Cardiac Care and COVID-19 - Important Questions Answered

Maddalena Lettino of San Gerardo Hospital, Monza (Italy) answers some important questions regarding cardiology patients, cardiac care and COVID-19 in the new series of podcasts by the European Society of Cardiology (ESC).

What have we learned from this experience? And what is the situation of the acute cardiology patient in this pandemic situation?

Dr. Lettino says that cardiology patients are not so many in these times because most of the patients arriving at the hospital are patients with infectious disease and probably cardiology patients are staying at home, waiting until they have much more severe symptoms to go to the hospital. The number of beds dedicated to COVID-19 infected patients are definitely much more than the number of beds dedicated to cardiology patients. She explained that in Italy, they had to change the organisation of the cardiovascular emergency network because they couldn’t have so many people from the cardiology department available for the current patients as most of the intensivists and doctors were dedicated to COVID-19 patients.

She also explained that keeping in mind the model of hub-and-spoke, they have several hubs in northern Italy in particular. These hubs receive patients from many more spokes than before and are still trying to maintain intensive care beds for them. Hence, the total number of intensive care beds available for cardiology patients are much less, but in this way, it’s much easier to organise the transportation of patients.

What is the incidence of ST elevation or ACS in ventilated COVID19 patients and how should they be managed?

According to Dr. Lettino, when the patients are in the general ward, they are mainly non-invasively ventilated and the EKG monitoring is very low and these patients usually are much more affected by respiratory symptoms then by any other kind of symptoms. Therefore, these patients have no far not required the attention of cardiologists. However, when these patients are in the intensive care units and mechanically ventilated, and if their condition gets worse and the severe respiratory failure becomes more evident, the development of multi-organ failure is a natural consequence. They could have also some changes in the EKG, or some alterations of troponin, But according to Dr. Lettino, so far they haven’t had acute coronary syndromes in these patients or at least, this has not been brought to their attention. Hence, it’s difficult to see what is the mortality of infected cardiovascular disease patients, but for sure, cardiovascular disease patients have a worse outcome. Mortality is much higher in cardiovascular disease patients than in patients without any cardiovascular disease. Mortality is even higher in cardiovascular disease patients compared with hypertensive patients who have higher mortality compared with patients who without any risk factors. Dr. Lettino explained that if they had to grade patients, it would be: patients with no risk factors= lower mortality, patients with some risk factors=higher mortality and patients with cardiovascular disease=the highest mortality.