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ABSTRACT Objective: To assess the impact of COVID 19 pandemic associated lockdown on the emergency patient visits and their management and outcome in a tertiary cardiac center of Pakistan Study Design: Comparative cross-sectional study. Place and Duration of Study: Rawalpindi Institute of Cardiology from Mar 2020 to May 2020. Methodology: Records of patients presenting at the emergency department(ED during the lockdown period(23rd March 2020 to 7th May) was assessed. Similarly records of patients presenting to the emergency department during the same period last year was assessed. The two were than compared. Parameters compared included the gender difference, the underlying disease, the number of ST elevation myocardial infarction(STEMI) patients, patients undergoing lysis and primary percutaneous coronary intervention(PCI) and the mortality. Data analysis was done in terms of numbers and percentage change in each parameter. Results: There was considerable decrease in the number of patients visiting the emergency department(32.48%)i.e from 13326 to 8997. In addition, the ST elevation myocardial infarction(STEMI) number declined considerably(37.84%) as did the primary percutaneous coronary intervention(PCI) number(66.43%) and the number of patients coming with non ST elevation acute coronary syndromes(NSTEACS)(72.32%) and decompensated heart failure(86.86%). The overall emergency department mortality also reduced by 42.1%. There was however an increase in the percentage of ST elevation myocardial infarction(STEMI) patients lysed. Conclusion: This study shows the dramatic decline in patient admissions with cardiac ailments in the emergency department of a tertiary care hospital highlighting the overall impact of morbidity and mortality secondary to the COVID 19 pandemic due to issues not directly related to COVID 19 and also gives us an eye opener to expect a high number of complicated cardiac patients coming to our hospital and to plan accordingly.
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ABSTRACT Objective: To study the HRCT chest findings in patients undergoing cardiac interventions during COVID-19 era. Study Design: Cross sectional analytical study. Place and Duration of Study: Armed Forces Institute of Cardiology and National Institute of Heart Disease (AFIC/NIHD) Rawalpindi, from Apr 2020 to May 2020. Methodology: All the admitted cardiac patients who were to undergo any invasive cardiac intervention underwent plain HRCT chest and polymerase chain Reaction (PCR) for SARS-CoV-2 simultaneously. One hundred and ten patients were studied. We analyzed preexisting respiratory illnesses, clinical, echocardiographic and radiological features. Data recording, storage, assessment and analysis was done by using SPSS-21. Results: Our study included 110 patients (87 Male, 23 Female, median age 52 Years). Common reasons for admission were coronary angiography 43 (39.1%), acute Left Ventricular Failure (LVF) 30 (27.3%), Percutaneous Coronary Intervention (PCI) 13 (11.8%) and chest pain evaluation 10 (9.1%). Cardiomegaly (29.1%) followed by consolidation (9.1%) were commonest radiological finding. Two third patients had abnormal HRCT chest but only few had radiological findings either suspicious (6.4%) or indeterminate (11.8%) for COVID-19. Respiratoy symptoms, positive PCR for COVID-19 and severe Left ventricular dysfunctions were correlated with abnormal HRCT findings, correlation being statistically significant (p-value 0.05). Conclusion: HRCT chest is a non-invasive and highly sensitive imaging modality, which can rapidly help in identifying, and isolating suspected cases of novel corona virus as well as in diagnosing unknown pre-existing lung diseases in cardiac patients.