Differentiating COVID-associated heart failure from other Diseases: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
Line 6: | Line 6: | ||
==Overview== | ==Overview== | ||
COVID-associated heart failure must be differentiated from other causes of dyspnea and/or hypoxia, including [[pneumonia]], [[ | COVID-associated heart failure must be differentiated from other causes of dyspnea and/or hypoxia, including [[pneumonia]], [[acute respiratory distress syndrome]], [[myocarditis]], and [[pulmonary embolism]]. | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
COVID-associated heart failure must be differentiated from [[pneumonia]], [[ | COVID-associated heart failure must be differentiated from [[pneumonia]], [[acute respiratory distress syndrome]], [[myocarditis]], and [[pulmonary embolism]]. | ||
<small> | |||
{| | |||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |||
! rowspan="2" |<small>Diseases</small> | |||
! colspan="3" |<small>Symptoms</small> | |||
! colspan="3" |<small>Physical Examination</small> | |||
! colspan="4" |<small>Diagnostic tests | |||
! rowspan="2" |<small>Other Findings</small> | |||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |||
!<small>Dyspnea on Exertion</small> | |||
!<small>Chest Pain</small> | |||
!<small>Hemoptysis</small> | |||
!<small>Fever</small> | |||
!<small>Tachypnea</small> | |||
!<small>Tachycardia</small> | |||
!<small>Chest X-ray</small> | |||
!<small>ECG</small> | |||
!<small>Echocardiography> | |||
!<small>CT scan and CMRI</small> | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[COVID-19-associated heart failure|COVID-19-associated heart failure]] | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |- | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |- | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Cardiomegaly]] | |||
*[[Pulmonary edema]] (interstitial, alveolar) | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Left ventricular hypertrophy]] | |||
*[[Low-voltage]] QRS | |||
*Non-specific ST-T change | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*Systoloic dysfunction (in HFrEF) | |||
*Diastoic dysfunction (in HFpEF) | |||
*[[COVID-19-associated stress cardiomyopathy|COVID-19-associated stress cardiomyopathy]] [[(apical ballooning)]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*CT: [[Cardiomegaly]], [[Pulmonary edema]] | |||
*CMR: Signs of underlying [[myocarditis]] may be seen. | |||
| style="background: #F5F5F5; padding: 5px;" | Increased [[NT-proBNP]] and cardiac [[troponin]]s levels | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[COVID-19-associated pneumonia]] | |||
| style="background: #F5F5F5; padding: 5px;" |✔ (Usually high) | |||
| style="background: #F5F5F5; padding: 5px;" |✔ ([[Pleuritic]]) | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Lobar Consalidation]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*Prolonged PR interval | |||
*Transient T wave inversions | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*CT: [[Lobar Consalidation]] | |||
| style="background: #F5F5F5; padding: 5px;" | Increased inflammatory markers, including [[ESR]], [[hs-CRP]] | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[COVID-19-associated acute respiratory distress syndrome|COVID-19-associated acute respiratory distress syndrome | |||
]] | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |- | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*Bilateral [[ground-glass opacities]] | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*Signs of RV dysfunction/RV dilatation may be seen. | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*CT: Bilateral [[ground-glass opacities]] | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[COVID-19-associated myocarditis]] | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |- | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Pericardial effusion]] may be detectable | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Non-specific:may show nonspecific ST-T abnormalities, [[sinus tachycardia]] and [[conduction abnormalities]] (such as bundle-branch blocks or atrioventricular conduction delays) | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*Non-specific: In [[fulminant myocarditis]], cardiac chamber sizes are usually normal with an increased septal thickness (secondary to acute myocardial edema), whereas in acute [[myocarditis]] marked left ventricular dilation and normal wall thickness might be seen. | |||
*[[Pericardial effusion]] may be be seen. | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*CMR: T2-weighted edema imaging shows the presence of “acute myocardial inflammation”. "[[Late gadolinium enhancement (LGE)]] imaging” can demonstrate myocardial damage. | |||
| style="background: #F5F5F5; padding: 5px;" | Increased cardiac [[troponin]]s level | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[COVID-19-associated pulmonary embolism]] | |||
| style="background: #F5F5F5; padding: 5px;" |✔ (Usually sudden-onset) | |||
| style="background: #F5F5F5; padding: 5px;" |✔ ([[Pleauritic]]) | |||
| style="background: #F5F5F5; padding: 5px;" |✔ (If massive PE) | |||
| style="background: #F5F5F5; padding: 5px;" |✔ (Low-grade) | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" |✔ | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*May show [[Fleischner sign]] (enlarged pulmonary artery), [[Hampton hump]], [[Westermark's sign]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Non-specific:may show [[S1Q3T3]] pattern | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*May show signs of RV strain, Rv dilatation, Rv dysfunction (if large PE) | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*On CT angiography: Intra-luminal filling defect | |||
*On MRI: Narrowing of involved vessel | |||
*No contrast seen distal to obstruction | |||
*Polo-mint sign (partial filling defect surrounded by contrast) | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*Increased [[D-dimer]], [[fibrinogen]], and [[fibrin degradation products]] levels | |||
*May have symptoms and/or signs of accompanying [[DVT]] | |||
|} | |||
== References == | == References == | ||
{{reflist|2}} | {{reflist|2}} |
Revision as of 17:05, 20 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mitra Chitsazan, M.D.[2] Mandana Chitsazan, M.D. [3]
Overview
COVID-associated heart failure must be differentiated from other causes of dyspnea and/or hypoxia, including pneumonia, acute respiratory distress syndrome, myocarditis, and pulmonary embolism.
Differential Diagnosis
COVID-associated heart failure must be differentiated from pneumonia, acute respiratory distress syndrome, myocarditis, and pulmonary embolism.
Diseases | Symptoms | Physical Examination | Diagnostic tests | Other Findings | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Dyspnea on Exertion | Chest Pain | Hemoptysis | Fever | Tachypnea | Tachycardia | Chest X-ray | ECG | Echocardiography> | CT scan and CMRI | ||
COVID-19-associated heart failure | ✔ | - | ✔ | - | ✔ | ✔ |
|
|
|
|
Increased NT-proBNP and cardiac troponins levels |
COVID-19-associated pneumonia | ✔ (Usually high) | ✔ (Pleuritic) | ✔ | ✔ | ✔ | ✔ |
|
- | Increased inflammatory markers, including ESR, hs-CRP | ||
COVID-19-associated acute respiratory distress syndrome | ✔ | - | ✔ | ✔ | ✔ | ✔ |
|
- |
|
|
- |
COVID-19-associated myocarditis | ✔ | ✔ | - | ✔ | ✔ | ✔ |
|
|
|
|
Increased cardiac troponins level |
COVID-19-associated pulmonary embolism | ✔ (Usually sudden-onset) | ✔ (Pleauritic) | ✔ (If massive PE) | ✔ (Low-grade) | ✔ | ✔ |
|
|
|
|
|