COVID-19: The Heart of the matter – #SAHeartCongress

To celebrate World Heart Month this September, join us for a 60-minute Twitter chat to share your views about the impact of COVID-19 on cardiovascular conditions which we will be moderating on behalf of SA Heart® (South African Heart Association) using the hashtag #SAHeartCongress as a lead up to their virtual event taking place between 29-31 October 2021. All stakeholders including cardiovascular specialists, allied health professionals, patients, NGO’s, policymakers, payers, journalists, educators, nurses, researchers and others working in cardiology both locally and globally are welcome. The public transcript will be recorded by Symplur.

Date: Tuesday, 28 September 2021
Time: 19:00 – 20:00 SAST
Hashtag: #SAHeartCongress
Moderator: @hcsmSA

Congress website: www.saheartcongress.org

 

QUESTIONS
T1: From your perspective, what impact has COVID-19 had on cardiovascular conditions?
T2: What do you think could be done to help improve the impact of COVID-19 on cardiovascular patients?
T3: What sort of difficulties have been experienced by cardiovascular experts working on the frontline to treat COVID-19 patients?
T4: How do you think the COVID-19 outbreak will impact cardiology in the future?
T5: What were some of the greatest lessons learned in your part of the world (LMIC or HIC perspective) for COVID-19 and cardiology?
CT: (Closing Thoughts): Is there anything you feel is important to add to this conversation?

 

Start your answers with T1, T2, T3, T4, T5 or CT for transcript purposes
Answer only after the moderator prompts. Questions will be prompted every 8-10 minutes, but keep answers coming using the relevant T and number. Introduce yourself if you are joining. Use the #SAHeartCongress hashtag in all tweets so you are visible to others in the chat as well as on the Symplur transcript afterwards.


COVID-19 and the Heart
The appearance of COVID-19 infection in late 2019 and its rapid spread throughout the world has had a devastating impact on the lives of patients and their families, medical facilities, and healthcare workers. Severe pneumonitis with ensuing hypoxia, thrombosis and multiorgan failure has resulted in more than 4 million deaths worldwide, created an overwhelming demand for intensive care facilities and left many survivors with disabling shortness of breath, lassitude and exhaustion that may persist for months.  The additional effects of the social, psychological, and economic stresses of the pandemic have yet to play out in full.  

Social distancing, the wearing of facemasks, sanitizing of hands and frequently handled objects, and isolation of asymptomatic infected patients and their contacts have been the mainstay in preventing the spread of infection. The vaccines, developed at warp speed, has reduced morbidity and mortality in those countries that ensured widespread vaccination of their population.

The COVID-19 pandemic has had both direct and indirect influences on the practice of cardiology. Our patients with pre-existing conditions such as hypertension, diabetes, obesity, coronary artery disease and advanced age suffer more severe illness and have a greater chance of dying when they contract COVID-19. The intense inflammatory response that accompanies the illness frequently results in myocarditis-like injury evidenced by a rise in high sensitivity troponin levels. While this myocardial injury may result in cardiac dysfunction and arrhythmias, its extent is generally limited and will have minimal functional consequences. Frank myocarditis is extremely rare. Though the rise in hs-troponin is generally minor, an elevated level independently predicts mortality.

Apart from the myocardial injury directly induced by the virus, the infection is frequently accompanied by a tendency to thrombosis which may be found in the lungs in association with epithelialitis of the small vessels, or encountered as deep venous thrombosis, acute pulmonary embolism, acute myocardial infarction, or ischaemic stroke. Measurement of d-dimer may reveal the presence of an undetected thrombotic tendency. The Factor Xa inhibitors enoxaparin and rivaroxaban have been used in standard prophylactic and therapeutic doses to counter these threats. It is counterproductive to exceed the standard dose as doing so increases the risk of bleeding. Antiplatelet treatment with aspirin is ineffective.

As with any severe, overwhelming viral infection COVID-19 may aggravate dysfunction in already compromised organs, for instance precipitating acute kidney injury or the unmasking heart failure in the patient with diastolic dysfunction. It may also cause multi-system inflammatory syndrome in children (MIS-C) that results in severe morbidity and a high mortality.

Effective treatment for COVID-19 infection in any of its phases is yet to be discovered. Early concerns about the possible adverse effects of ACE inhibitors and angiotensin receptor blockers proved to be unfounded. To date a bewildering number of agents have been used in attempts to control the infection. Atorvastatin, bamlamivimab, baricitinib, BCG vaccination, convalescent plasma, dexamethasone, hydroxychloroquine, interferon, interleukin-6 antagonism, ivermectin, lopinovir, monoclonal antibodies, recombinant human granulocyte colony stimulating factor, remdesivir, tolicizumab, vitamin C, vitamin D and zinc have all been evaluated. Of these only dexamethasone has entered routine use in severely ill patients. While some of these agents are reported to shorten hospital stay and reduce the need for ventilation, no trial has provided conclusive proof of any conclusive proof of any agent’s or combination of agents’ superiority.

The emergence of the pandemic was accompanied initially by a decrease in the number of patients admitted to hospital for the treatment of acute coronary syndrome. This reduction has been ascribed to patients resisting going to hospital for fear of exposure to COVID-19. Their hesitancy led to later presentation, a greater incidence of complications and a higher out-of-hospital death rate.  A study during a later phase of the pandemic found that ACS admission rates were returning to normal. Notwithstanding this tendency to revert to the former “norm”, moratoria on the admission of elective cases and the diversion of resources and personnel to care for critically ill COVID-19 patients combined with patients’ anxieties about hospital admission currently limits the ability of cardiologists to treat non-COVID patients in hospital.

The COVID-19 pandemic has generated a tsunami of publications in medical literature. While knowledge of the disease has increased remarkably, the urgency with which answers to the problem have been sought has resulted in many small observational studies of questionable quality being published with less stringent review of the data before it is presented. Add to this the controversial contributions of conspiracy theorists and it becomes clear that uncertainty and many questions remain.

Authored by Dr Anthony Dalby, Cardiologist, Life Fourways Hospital

Some of the critical topics related to COVID-19 and cardiology which will be highlighted at the #SAHeartCongress this year include GUCH patients, Myocardial injury in COVID-19 and evidence for cardiac MRI, Utility of Echocardiography, Approach to the management of a patient with COVID-19 and acute coronary syndrome, Children with heart disease and COVID-19 and Insights into the right ventricle in COVID-19 related lung injury. To register, visit www.saheartcongress.org/Registration



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  1. Chats are public. Even if you use a platform like tchat.io, they still show on your timeline. Think before you tweet! Read more about maintaining a good digital footprint here.
  2. Tweets are limited to 280 characters and 140 on some tweetchat platforms, so keep answers as simple as possible. Answer one question as many times as you like.
  3. Respect other members of the community and show courtesy at all times.
    Refer to the Twitter Terms and Conditions of use. Disrespectful behavior can be reported.
  4. Don’t be afraid to lurk although participation is encouraged.
  5. Visit www.symplur.com to check out the analytics and transcript for #SAHeartCongress after the chat.
  6. If you don’t understand a question from the moderator speak up and ask for clarity.
  7. Use this opportunity to network with other stakeholders and follow them.
  8. When entering the Twitter chat, first introduce yourself and tell other members what you do so they get to know you.
  9. If you agree with someone’s perspective retweet (RT) them to show support.
  10. The chat runs for 60 minutes but you can join at any time.
  11. Start answers with the relevant T and number.
  12. Answer each question after the moderator prompts but keep answers coming even if we move onto the next question. We don’t want to miss out on your views.
  13. Both panel experts and attendees are invited to participate because everyone’s perspective counts.
  14. Use the hashtag #SAHeartCongress in all of your tweets or you won’t be visible to others as well as on the transcript recording.
  15. Have fun, and invite others to support the session!

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