covid-19 | 1.Using hydroxychloroquine and chloroquine 2. using CYP3a4 inhibitore that increases
hydroxychloroquine level include;lupinavir,ritonavir . azithromycin 3. hydroxychloquine does not resultPMID: 17646028 significant prolonged QTinterval in cases without LQTS [13] 3. fever:PMID: 18551196 causes QT prolongation and cardiac arrest in Long QTS type2 in the setting of septic shock in covid-19.[14]
|
1.Fever may increased PR interval, QRS width, and the maximum J point in patients with BrS[15]'PMID:' 18678856
2. fever increases the risk of cardiac arrest in BrS 3. Risk of life threatening arrythmia in BrS related to fever was (65%)higher in young patients less than 5 year old (%65)PMID: 29649615 and %25 in patients older than 70 year old.[16] |
1.There is no risk of arrhythmia when patients affected by covid19. |
2.Fever is not the risk factor of arrhythmia |
| symptoms | torsade de pointes and fatal ventricular arrhythmia | ventricular fibrilation and sudden cardiac death | syncope,ventricular fibrillation, sudden cardiac death | ventricular arrhythmia during exercise and stress related to covid-19 |
| management | do not use ≥ one drugs inducing prolongation of QT interval in the setting of LQTc and covid-19 | 1.controlling the fever with parastamol
2.ECG monitoring untill resolving type1 brugada pattern 3. self isolation |
2. hydroxychloroquine may prolonge QTinterval and useful in treatment of SQTS type 1 (KCNH2-related) and type 3 (KCNJ2 related[17] PMID: 30441573 | 1.do not use epinephrine in the setting of ventricular arrhythmia
2. flecainide is treatment of choice without any interaction with lopinavir, ritonavir and chloroquine. |
Epidemiology and Demographics
Incidence
- There is a two-times rise in the incidence of Out of hospital Sudden cardiac arrest (OHCA) during the COVID-19 pandemic as compared to the non-pandemic time period.
- According to a study done in China, about 12% of patients with COVID-19 without a history of heart problems experience cardiac arrest during their hospitalization.[18]
- In a study done among 761 Chinese patients with severe COVID-19, about 20% patients developed in-hospital cardiac arrest within 40 days of their hospitalization course.[19]
Mortality
- There is a significant increase in the mortality rate of the OHCA patients.[20]
Age
- Mean age 69.7 years is observed among patients who experienced Out of hospital Sudden cardiac arrest (OHCA) .[20] .
Gender
- Studies show that males have a slightly higher incidence of Out of hospital Sudden cardiac arrest (OHCA) as compared to the females.[20]
Race
A higher incidence is seen among African-Americans as compared to the Caucasians.[21]
Risk Factors
- Common risk factors in the development of arrhythmia and cardiac arrest in covid-19 are :[22]PMID: 32244059
- fever
- stress
- electrolytis disrturbances
- use of viral drugs
Screening
- To view screening for COVID-19, click here.
Natural History, Complications, and Prognosis
- The proportion of patients developed out of hospital cardiac arrest (OHCA) increased during covid-19 pandemic.[23]
DOI: 10.1056/NEJMp2008017
- Common causes of OHCA durig covid-19 pandemic include:1.acute cardiac events ( coronary syndrome, heart failure,arrhythmia,) 2.http://dx.doi.org/10.1016/j.thromres.2020.04.013 thromboembolic events related to covid19 (pulmonary embolism, acute coronary syndrome)[24]
3.Acute respiratory distress and hypoxia related to covid19 4. late presentation for example acute MI in hospital due to lockdown and movement restriction 4. Overwelming of medical service 5. Myocarditis
5. Letal arrhythmia by using azithromycin and https://doi.org/10.1016/S0140-6736(20)31180-6 6.Myocardial injury and myocarditis
- Prognosis of patients with severe COVID-19 pneumonia with in hospital cardiac arrest (IHCA) was poor in wohan .[25]: 32283117
Diagnosis
Diagnostic Criteria[edit | edit source]
- The diagnosis of sudden cardiac death is made when the following diagnostic criteria are met:
- Prodromes phase occuring weeks or months before an event includes: new or worsening cardiovascular symptoms(chest pain, dyspnea, palpitations, fatigability)
- Onset of terminal event occuring one hour before cardiac arrest includes:abrupt change in clinical status( arrhythmia, hypotension, chest pain, dyspnea,lightheadness)
- Cardiac arrest includes: sudden collapse, loss of effective circulation, loss of consciousness
- Biologic death: failure of resuscitation or failure of electerical, mechanical or CNS function after initial resuscitation
Symptoms[edit | edit source]
- Symptoms before cardiac arrest in covid19 may include the following:
- Chest pain
- Palpitation
- Dyspnea
- Lightheadness
Physical Examination[edit | edit source
- Physical examination may be remarkable for:
- [finding 1]
- [finding 2]
- [finding 3]
- [finding 4]
- [finding 5]
- [finding 6]
Laboratory Findings[edit | edit source]
- An elevated concentration of serum cardiac troponinI was detected in severe COVID-19 patients with cardiac complications. PMID: 32382587
Imaging Findings[edit | edit source]
- There are no imaging study findings associated with cardiac arrest in COVID-19.
Electrocardiogram
- Findings on EKG during inhospital cardiac arrest(IHCA) in covid19 include:asystole(89.7%),pulseless electrical activity(4.4%) shockable rhythm(5.9%)[25]PMID: 32283117
- Other abnormal EKG findings include QT prolongation. ECG shows corrected QT interval (QTc) more than 500 ms..
Treatment
- The mainstay of therapy for cardiac arrest in COVID-19 is cardiopulmonary rescucitation. https://doi.org/10.1161/CIRCULATIONAHA.120.047463
- Immediate basic life support or advanced cardiac life support with an automatic external defibrillator is essential to safe the life of the patient. If the COVID-19 infection was confirmed, the EMS personnel is instructed to wear personal protective equipment (PPE) before performing cardiopulmonary resuscitation.
Prevention
- .Effective measures for the primary prevention of ventricular arrhythmia during using hydroxychloroquine in1. long QT syndrome or 2.aquired LQTS or 3.heart rate<50/min or 4. recieving azithromycin,redmisivir, lopinavir, ritonavir, include EKG and QTc measurement.[22]PMID: 32244059
- If QTc ≥500 ms, consult with cardiologist.
- If QTc<500ms, start hydroxychloroquine and repeat EKG after 1-3 days.
- After starting first dose of hydroxychloroquine, If QTc≥500mse, increased QTc>60ms, or ventricular ectopy were observed , repeat EKG after 4 hours.
- Treatment of hypokalemia due to diarrhea associated COVID-19 ,which prolonges QTinterval.
- 2.Effective measures for the primary prevention of ventricular arrhythmia in brugada syndrome is starting acetaminophen or parastamol immediately if there is sign of fever and also self isolation.
References
- ↑ Liu, Yen-Chin; Kuo, Rei-Lin; Shih, Shin-Ru (2020). "COVID-19: The first documented coronavirus pandemic in history". Biomedical Journal. doi:10.1016/j.bj.2020.04.007. ISSN 2319-4170.
- ↑ Baldi, Enrico; Sechi, Giuseppe M.; Mare, Claudio; Canevari, Fabrizio; Brancaglione, Antonella; Primi, Roberto; Klersy, Catherine; Palo, Alessandra; Contri, Enrico; Ronchi, Vincenza; Beretta, Giorgio; Reali, Francesca; Parogni, Pierpaolo; Facchin, Fabio; Bua, Davide; Rizzi, Ugo; Bussi, Daniele; Ruggeri, Simone; Oltrona Visconti, Luigi; Savastano, Simone (2020). "Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy". New England Journal of Medicine. doi:10.1056/NEJMc2010418. ISSN 0028-4793.
- ↑ Sayre, Michael R.; Barnard, Leslie M.; Counts, Catherine R.; Drucker, Christopher J.; Kudenchuk, Peter J.; Rea, Thomas D.; Eisenberg, Mickey S. (2020). "Prevalence of COVID-19 in Out-of-Hospital Cardiac Arrest: Implications for Bystander CPR". Circulation. doi:10.1161/CIRCULATIONAHA.120.048951. ISSN 0009-7322.
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|doi=value (help). Missing or empty|title=(help) - ↑ 6.0 6.1 6.2 6.3 Driggin, Elissa; Madhavan, Mahesh V.; Bikdeli, Behnood; Chuich, Taylor; Laracy, Justin; Biondi-Zoccai, Giuseppe; Brown, Tyler S.; Der Nigoghossian, Caroline; Zidar, David A.; Haythe, Jennifer; Brodie, Daniel; Beckman, Joshua A.; Kirtane, Ajay J.; Stone, Gregg W.; Krumholz, Harlan M.; Parikh, Sahil A. (2020). "Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic". Journal of the American College of Cardiology. 75 (18): 2352–2371. doi:10.1016/j.jacc.2020.03.031. ISSN 0735-1097.
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|pmc=value (help). PMID 32359771 Check|pmid=value (help). - ↑ Giudicessi JR, Roden DM, Wilde A, Ackerman MJ (May 2020). "Genetic susceptibility for COVID-19-associated sudden cardiac death in African Americans". Heart Rhythm. doi:10.1016/j.hrthm.2020.04.045. PMC 7198426 Check
|pmc=value (help). PMID 32380288 Check|pmid=value (help). Vancouver style error: initials (help) - ↑ Straus SM, Kors JA, De Bruin ML, van der Hooft CS, Hofman A, Heeringa J, Deckers JW, Kingma JH, Sturkenboom MC, Stricker BH, Witteman JC (January 2006). "Prolonged QTc interval and risk of sudden cardiac death in a population of older adults". J. Am. Coll. Cardiol. 47 (2): 362–7. doi:10.1016/j.jacc.2005.08.067. PMID 16412861.
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- ↑ van der Werf C, Wilde AA (April 2013). "Catecholaminergic polymorphic ventricular tachycardia: from bench to bedside". Heart. 99 (7): 497–504. doi:10.1136/heartjnl-2012-302033. PMID 23390049.
- ↑ van Noord C, Eijgelsheim M, Stricker BH (July 2010). "Drug- and non-drug-associated QT interval prolongation". Br J Clin Pharmacol. 70 (1): 16–23. doi:10.1111/j.1365-2125.2010.03660.x. PMC 2909803. PMID 20642543.
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- ↑ Amin AS, Herfst LJ, Delisle BP, Klemens CA, Rook MB, Bezzina CR, Underkofler HA, Holzem KM, Ruijter JM, Tan HL, January CT, Wilde AA (July 2008). "Fever-induced QTc prolongation and ventricular arrhythmias in individuals with type 2 congenital long QT syndrome". J. Clin. Invest. 118 (7): 2552–61. doi:10.1172/JCI35337. PMC 2423868. PMID 18551196.
- ↑ Amin AS, Meregalli PG, Bardai A, Wilde AA, Tan HL (August 2008). "Fever increases the risk for cardiac arrest in the Brugada syndrome". Ann. Intern. Med. 149 (3): 216–8. doi:10.7326/0003-4819-149-3-200808050-00020. PMID 18678856.
- ↑ Michowitz Y, Milman A, Sarquella-Brugada G, Andorin A, Champagne J, Postema PG, Casado-Arroyo R, Leshem E, Juang J, Giustetto C, Tfelt-Hansen J, Wijeyeratne YD, Veltmann C, Corrado D, Kim SH, Delise P, Maeda S, Gourraud JB, Sacher F, Mabo P, Takahashi Y, Kamakura T, Aiba T, Conte G, Hochstadt A, Mizusawa Y, Rahkovich M, Arbelo E, Huang Z, Denjoy I, Napolitano C, Brugada R, Calo L, Priori SG, Takagi M, Behr ER, Gaita F, Yan GX, Brugada J, Leenhardt A, Wilde A, Brugada P, Kusano KF, Hirao K, Nam GB, Probst V, Belhassen B (September 2018). "Fever-related arrhythmic events in the multicenter Survey on Arrhythmic Events in Brugada Syndrome". Heart Rhythm. 15 (9): 1394–1401. doi:10.1016/j.hrthm.2018.04.007. PMID 29649615. Vancouver style error: initials (help)
- ↑ Luo C, Wang K, Liu T, Zhang H (July 2018). "Computational Analysis of the Action of Chloroquine on Short QT Syndrome Variant 1 and Variant 3 in Human Ventricles". Conf Proc IEEE Eng Med Biol Soc. 2018: 5462–5465. doi:10.1109/EMBC.2018.8513572. PMID 30441573.
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- ↑ 20.0 20.1 20.2 Marijon E, Karam N, Jost D, Perrot D, Frattini B, Derkenne C; et al. (2020). "Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study". Lancet Public Health. doi:10.1016/S2468-2667(20)30117-1. PMC 7255168 Check
|pmc=value (help). PMID 32473113 PMID: 32473113 Check|pmid=value (help). - ↑ Giudicessi JR, Roden DM, Wilde AAM, Ackerman MJ (2020). "Genetic susceptibility for COVID-19-associated sudden cardiac death in African Americans". Heart Rhythm. doi:10.1016/j.hrthm.2020.04.045. PMC 7198426 Check
|pmc=value (help). PMID 32380288 PMID: 32380288 Check|pmid=value (help). - ↑ 22.0 22.1 Wu CI, Postema PG, Arbelo E, Behr ER, Bezzina CR, Napolitano C, Robyns T, Probst V, Schulze-Bahr E, Remme CA, Wilde A (March 2020). "SARS-CoV-2, COVID-19, and inherited arrhythmia syndromes". Heart Rhythm. doi:10.1016/j.hrthm.2020.03.024. PMC 7156157 Check
|pmc=value (help). PMID 32244059 Check|pmid=value (help). Vancouver style error: initials (help) - ↑ Pfefferbaum, Betty; North, Carol S. (2020). "Mental Health and the Covid-19 Pandemic". New England Journal of Medicine. doi:10.1056/NEJMp2008017. ISSN 0028-4793.
- ↑ Klok, F.A.; Kruip, M.J.H.A.; van der Meer, N.J.M.; Arbous, M.S.; Gommers, D.A.M.P.J.; Kant, K.M.; Kaptein, F.H.J.; van Paassen, J.; Stals, M.A.M.; Huisman, M.V.; Endeman, H. (2020). "Incidence of thrombotic complications in critically ill ICU patients with COVID-19". Thrombosis Research. 191: 145–147. doi:10.1016/j.thromres.2020.04.013. ISSN 0049-3848.
- ↑ 25.0 25.1 Shao F, Xu S, Ma X, Xu Z, Lyu J, Ng M, Cui H, Yu C, Zhang Q, Sun P, Tang Z (June 2020). "In-hospital cardiac arrest outcomes among patients with COVID-19 pneumonia in Wuhan, China". Resuscitation. 151: 18–23. doi:10.1016/j.resuscitation.2020.04.005. PMC 7151543 Check
|pmc=value (help). PMID 32283117 Check|pmid=value (help). - ↑ Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui D, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS (April 2020). "Clinical Characteristics of Coronavirus Disease 2019 in China". N. Engl. J. Med. 382 (18): 1708–1720. doi:10.1056/NEJMoa2002032. PMC 7092819 Check
|pmc=value (help). PMID 32109013 Check|pmid=value (help). Vancouver style error: initials (help)
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