Sandbox:Sara Haddadi: Difference between revisions

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← Older edit

VisualWikitext

Latest revision as of 17:25, 6 August 2020

Sara Haddadi MD, Miami FL

}} | | | | | }}

A01

B01

B02

B03

C01

C02

D01

D02

D03

D04

D05

E01

E02

^[1]

Acute Cough

History and physical

examination, ask about environmental and occupational factors and travel exposures

± investigations

Life-threatening diagnosis

Non-life-threatening diagnosis

Pneumonia, severe

exacerbation of asthma or COPD, PE, heart failure, other serious

disease

Infections

Exacerbation of pre-existing condition

LRTI

URTI

Asthma

Bronchiectasis

UACS

COPD

Evaluate and treat first

Acute Bronchitis

Pertussis

Consider TB in

endemic areas

or high risk

Acute Cough

History and physical

examination, ask about environmental and occupational factors and travel exposures

± investigations

C01

C02

D01'
D01

X

D02'
D02

LRTI

URTI

E02

E03

E05

E04

E01

Y

Z

ZZ

Natural History, Complications and Prognosis

In a case series with 187 patients who had confirmed COVID-19, 27.8% of patients had a myocardial injury, which caused cardiac dysfunction and arrhythmias. The result was significantly higher mortality among patients with myocardial injury.

Based on the Troponin level The mortality during hospitalization was shown to be as below:
- 7.62% for patients without underlying CVD and normal TnT levels
- 13.33% for those with underlying CVD and normal TnT levels
- 37.50% for those without underlying CVD but elevated TnT levels
- 69.44% for those with underlying CVD and elevated TnTs.^[2]

Classification of Infra-Hisian Block
Types of Infra-Hisian Block	Sub-type
Type 2 second degree heart block (Mobitz II)	_
Left bundle branch block	Left anterior fascicular block
Right bundle branch block	_

underlying medical conditions that increase a person’s risk of severe illness from COVID-19
Level of Evidence	Condition
Strongest and Most Consistent Evidence	Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies Cancer Chronic kidney disease COPD Obesity (BMI> 30) Sickle cell disease Solid organ transplantation
Mixed Evidence	Left anterior fascicular block
Limited Evidence	_

- Blood disorders
- Chronic kidney disease
- Chronic liver disease
- Compromised immune system (immunosuppression)
- Current or recent pregnancy in the last two weeks
- Endocrine disorders
- Metabolic disorders
- Heart disease
- Lung disease
- Neurological and neurodevelopmental conditions
CDC has published the following conditions listed in the table below as the risk factors for a severe COVID-19. These conditions are categorized into the following groups based on the current studies evidence:

Strongest and most consistent evidence: define as consistent evidence from multiple small studies or a strong association from a large study are categorized. They increase the severity of COVID-19 regardless of the individual's age:^[3]
Mixed evidence: Defined as multiple studies that reached different conclusions about the risk associated with a condition
Limited evidence: Defined as consistent evidence from a small number of studies. Limited evidence: Defined as consistent evidence from a small number of studies.

underlying medical conditions that increase a person’s risk of severe illness from COVID-19
Level of Evidence	Condition
Strongest and Most Consistent Evidence	Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies Cancer Chronic kidney disease COPD Obesity (BMI> 30) Sickle cell disease Solid organ transplantation Type 2 diabetes mellitus
Mixed Evidence	Asthma Cerebrovascular disease Hypertension Pregnancy smoking Use of corticosteroids or other immunosuppressive medications
Limited Evidence	Bone marrow transplantation HIV Immune deficiencies Inherited metabolic disorders Liver disease Neurologic conditions Other chronic lung diseases Pediatrics Thalassemia Type 1 diabetes mellitus

This list is a living document that will be periodically updated, and it could rapidly change as the science evolves.

References

↑ Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA; et al. (2018). "Fourth Universal Definition of Myocardial Infarction (2018)". J Am Coll Cardiol. 72 (18): 2231–2264. doi:10.1016/j.jacc.2018.08.1038. PMID 30153967.
↑ Guo T, Fan Y, Chen M, Wu X, Zhang L, He T; et al. (2020). "Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)". JAMA Cardiol. doi:10.1001/jamacardio.2020.1017. PMC 7101506 Check |pmc= value (help). PMID 32219356 Check |pmid= value (help).
↑ (PDF) https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf. Missing or empty |title= (help)

6/20/2020

Acute Coronary Syndromes

Pathophysiology

The mechanism of COVID-19 cardiovascular injury has not been fully understood and is likely multifactorial.

SARS-CoV-2 virus attaches to ACE 2 protein for ligand binding before entering the cell via receptor-mediated endocytosis.
- Based on single-cell RNA sequencing more than 7.5% of myocardial cells have positive ACE2 expression. This protein can mediate the entry of SARS-CoV-2 and result in direct cardiotoxicity.
The cytokine release caused by the virus may lead to vascular inflammation, plaque instability, myocardial inflammation, a hypercoagulable state, or direct myocardial suppression.

Pathological changes:

In the level of cardiac tissue: minimal change to interstitial inflammatory infiltration and myocyte necrosis
In the level of vasculature: micro-thrombosis and vascular inflammation^[1]

ST-Elevation MI (STEMI)

A US model from 9 major centers showed a 38% drop in total STEMI activations during the COVID-19 pandemic. There is a 40% reduction noted in Spain as well. there was also a delay between the first presentation to a medical encounter up to 318 min. This is important since COVID-19 can potentially be a cause of STEMI through microthrombi, cytokine storm, coronary spasm, or direct endothelial injury.^[2]

Potential etiologies for the reduction in STEMI PPCI activations:
- avoidance of medical care due to social distancing or concerns of contracting COVID-19 in the hospital
- STEMI misdiagnosis
- increased use of pharmacological reperfusion due to COVID-19

It is very important to realize if patients' anxiety is the reason behind decreasing the presentation of STEMI to U.S. hospitals.^[3]

Treatment of STEMI & COVID-19: The specific protocols for the treatment have been evolving. Early recommendations showed intravenous thrombolysis as first-line therapy for STEMI patients with confirmed COVID-19 since most hospitals do not have protected cardiac catheterization labs.^[2]

Signs and Symptoms

The signs and symptoms of acute coronary syndrome include:^[4]

Chest pain

Substernal chest pain
Occurs at rest or exertion
Radiation to neck, jaw, left shoulder and left arm
Aggravated by physical activity and emotional stress
Relieved by rest, nitroglycerin or both

Chest discomfort described crushing, squeezing, burning, choking, tightness or aching
Dyspnea
Diaphoresis
Nausea and vomiting
Fatigue
Syncope

Treatment

In patients with ACS, and COVID-19 treatment should follow the guideline of the updated Society for Cardiovascular Angiography and Interventions guidelines.^[5]

For patient information, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief:

Synonyms and keywords: Novel coronavirus, covid-19, COVID-19, SARS-CoV-2, Wuhan coronavirus

Overview

COVID-19 patients with cardiovascular comorbidities have higher mortality.
Hospitalized patients with COVID-19 and Cardiovascular disease seem to be more prevalent in both the USA and China. ^[1]
In a case series with 187 patients who had confirmed COVID-19, 27.8% of patients had a myocardial injury, which caused cardiac dysfunction and arrhythmias. The result was significantly higher mortality among patients with myocardial injury.
It seems to be advisable to triage patients with COVID-19 based on their underlying CVD for a more aggressive treatment plan.
The mortality during hospitalization was shown to be 7.62% for patients without underlying CVD and normal TnT levels, 13.33% for those with underlying CVD and normal TnT levels, 37.50% for those without underlying CVD but elevated TnT levels, and 69.44% for those with underlying CVD and elevated TnTs.^[6]

Historical Perspective

Classification

ST-Elevation Myocardial Infarction (STEMI)

A US model from 9 major centers showed a 38% drop in total STEMI activations during the COVID-19 pandemic. There is a 40% reduction noted in Spain as well. there was also a delay between the first presentation to a medical encounter up to 318 min. This is important since COVID-19 can potentially be a cause of STEMI through microthrombi, cytokine storm, coronary spasm, or direct endothelial injury.^[2]

Potential etiologies for the reduction in STEMI PPCI activations:
- avoidance of medical care due to social distancing or concerns of contracting COVID-19 in the hospital
- STEMI misdiagnosis
- increased use of pharmacological reperfusion due to COVID-19

It is very important to realize if patients' anxiety is the reason behind decreasing the presentation of STEMI to U.S. hospitals.^[3]

Treatment of STEMI & COVID-19: The specific protocols for the treatment have been evolving. Early recommendations showed intravenous thrombolysis as first-line therapy for STEMI patients with confirmed COVID-19 since most hospitals do not have protected cardiac catheterization labs.^[2]

Pathophysiology

The mechanism of COVID-19 cardiovascular injury has not been fully understood and is likely multifactorial.

SARS-CoV-2 virus attaches to ACE 2 protein for ligand binding before entering the cell via receptor-mediated endocytosis.
- Based on single-cell RNA sequencing more than 7.5% of myocardial cells have positive ACE2 expression. This protein can mediate the entry of SARS-CoV-2 and result in direct cardiotoxicity.
The cytokine release caused by the virus may lead to vascular inflammation, plaque instability, myocardial inflammation, a hypercoagulable state, or direct myocardial suppression.

Pathological changes:

In the level of cardiac tissue: minimal change to interstitial inflammatory infiltration and myocyte necrosis
In the level of vasculature: micro-thrombosis and vascular inflammation^[1]

Diagnosis

History and Symptoms

The signs and symptoms of acute coronary syndrome include:^[4]

Chest pain

Substernal chest pain
Occurs at rest or exertion
Radiation to neck, jaw, left shoulder and left arm
Aggravated by physical activity and emotional stress
Relieved by rest, nitroglycerin or both

Chest discomfort described crushing, squeezing, burning, choking, tightness or aching
Dyspnea
Diaphoresis
Nausea and vomiting
Fatigue
Syncope

Treatment

Medical Therapy | Interventions | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies In patients with ACS, and COVID-19, treatment should follow the guidelines of the updated Society for Cardiovascular Angiography and Interventions.^[1] ^[5]

History and Symptoms

Chest pain

Substernal chest pain
Occurs at rest or exertion
Radiation to neck, jaw, left shoulder and left arm
Aggravated by physical activity and emotional stress
Relieved by rest, nitroglycerin or both

Chest discomfort described crushing, squeezing, burning, choking, tightness or aching
Dyspnea
Diaphoresis
Nausea and vomiting
Fatigue
Syncope^[4]

Physical Examination

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

Treatment

In patients with ACS, and COVID-19, treatment should follow the guidelines of the updated Society for Cardiovascular Angiography and Interventions.^[1] ^[5]

↑ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 Kang Y, Chen T, Mui D, Ferrari V, Jagasia D, Scherrer-Crosbie M; et al. (2020). "Cardiovascular manifestations and treatment considerations in covid-19". Heart. doi:10.1136/heartjnl-2020-317056. PMC 7211105 Check |pmc= value (help). PMID 32354800 Check |pmid= value (help).
↑ ^2.0 ^2.1 ^2.2 ^2.3 Ullah W, Sattar Y, Saeed R, Ahmad A, Boigon MI, Haas DC; et al. (2020). "As the COVID-19 pandemic drags on, where have all the STEMIs gone?". Int J Cardiol Heart Vasc. 29: 100550. doi:10.1016/j.ijcha.2020.100550. PMC 7261452 Check |pmc= value (help). PMID 32550258 Check |pmid= value (help).
↑ ^3.0 ^3.1 Garcia S, Albaghdadi MS, Meraj PM, Schmidt C, Garberich R, Jaffer FA; et al. (2020). "Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States During COVID-19 Pandemic". J Am Coll Cardiol. 75 (22): 2871–2872. doi:10.1016/j.jacc.2020.04.011. PMC 7151384 Check |pmc= value (help). PMID 32283124 Check |pmid= value (help).
↑ ^4.0 ^4.1 ^4.2 Abidov A, Rozanski A, Hachamovitch R, Hayes SW, Aboul-Enein F, Cohen I; et al. (2005). "Prognostic significance of dyspnea in patients referred for cardiac stress testing". N Engl J Med. 353 (18): 1889–98. doi:10.1056/NEJMoa042741. PMID 16267320. Review in: Evid Based Med. 2006 Jun;11(3):91
↑ ^5.0 ^5.1 ^5.2 Szerlip M, Anwaruddin S, Aronow HD, Cohen MG, Daniels MJ, Dehghani P; et al. (2020). "Considerations for cardiac catheterization laboratory procedures during the COVID-19 pandemic perspectives from the Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship (SCAI ELM) Members and Graduates". Catheter Cardiovasc Interv. doi:10.1002/ccd.28887. PMID 32212409 Check |pmid= value (help).
↑ Guo T, Fan Y, Chen M, Wu X, Zhang L, He T; et al. (2020). "Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)". JAMA Cardiol. doi:10.1001/jamacardio.2020.1017. PMC 7101506 Check |pmc= value (help). PMID 32219356 Check |pmid= value (help).

[pmid30153967-1] Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA; et al. (2018). "Fourth Universal Definition of Myocardial Infarction (2018)". J Am Coll Cardiol. 72 (18): 2231–2264. doi:10.1016/j.jacc.2018.08.1038. PMID 30153967.

[pmid32219356-2] Guo T, Fan Y, Chen M, Wu X, Zhang L, He T; et al. (2020). "Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)". JAMA Cardiol. doi:10.1001/jamacardio.2020.1017. PMC 7101506 Check |pmc= value (help). PMID 32219356 Check |pmid= value (help).

[3] (PDF) https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf. Missing or empty |title= (help)

[pmid32354800-4] 1.0 ^1.1 ^1.2 ^1.3 ^1.4 Kang Y, Chen T, Mui D, Ferrari V, Jagasia D, Scherrer-Crosbie M; et al. (2020). "Cardiovascular manifestations and treatment considerations in covid-19". Heart. doi:10.1136/heartjnl-2020-317056. PMC 7211105 Check |pmc= value (help). PMID 32354800 Check |pmid= value (help).

[pmid32550258-5] 2.0 ^2.1 ^2.2 ^2.3 Ullah W, Sattar Y, Saeed R, Ahmad A, Boigon MI, Haas DC; et al. (2020). "As the COVID-19 pandemic drags on, where have all the STEMIs gone?". Int J Cardiol Heart Vasc. 29: 100550. doi:10.1016/j.ijcha.2020.100550. PMC 7261452 Check |pmc= value (help). PMID 32550258 Check |pmid= value (help).

[pmid32283124-6] 3.0 ^3.1 Garcia S, Albaghdadi MS, Meraj PM, Schmidt C, Garberich R, Jaffer FA; et al. (2020). "Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States During COVID-19 Pandemic". J Am Coll Cardiol. 75 (22): 2871–2872. doi:10.1016/j.jacc.2020.04.011. PMC 7151384 Check |pmc= value (help). PMID 32283124 Check |pmid= value (help).

[pmid16267320-7] 4.0 ^4.1 ^4.2 Abidov A, Rozanski A, Hachamovitch R, Hayes SW, Aboul-Enein F, Cohen I; et al. (2005). "Prognostic significance of dyspnea in patients referred for cardiac stress testing". N Engl J Med. 353 (18): 1889–98. doi:10.1056/NEJMoa042741. PMID 16267320. Review in: Evid Based Med. 2006 Jun;11(3):91

[pmid32212409-8] 5.0 ^5.1 ^5.2 Szerlip M, Anwaruddin S, Aronow HD, Cohen MG, Daniels MJ, Dehghani P; et al. (2020). "Considerations for cardiac catheterization laboratory procedures during the COVID-19 pandemic perspectives from the Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship (SCAI ELM) Members and Graduates". Catheter Cardiovasc Interv. doi:10.1002/ccd.28887. PMID 32212409 Check |pmid= value (help).

[pmid32219356-9] Guo T, Fan Y, Chen M, Wu X, Zhang L, He T; et al. (2020). "Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)". JAMA Cardiol. doi:10.1001/jamacardio.2020.1017. PMC 7101506 Check |pmc= value (help). PMID 32219356 Check |pmid= value (help).

[1]

[2]

[3]

[1]

[2]

[3]

[4]

[5]

[6]

@@ Line 1: / Line 1: @@
 # Sara Haddadi MD, Miami FL
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+{{familytree | | | | | | | | | | | C01 |-|+|-| C02 | | | | | | | | | | | |!| | | |C01= |C02= }}
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+{{familytree | | | | | | | | | | | | | | |)|-| D01 | | | | | | | |  E01 | | | | E02 |D01= |E01=E01|E02=E02}}
+{{familytree | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
+{{familytree | | | | | | | | | | | | | | |`|-| E01 | | | | |E01= |E02= }}
+{{familytree/end}}
+<ref name="pmid30153967">{{cite journal| author=Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA | display-authors=etal| title=Fourth Universal Definition of Myocardial Infarction (2018). | journal=J Am Coll Cardiol | year= 2018 | volume= 72 | issue= 18 | pages= 2231-2264 | pmid=30153967 | doi=10.1016/j.jacc.2018.08.1038 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30153967  }} </ref>
+{{familytree/start}}<nowiki>{{familytree | | | | | | | | | '''Acute Cough''' | | | | | |'''Acute Cough'''='''Acute Cough'''}}
+{{familytree | | | | | | | | | |!| | | | | | | | }}
+{{familytree | | | | | | | | | History and physical
+examination, ask about
+environmental and
+occupational factors
+and travel exposures
+± investigations | | | | | |History and physical
+examination, ask about
+environmental and
+occupational factors
+and travel exposures
+± investigations=History and physical
+examination, ask about
+environmental and
+occupational factors
+and travel exposures
+± investigations}}
+{{familytree | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }}
+{{familytree | | Life-threatening
+diagnosis | | | | | | | | | | | |Non-life-threatening
+diagnosis|Life-threatening
+diagnosis=Life-threatening
+diagnosis|Non-life-threatening
+diagnosis=Non-life-threatening
+diagnosis}}
+{{familytree | | |!| | | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| }}
+{{familytree | | |!| | | | | | | |!| | | | | | | | | | | |!| }}
+{{familytree | | Pneumonia, severe
+exacerbation of asthma
+or COPD, PE, heart
+failure, other serious
+disease
+ | | | | | |Infections| | | | | | | | | | Exacerbation of pre-existing condition |Pneumonia, severe
+exacerbation of asthma
+or COPD, PE, heart
+failure, other serious
+disease
+=Pneumonia, severe
+exacerbation of asthma
+or COPD, PE, heart
+failure, other serious
+disease|Exacerbation of pre-existing condition=Exacerbation of pre-existing condition|Infections=Infections}}
+{{familytree | | |!| | | | | |,|-|^|-|.| | | | | | |,|-|-|-|+|-|-|-|,|-|-|-|.|}}
+{{familytree | | |!| | | | LRTI | | | URTI | | | | Asthma | | Bronchiectasis | | UACS | | COPD |LRTI=LRTI|URTI=URTI|Asthma=Asthma|Bronchiectasis=Bronchiectasis|UACS=UACS|COPD=COPD}}
+{{familytree | | Evaluate
+and treat first | |,|-|+|-|-|.| | | | | | | | | | | | | |Evaluate
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+{{familytree | | | | | |!| |!| | |!| | | | | | | | | | | }}
+{{familytree | | | | |  Acute Bronchitis  |!| |  Pertussis  | | | | | | | | | | | | |Acute Bronchitis=Acute Bronchitis|Pertussis=Pertussis}}
+{{familytree | | | | | | | |!| | | | | | | | | | | | | | }}
+{{familytree | | | | | | | Consider TB in
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+=Consider TB in
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+examination, ask about
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+± investigations | | | | | |History and physical
+examination, ask about
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+{{familytree | | |!| | | | | | | |!| | | | | | | | | | | |!| }}
+{{familytree | | D01 | | | | | |  X  | | | | | | | | | | D02 |D01=D01'<br>D01''|D02=D02'<br>D02''|X=X}}
+{{familytree | | |!| | | | | |,|-|^|-|.| | | | | | |,|-|-|-|+|-|-|-|,|-|-|-|.|}}
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+{{familytree | | | | | | | ZZ  | | | | | | | | | | | | |ZZ=ZZ}}
+{{familytree/end}}
+==Natural History, Complications and Prognosis==
+In a case series with 187 patients who had confirmed COVID-19, 27.8% of patients had a [[myocardial injury]], which caused cardiac dysfunction and [[arrhythmias]]. The result was significantly higher mortality among patients with myocardial injury.
+*Based on the Troponin level The mortality during hospitalization was shown to be as below:
+**7.62% for patients without underlying CVD and normal [[TnT]] levels
+**13.33% for those with underlying CVD and normal TnT levels
+**37.50% for those without underlying [[Cardiovascular disease|CVD]] but elevated TnT levels
+**69.44% for those with underlying CVD and elevated TnTs.<ref name="pmid32219356">{{cite journal| author=Guo T, Fan Y, Chen M, Wu X, Zhang L, He T | display-authors=etal| title=Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). | journal=JAMA Cardiol | year= 2020 | volume=  | issue=  | pages=  | pmid=32219356 | doi=10.1001/jamacardio.2020.1017 | pmc=7101506 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32219356  }} </ref>
-asnjndksjfljldkflrmelgvnlkfr
 {| class="wikitable"
@@ Line 26: / Line 156: @@
+{| class="wikitable"
+|+underlying medical conditions that increase a person’s risk of severe illness from COVID-19
+!style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Level of Evidence}}
+!style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Condition}}
+|-
+|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Strongest and Most Consistent Evidence]]
+|
+*Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
+*Cancer
+*Chronic kidney disease
+*COPD
+*Obesity (BMI> 30)
+*Sickle cell disease
+*Solid organ transplantation
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Mixed Evidence]]
+|[[Left anterior fascicular block]]
+|-
+|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Limited Evidence]]
+|_
+|}
+**[[Blood disorder|Blood disorders]]
+**[[Chronic kidney disease]]
+**[[Chronic liver disease]]
+**[[Immunosuppression|Compromised immune system (immunosuppression)]]
+**Current or recent [[pregnancy]] in the last two weeks
+**[[Endocrine disorder|Endocrine disorders]]
+**[[Metabolic disorder|Metabolic disorders]]
+**[[Heart disease]]
+**[[Respiratory disease|Lung disease]]
+**[[Neurological disease|Neurological]] and [[Neurodevelopmental disorders|neurodevelopmental conditions]]
+*[[Centers for Disease Control and Prevention|CDC]] has published the following conditions listed in the table below as the risk factors for a severe [[COVID-19]]. These conditions are categorized into the following groups based on the current studies evidence:
+#Strongest and most consistent evidence: define as consistent evidence from multiple small studies or a strong association from a large study are categorized. They increase the severity of COVID-19 regardless of the individual's age:<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
+#Mixed evidence: Defined as multiple studies that reached different conclusions about the risk associated with a condition
+#Limited evidence: Defined as consistent evidence from a small number of studies. Limited evidence: Defined as consistent evidence from a small number of studies.
+{| class="wikitable"
+|+underlying medical conditions that increase a person’s risk of severe illness from COVID-19
+!style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Level of Evidence}}
+!style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Condition}}
+|-
+|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Strongest and Most Consistent Evidence]]
+|
+*Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
+*Cancer
+*Chronic kidney disease
+*COPD
+*Obesity (BMI> 30)
+*Sickle cell disease
+*Solid organ transplantation
+*Type 2 diabetes mellitus
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Mixed Evidence]]
+|
+*[[Asthma]]
+*[[Cerebrovascular disease]]
+*[[Hypertension]]
+*[[Pregnancy]]
+*[[smoking]]
+*Use of [[corticosteroids]] or other [[immunosuppressive medications]]
+|-
+|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Limited Evidence]]
+|
+*Bone marrow transplantation
+*HIV
+*Immune deficiencies
+*Inherited metabolic disorders
+*[[Liver disease]]
+*[[Neurologic]] conditions
+*Other chronic lung diseases
+*Pediatrics
+*[[Thalassemia]]
+*[[Type 1 diabetes mellitus]]
+|}
+This list is a living document that will be periodically updated, and it could rapidly change as the science evolves.
 ==References==
@@ Line 85: / Line 288: @@
 {{CMG}}; {{AE}}
-{{SK}}
+{{SK}} Novel coronavirus, covid-19, COVID-19, SARS-CoV-2, Wuhan coronavirus
 ==[[Xyz overview|Overview]]==
@@ Line 97: / Line 301: @@
 ==[[Xyz classification|Classification]]==
+===ST-Elevation Myocardial Infarction (STEMI)===
+A US model from 9 major centers showed a 38% drop in total STEMI activations during the COVID-19 pandemic. There is a 40% reduction noted in Spain as well. there was also a delay between the first presentation to a medical encounter up to 318 min. This is important since COVID-19 can potentially be a cause of STEMI through microthrombi, cytokine storm, coronary spasm, or direct endothelial injury.<ref name="pmid32550258">{{cite journal| author=Ullah W, Sattar Y, Saeed R, Ahmad A, Boigon MI, Haas DC | display-authors=etal| title=As the COVID-19 pandemic drags on, where have all the STEMIs gone? | journal=Int J Cardiol Heart Vasc | year= 2020 | volume= 29 | issue=  | pages= 100550 | pmid=32550258 | doi=10.1016/j.ijcha.2020.100550 | pmc=7261452 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32550258  }} </ref>
+*Potential etiologies for the reduction in STEMI PPCI activations:
+**avoidance of medical care due to social distancing or concerns of contracting COVID-19 in the hospital
+**STEMI misdiagnosis
+**increased use of pharmacological reperfusion due to COVID-19
+It is very important to realize if patients' anxiety is the reason behind decreasing the presentation of STEMI to U.S. hospitals.<ref name="pmid32283124">{{cite journal| author=Garcia S, Albaghdadi MS, Meraj PM, Schmidt C, Garberich R, Jaffer FA | display-authors=etal| title=Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States During COVID-19 Pandemic. | journal=J Am Coll Cardiol | year= 2020 | volume= 75 | issue= 22 | pages= 2871-2872 | pmid=32283124 | doi=10.1016/j.jacc.2020.04.011 | pmc=7151384 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32283124  }} </ref>
+*Treatment of STEMI & COVID-19: The specific protocols for the treatment have been evolving. Early recommendations showed intravenous thrombolysis as first-line therapy for STEMI patients with confirmed COVID-19 since most hospitals do not have protected cardiac catheterization labs.<ref name="pmid32550258">{{cite journal| author=Ullah W, Sattar Y, Saeed R, Ahmad A, Boigon MI, Haas DC | display-authors=etal| title=As the COVID-19 pandemic drags on, where have all the STEMIs gone? | journal=Int J Cardiol Heart Vasc | year= 2020 | volume= 29 | issue=  | pages= 100550 | pmid=32550258 | doi=10.1016/j.ijcha.2020.100550 | pmc=7261452 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32550258  }} </ref>
 ==[[Xyz pathophysiology|Pathophysiology]]==
@@ Line 106: / Line 318: @@
 *In the level of cardiac tissue: minimal change to interstitial inflammatory infiltration and myocyte necrosis
 *In the level of vasculature: micro-thrombosis and vascular inflammation<ref name="pmid32354800">{{cite journal| author=Kang Y, Chen T, Mui D, Ferrari V, Jagasia D, Scherrer-Crosbie M | display-authors=etal| title=Cardiovascular manifestations and treatment considerations in covid-19. | journal=Heart | year= 2020 | volume=  | issue=  | pages=  | pmid=32354800 | doi=10.1136/heartjnl-2020-317056 | pmc=7211105 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32354800  }} </ref>
-==[[Xyz causes|Causes]]==
-==[[Xyz differential diagnosis|Differentiating Xyz from other Diseases]]==
-==[[Xyz epidemiology and demographics|Epidemiology and Demographics]]==
-==[[Xyz risk factors|Risk Factors]]==
-==[[Xyz screening|Screening]]==
-==[[Xyz natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
 ==Diagnosis==
@@ Line 138: / Line 338: @@
 ==Treatment==
 [[Xyz medical therapy|Medical Therapy]] | [[Xyz interventions|Interventions]] | [[Xyz surgery|Surgery]] | [[Xyz primary prevention|Primary Prevention]] | [[Xyz secondary prevention|Secondary Prevention]] | [[Xyz cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Xyz future or investigational therapies|Future or Investigational Therapies]]
+In patients with ACS, and COVID-19, treatment should follow the guidelines of the updated Society for Cardiovascular Angiography and Interventions.<ref name="pmid32354800">{{cite journal| author=Kang Y, Chen T, Mui D, Ferrari V, Jagasia D, Scherrer-Crosbie M | display-authors=etal| title=Cardiovascular manifestations and treatment considerations in covid-19. | journal=Heart | year= 2020 | volume=  | issue=  | pages=  | pmid=32354800 | doi=10.1136/heartjnl-2020-317056 | pmc=7211105 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32354800  }} </ref> <ref name="pmid32212409">{{cite journal| author=Szerlip M, Anwaruddin S, Aronow HD, Cohen MG, Daniels MJ, Dehghani P | display-authors=etal| title=Considerations for cardiac catheterization laboratory procedures during the COVID-19 pandemic perspectives from the Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship (SCAI ELM) Members and Graduates. | journal=Catheter Cardiovasc Interv | year= 2020 | volume=  | issue=  | pages=  | pmid=32212409 | doi=10.1002/ccd.28887 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32212409  }} </ref>
-==Case Studies==
+===History and Symptoms===
-[[Xyz case study one|Case #1]]
+*[[Chest pain]]
+:*[[Chest pain|Substernal chest pain]]
+:*Occurs at rest or [[exertion]]
+:*Radiation to neck, jaw, left shoulder and left arm
+:*Aggravated by physical activity and emotional stress
+:*Relieved by rest, [[nitroglycerin]] or both
+*Chest discomfort described crushing, squeezing, burning, choking, tightness or aching
+*[[Dyspnea]]
+*[[Diaphoresis]]
+*[[Nausea]] and [[vomiting]]
+*[[Fatigue]]
+*[[Syncope]]<ref name="pmid16267320">{{cite journal| author=Abidov A, Rozanski A, Hachamovitch R, Hayes SW, Aboul-Enein F, Cohen I et al.| title=Prognostic significance of dyspnea in patients referred for cardiac stress testing. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 18 | pages= 1889-98 | pmid=16267320 | doi=10.1056/NEJMoa042741 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16267320  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17213112 Review in: Evid Based Med. 2006 Jun;11(3):91] </ref>
-[[Category: (name of the system)]]
+===Physical Examination===
+Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
+==Treatment==
+In patients with ACS, and COVID-19, treatment should follow the guidelines of the updated Society for Cardiovascular Angiography and Interventions.<ref name="pmid32354800">{{cite journal| author=Kang Y, Chen T, Mui D, Ferrari V, Jagasia D, Scherrer-Crosbie M | display-authors=etal| title=Cardiovascular manifestations and treatment considerations in covid-19. | journal=Heart | year= 2020 | volume=  | issue=  | pages=  | pmid=32354800 | doi=10.1136/heartjnl-2020-317056 | pmc=7211105 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32354800  }} </ref> <ref name="pmid32212409">{{cite journal| author=Szerlip M, Anwaruddin S, Aronow HD, Cohen MG, Daniels MJ, Dehghani P | display-authors=etal| title=Considerations for cardiac catheterization laboratory procedures during the COVID-19 pandemic perspectives from the Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship (SCAI ELM) Members and Graduates. | journal=Catheter Cardiovasc Interv | year= 2020 | volume=  | issue=  | pages=  | pmid=32212409 | doi=10.1002/ccd.28887 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32212409  }} </ref>

Sandbox:Sara Haddadi: Difference between revisions

Latest revision as of 17:25, 6 August 2020

Natural History, Complications and Prognosis

References

Acute Coronary Syndromes

Pathophysiology

ST-Elevation MI (STEMI)

Signs and Symptoms

Treatment

Overview

Historical Perspective

Classification

ST-Elevation Myocardial Infarction (STEMI)

Pathophysiology

Diagnosis

History and Symptoms

Treatment

History and Symptoms

Physical Examination

Treatment

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