Cardiac Care and COVID-19: Perspectives in Medical Practice

Ozgur Karcioglu

• Publisher: Bentham Science Publishers
• Year: 2021
• ISBN:
  9781681088204
• Topic: Medicine
• Subtopic: Cardiology

Cardiac Care and COVID-19: Perspectives in Medical Practice is an accessible reference on diagnoses and treatment modalities for cardiac diseases in general, and emergency cardiac conditions to be more specific, with respect to the current COVID-19 pandemic. Chapters in the book give updated descriptions of common problems in emergency medicine and cardiovascular disease. Each chapter is dedicated to a specific cardiovascular disease and explains management principles, diagnostic procedures and therapy. Examples of medical cases have also been used to highlight complex issues to give a concrete understanding of the cardiac care in COVID-19 patients to the medical practitioner, whether they are involved in critical care or in outpatient clinics. Key Features: - Clinical guidelines for critical care and cardiovascular management of COVID-19 patients - Topic-based information about cardiovascular diseases - Covers a range of cardiovascular problems including myocarditis, arrhythmias, chest pain, acute coronary syndrome - Information on pulmonary embolism and associated problems - Reader friendly presentation - Case-based examples for explaining concepts The range of topics combined with the simple presentation make this an essential reference for healthcare workers in emergency medicine, cardiology and nursing. General physicians interested in the cardiovascular impact of COVID-19 will also benefit from the information provided in the book.

Chest Pain and Acute Coronary Syndromes (ACS)

Ozgur KARCIOGLU

Abstract

Acute coronary syndromes (ACS), especially acute myocardial infarction (AMI), is the leading cause of death in the world. These represent damage to the cardiac myocytes in the setting of acute cessation of blood supply. Chest pain is a common presentation in patients with AMI; however, there are multiple non-cardiac causes of chest pain. The diagnosis cannot always be made based on the initial presentation. The emergent evaluation of a patient with probable ACS includes a careful assessment of history, risk factors and presenting signs and symptoms, de novo ECG abnormalities, and workup of cardiac troponins. Validated risk scores, such as HEART, TIMI, and GRACE, can be helpful in predicting outcomes and the likelihood of ACS in a patient with chest pain. ECG should be performed within 10 minutes of presentation. ST elevation MI (STEMI) is diagnosed with elevated ST segments in two consecutive leads on ECG. Likewise, elevated levels of cardiac troponins in the first hours of presentation are mostly a prerequisite for diagnosis.

Although cardiac catheterization is viewed as the standard diagnostic modality for coronary artery disease, exercise testing, stress studies, echocardiography, and coronary computed tomography angiography (CCTA) may be important adjuncts. Cardiac catheterization laboratory (CCL), coronary care units, EDs, EMS, and primary care institutions need to cooperate in unison to produce the best results for public health.

This chapter gives a brief outline of the diagnosis and management of ACS in the pandemic period.

Keywords: Acute coronary syndrome, Acute myocardial infarction, Cardiac catheterization, COVID-19, ST elevation myocardial infarction.

INTRODUCTION

Cardiovascular disease is the most common cause of death among adults in most parts of the world. These may be deaths in a short time following Acute Myocardial Infarction (AMI) or may develop as a result of other acute coronary syndromes (ACS). Approximately half of the patients with out-of-hospital cardiac arrest with the first rhythm identified as VF and who survive hospital admission have evidence of acute MI. Of all out-of-hospital cardiac arrests, .50% will have significant coronary artery lesions on acute coronary angiography (Al-Khatib SM, 2018). Sudden cardiac death (SCD) constitutes major public health problems,

accounting for approximately 50% of all cardiovascular deaths. For this reason, a great economic resource is allocated for the prevention of cardiovascular diseases (CVD) in the world, especially in developed countries. In developing countries, on the other hand, larger bills are faced because therapeutic approaches are prominent rather than preventive medicine.

Etiology

The inability to meet the oxygen requirement of the heart with the supplied blood for a certain period of time and the accumulation of substances such as lactic acid and free radicals in the myocardial tissue precipitates chest pain (CP). In other words, it is acute ischemia of myocardial cells that directly triggers the pain.

The amount of blood passing through a vein is proportional to the diameter of the vein. When atherosclerosis reduces the vessel diameter by half, there is a serious decrease in the blood carried by vessel. As a rule, reduced blood flow to the coronary arteries is caused by atherosclerosis. However, sometimes abnormal spasm of the arteries can also cause insufficient blood flow, which is called vasospastic angina or “Prinzmetal's angina”.

CP is the most common complaint of AMI. However, CP has many causes other than AMI or CVD. History is an important aid in distinguishing them. Pain or discomfort radiating to the shoulder, arm, neck, or jaw may indicate heart disease. Since ischemia afflicts dermatomes between C8 and T4, this kind of spreading pain occurs. In many cases, pain can be defined in the areas listed in addition to CP, or in some cases, only these pains can be noted. For example, an AMI case may present with neck or arm pain without CP.

Pathogenesis

CP is divided into visceral or somatic, in accord with the mechanism. Visceral pain is pain caused by internal organs such as the heart, blood vessels, esophagus, and visceral pleura. Somatic pain is easily identified, its location is well-defined and indicated (e.g., by the finger), and it is a sharp pain, while visceral pain is not well localized due to pain fibers entering the spinal cord at different levels, difficult to describe, vaguely defined, unclear and blunt. There is also a psychological component in vital diseases such as ACS, DAA, and PE. This consists of fear of death (angor animi, severe anguish, nonspecific fear, and anxiety).

Noncardiac Chest Pain

NCCP is also a common presentation encountered in routine practice. Most of them are classified in the 'pleuritic' CP and are of the nature of “somatic pain” (Table 1). Well-defined, sharply circumscribed area of pain is generally in this category, but it should be noted that there may be exceptions. In other words, a pain that appears to be precisely somatic may, in fact, be a harbinger of severe visceral pain, for example, ACS or aortic dissection.

Table 1 Causes of pleuritic or somatic CP include.

• Pulmonary embolism (PE).

• Pneumothorax.

• Pneumonia.

• Pericarditis.

• Serositis/connective tissue disease.

• Malignancies involving the pleura.

• Pathologies below the diaphragm.

• Musculoskeletal disorders

Angina pectoris is examined under two headings: Stable angina and unstable angina pectoris (USAP). Stable angina pectoris (SAP) is the feeling of pain with ischemia as the oxygen requirement of the heart increases during effort without coronary thrombus. SAP attacks always begin with physical or emotional stress, and often the patient recognizes and predicts this pain. SAP usually resolves when the patient is at rest or with the use of agents such as isosorbide dinitrate or with oxygen. USAP is not so easily relieved. USAP can start at rest, even while asleep. It is also called preinfarction angina because it often represents underlying severe atherosclerosis (Table 2). Fig. (1) illustrates the advancement of coronary arterial atherosclerotic process and its reflections on ECG.

Table 2 The criteria sought for the definition of USAP.

- anginal pain that started for the first time in the last 1.5 months

- the change in the duration and characteristics of the pain (e.g., it used to last 3 minutes but now it is 15 minutes, or it used to be start while running but now walking)

- Pain within the first 2 weeks after AMI

- Pain precipitated in the early period after PTCA

- Pain concurrent with changes in ECG findings.

Fig. (1))
Schematization of the progression of coronary artery disease. A . Patient with stable angina, B. Patient with USAP, who can progress to AMI at any time. C. Patient with hyperacute STEMI and transmural infarction. The findings accompanying this are also seen in ECG traces.

Medical H...

Table of contents

• BENTHAM SCIENCE PUBLISHERS LTD.
• PREFACE
• Introduction: Cardiac Disease in the Pandemic Era: Teaching an Old Dog New Tricks?
• Cardiovascular Disease and COVID-19
• Myocardial Damage, Myocarditis, and COVID-19
• Coagulopathies, Prothrombotic State, Thromboembolism, Bleeding, and COVID-19
• Chest Pain and Acute Coronary Syndromes (ACS)
• Heart Failure and Acute Pulmonary Edema (APEd)
• Acute Pulmonary Embolism (APE)
• Hypertension and Aortic Diseases in The Pandemic Era
• Aortic Diseases: Abdominal Aortic Aneurysm (AAA) and Dissecting Aortic Aneurysm (DAA)
• Supraventricular Arrhythmias and Their Management in the Emergency Setting: PSVT and AF
• Agents Used in the Treatment of Arrhythmias and Advanced Cardiovascular Life Support
• Electrotherapies: Emergency Defibrillation, Cardioversion, and Transcutaneous Pacing
• Conclusion