Transthoracic echocardiographic analysis of moderate to severe COVID-19 patients admitted to ICU at tertiary hospital in India

Background:To describe the transthoracic echocardiographic findings of moderate to severe COVID-19 patients admitted to ICU.Methods: We studied thetransthoracic echocardiographic findings performed within 48 hours on admission toICU of 426 moderate to severe COVID-19 patients from July 2020 to September 2020 during their course of treatment. Echocardiographic study included left ventricular (LV) systolic and diastolic function, left ventricle wall motion abnormalities and right ventricular (RV) assessment.Results: The median age of patients was 58.2 (range 19 to 92 years) and majority of patients were male (71%). Pre-existing comorbidities were reported in 95.5% of patient’s, majority being hypertension (42.7%) and diabetes mellitus (39.2%).Abnormal echo findings were noted in 40.8% (n=174) with majority of abnormal findingsnoted in age group of 60-69 (n=54), men (n=114) and in patients with pre-existing coronary artery disease (CAD)(n=28). The common pattern of cardiac abnormalities was LV systolic dysfunction (n=73, 17.1%), RV dysfunction (n=30, 7%) and abnormal PA pressures (n=144, 85.2%). Abnormal echo findings were noted in 46% of patients who died and 33.9% of patients who required hospital stay of more than 10 days.Conclusions:Forty percent of admitted patients to ICU had abnormal echocardiography findings with around eighty five percent of them having raised pulmonary artery pressure

A Study of ECG and Echocardiographic Findings in Chronic Obstructive Pulmonary Disease Patients in a Tertiary Care Hospital

COPD has considerable effects on cardiac functions. Most of the increased mortality and morbidity associated with COPD is due to cardiac involvement. We wanted to assess the electrocardiographic and echocardiographic findings in COPD, correlate these findings in assessing the severity and duration of the disease, analyse these findings in assessing right ventricular dysfunction and compare the results of clinical, electrocardiographic and echocardiographic findings in detecting right ventricular dysfunction in COPD. METHODS50 COPD patients fulfilling the inclusion criteria were recruited. They were staged by PFT and evaluated by ECG and echocardiography. Statistical analysis of correlation was done, and statistical significance was taken as p < 0.05. RESULTSAmong the total of 50 cases selected for study 80 % were males, 20 % were females. On the basis of GOLD guidelines there were 8 %, 44 %, 36 %, 12 % mild, moderate, severe and very severe COPD cases respectively. Symptoms at presentation were cough with sputum (92 %), breathlessness (96 %), swelling of feet (24 %), fever (16 %), and decreased urine output (4 %). Physical signs at presentation were tachypnoea (68 %), loud P2 (24 %), parasternal heave (20 %), raised JVP (24 %), pedal oedema (16 %) and ascites (4 %). ECG findings analysis were P-pulmonale (46 %), RAD (38 %), RVH (34 %), low voltage complexes (30 %), poor progression of r-wave (30 %) and incomplete RBBB (12 %). Correlation of all the above ECG findings showed statistical significance (p < 0.05) with disease severity and disease duration (p < 0.05). Echocardiographic findings were pulmonary hypertension (50 %), Cor pulmonale (44 %), RV dilatation (44 %), RA dilatation (32 %), RVH (24 %), interventricular septal motion abnormality (14 %), LVDD (16 %), LVSD (4 %) and RVSD (4 %). All the above echocardiographic findings of RV dysfunction i.e. PAH, Cor pulmonale, RA dilatation, RVD, RVH and RVSD were statistically significant with disease severity and duration (p < 0.05) along with LVDD, LVSD. CONCLUSIONSThis study emphasises on early cardiac screening of all COPD patients which will be helpful in the assessment of the prognosis and will further assist in identifying the individuals likely to suffer increased morbidity and mortality.

Right-sided heart failure in congenital heart diseases / 소아과

Right-sided heart failure is a major problem among patients with congenital heart diseases, due to the prevalence of congenital heart defects and the association of pulmonary hypertension. More attention is focused on the structure of the right heart particularly in association with congenital heart defects and chronic lung disease. The right ventricle (RV) may support the pulmonary circulation, and sometimes the systemic circulation (systemic RV) in congenital heart defects. Despite major progress being made, assessing the RV remains challenging, often requiring a multi-imaging approach and expertise (echocardiography, magnetic resonance imaging, nuclear and cineangiography). Evidence is accumulating that RV dysfunction develops in many of these patients and leads to considerable morbidity and mortality. While there is extensive literature on the pathophysiology and treatment of left heart failure, the data for right-sided heart failure is scarce. Therefore RV function in certain groups of congenital heart disease patients needs close surveillance and timely and appropriate intervention to optimise outcomes. An understanding of RV physiology and hemodynamics will lead to a better understanding of current and future treatment strategies for right heart failure. This will review right-sided heart failure with the implications of volume and pressure loading of the RV in congenital heart diseases.

Right-sided heart failure in congenital heart diseases / 소아과

Right-sided heart failure is a major problem among patients with congenital heart diseases, due to the prevalence of congenital heart defects and the association of pulmonary hypertension. More attention is focused on the structure of the right heart particularly in association with congenital heart defects and chronic lung disease. The right ventricle (RV) may support the pulmonary circulation, and sometimes the systemic circulation (systemic RV) in congenital heart defects. Despite major progress being made, assessing the RV remains challenging, often requiring a multi-imaging approach and expertise (echocardiography, magnetic resonance imaging, nuclear and cineangiography). Evidence is accumulating that RV dysfunction develops in many of these patients and leads to considerable morbidity and mortality. While there is extensive literature on the pathophysiology and treatment of left heart failure, the data for right-sided heart failure is scarce. Therefore RV function in certain groups of congenital heart disease patients needs close surveillance and timely and appropriate intervention to optimise outcomes. An understanding of RV physiology and hemodynamics will lead to a better understanding of current and future treatment strategies for right heart failure. This will review right-sided heart failure with the implications of volume and pressure loading of the RV in congenital heart diseases.

Comparison of Effect Between Thrombolysis and Anticoagulation in Major Pulmonary Thromboembolism / 결핵및호흡기질환

BACKGROUND: 'Major pulmonary thromboembolism' is defined as right ventricular (RV) dysfunction, with or without shock, accompanied by significant morbidity and mortality. In this study, those with major pulmonary thromboembolism were divided into the shock and RV dysfunction only groups, and then investigated the mortality and complications in thrombolysis or anticoagulation, respectively. METHODS: In a retrospective study, between January 1995 and December 2004, 60 eligible patients with a major pulmonary thromboembolism, admitted in Asan Medical Center, were included. RESULTS: A total of 57 patients were treated with medical therapy. Thrombolysis was performed in 13 patients (23%) and anticoagulation in 44 (77%). There were no differences in the APACHE II and SOFA scores between the two groups. 6 (46%) and 11 (25%) patients died in the thrombolysis and anticoagulation groups, respectively (p=0.176). In the 19 patients (33%) showing shock, thrombolysis was performed in 9 (47%) and anticoagulation in 10 (53%). 4 (44%) of the 9 patients treated with thrombolytic agents and 3 (30%) of the 10 treated with anticoagulants died (p=0.650). In the 38 patients (67%) showing RV dysfunction only, thrombolysis was performed in 4 (11%) and anticoagulation in 34 (89%). 2 (50%) of the 4 patients treated with thrombolytics and 8 (24%) of the 34 treated with anticoagulants died (p=0.279). Three patients (23%) who underwent thrombolysis had a major bleeding episode, compared with 2 (5%) who were treated with anticoagulants (p=0.072). CONCLUSION: The results of our study showed that thrombolysis did not lower mortality and tended to increase major bleeding compared with anticoagulation in both the shock and RV dysfunction only groups. Further evaluation of the efficacy and safety of thrombolytic therapy for major thromboembolism appears warranted in Korea.