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2.
Cardiol Young ; 30(11): 1588-1594, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-899833

ABSTRACT

The COVID-19 pandemic is currently ravaging the globe and the African continent is not left out. While the direct effects of the pandemic in regard to morbidity and mortality appear to be more significant in the developed world, the indirect harmful effects on already insufficient healthcare infrastructure on the African continent would in the long term be more detrimental to the populace. Women and children form a significant vulnerable population in underserved areas such as the sub-Saharan region, and expectedly will experience the disadvantages of limited healthcare coverage which is a major fall out of the pandemic. Paediatric cardiac services that are already sparse in various sub-Saharan countries are not left out of this downsizing. Restrictions on international travel for patients out of the continent to seek medical care and for international experts into the continent for regular mission programmes leave few options for children with cardiac defects to get the much-needed care.There is a need for a region-adapted guideline to scale-up services to cater for more children with congenital heart disease (CHD) while providing a safe environment for healthcare workers, patients, and their caregivers. This article outlines measures adapted to maintain paediatric cardiac care in a sub-Saharan tertiary centre in Nigeria during the COVID-19 pandemic and will serve as a guide for other institutions in the region who will inadvertently need to provide these services as the demand increases.


Subject(s)
COVID-19/prevention & control , Cardiology , Delivery of Health Care , Heart Defects, Congenital/therapy , Pediatrics , Thoracic Surgery , Ambulatory Care/methods , COVID-19/diagnosis , COVID-19/epidemiology , Cardiac Catheterization/methods , Cardiac Surgical Procedures/methods , Developing Countries , Echocardiography/methods , Echocardiography, Transesophageal/methods , Emergency Service, Hospital , Heart Defects, Congenital/diagnosis , Humans , Infection Control/methods , Mass Screening , Nigeria , Personal Protective Equipment , Point-of-Care Systems , Practice Guidelines as Topic , Telemedicine/methods , Triage/methods
3.
Am J Case Rep ; 21: e926915, 2020 Sep 23.
Article in English | MEDLINE | ID: covidwho-789900

ABSTRACT

BACKGROUND Recent studies demonstrated evidence of coagulation dysfunction in hospitalized patients with severe coronavirus disease 2019 (COVID-19) due to excessive inflammation, hypoxia, platelet activation, endothelial dysfunction, and stasis. Effective anticoagulation therapy may play a dominant role in the management of severe COVID-19 cases. CASE REPORT A 73-year-old man with a 6-day history of fever up to 38.5°C, dyspnea, cough, and fatigue was diagnosed with COVID-19. He had a past medical history significant for hypertension and coronary artery bypass grafting. Two days after hospital admission, the patient developed acute respiratory failure, requiring intubation, mechanical ventilation, and transfer to the intensive care unit (ICU). He received treatment including antibiotics, hydroxychloroquine, tocilizumab, vasopressors, prone positioning, and anticoagulation with enoxaparin at a prophylactic dose. After a 15-day ICU stay, the patient was hemodynamically stable but still hypoxemic; a transthoracic echocardiogram at that time, followed by a transesophageal echocardiogram for better evaluation, revealed the presence of a right atrium thrombus without signs of acute right ventricular dilatation and impaired systolic function. Since the patient was hemodynamically stable, we decided to treat him with conventional anticoagulation under close monitoring for signs of hemodynamic deterioration; thus, the prophylactic dose of enoxaparin was replaced by therapeutic dosing, which was a key component of the patient's successful outcome. Over the next few days he showed significant clinical improvement. The follow-up transesophageal echocardiogram 3 weeks after effective therapeutic anticoagulation revealed no signs of right heart thrombus. CONCLUSIONS The presented COVID-19 case, one of the first reported cases with evidence of right heart thrombus by transesophageal echocardiography, highlights the central role of diagnostic imaging strategies and the importance of adequate anticoagulation therapy in the management of severe COVID-19 cases in the ICU.


Subject(s)
Coronavirus Infections/complications , Echocardiography, Transesophageal/methods , Heart Atria/diagnostic imaging , Heart Diseases/therapy , Pneumonia, Viral/complications , Severe Acute Respiratory Syndrome/complications , Thrombosis/therapy , Aged , COVID-19 , Combined Modality Therapy , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Cough/diagnosis , Cough/etiology , Critical Care/methods , Disease Progression , Emergency Service, Hospital , Fever/diagnosis , Fever/etiology , Follow-Up Studies , Greece , Heart Atria/pathology , Heart Diseases/diagnostic imaging , Heart Diseases/etiology , Humans , Intensive Care Units , Length of Stay , Male , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/therapy , Severity of Illness Index , Thrombosis/diagnostic imaging , Thrombosis/etiology , Treatment Outcome
7.
J Am Soc Echocardiogr ; 33(8): 1040-1047, 2020 08.
Article in English | MEDLINE | ID: covidwho-342809

ABSTRACT

BACKGROUND: The COVID-19 pandemic has placed an extraordinary strain on healthcare systems across North America. Defining the optimal approach for managing a critically ill COVID-19 patient is rapidly changing. Goal-directed transesophageal echocardiography (TEE) is frequently used by physicians caring for intubated critically ill patients as a reliable imaging modality that is well suited to answer questions at bedside. METHODS: A multidisciplinary (intensive care, critical care cardiology, and emergency medicine) group of experts in point-of-care echocardiography and TEE from the United States and Canada convened to review the available evidence, share experiences, and produce a consensus statement aiming to provide clinicians with a framework to maximize the safety of patients and healthcare providers when considering focused point-of-care TEE in critically ill patients during the COVID-19 pandemic. RESULTS: Although transthoracic echocardiography can provide the information needed in most patients, there are specific scenarios in which TEE represents the modality of choice. TEE provides acute care clinicians with a goal-directed framework to guide clinical care and represents an ideal modality to evaluate hemodynamic instability during prone ventilation, perform serial evaluations of the lungs, support cardiac arrest resuscitation, and guide veno-venous ECMO cannulation. To aid other clinicians in performing TEE during the COVID-19 pandemic, we describe a set of principles and practical aspects for performing examinations with a focus on the logistics, personnel, and equipment required before, during, and after an examination. CONCLUSIONS: In the right clinical scenario, TEE is a tool that can provide the information needed to deliver the best and safest possible care for the critically ill patients.


Subject(s)
Coronavirus Infections/epidemiology , Critical Care/organization & administration , Cross Infection/prevention & control , Echocardiography, Transesophageal/methods , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Severe Acute Respiratory Syndrome/epidemiology , COVID-19 , Canada/epidemiology , Consensus , Coronavirus Infections/prevention & control , Female , Humans , Infection Control/methods , Male , North America/epidemiology , Pandemics/prevention & control , Patient Positioning , Pneumonia, Viral/prevention & control , Point-of-Care Systems , Risk Assessment , Safety Management
8.
J Card Surg ; 35(6): 1348-1350, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-343637

ABSTRACT

The novel coronavirus, now termed SARS-CoV-2, has caused a significant global impact in the space of 4 months. Almost all elective cardiac surgical operations have been postponed with only urgent and emergency operations being considered in order to maximise resource utilisation. We present a case of a 69-year old lady with an infected prosthetic aortic valve for consideration of urgent inpatient surgery. Despite being asymptomatic and testing negative initially for COVID-19 RT-PCR swab, further investigations with CT revealed suspicious findings. She subsequently tested positive on a repeat swab and unfortunately deteriorated rapidly with complications including gastro-intestinal and intracerebral haemorrhage.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Heart Valve Prosthesis Implantation/adverse effects , Pneumonia, Viral/diagnosis , Prosthesis-Related Infections/surgery , Prosthesis-Related Infections/virology , Time-to-Treatment , Aged , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Echocardiography, Transesophageal/methods , Emergency Service, Hospital , Fatal Outcome , Female , Heart Valve Prosthesis Implantation/methods , Humans , Pandemics , Prosthesis-Related Infections/diagnostic imaging , Radiography, Thoracic/methods , Reoperation/methods , SARS-CoV-2 , Tomography, X-Ray Computed/methods
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