A. Herrey, A. Osman, P. Soma-Pillay, K. Sliwa, N. Ntusi
{"title":"COVID-19 and the cardiovascular system in pregnancy","authors":"A. Herrey, A. Osman, P. Soma-Pillay, K. Sliwa, N. Ntusi","doi":"10.24170/17-3-4375","DOIUrl":"https://doi.org/10.24170/17-3-4375","url":null,"abstract":"Pregnancy and coronavirus disease-2019 (COVID-19) share several common features which makes differentiation between the 2 difficult. Both are multisystem disorders, may present with breathlessness, are associated with hypercoagulability and frequently cause significant anxiety in both the patient and those around them. Pregnancy represents a state of partial immune suppression, with pregnant women more vulnerable to viral infections. However, these concerns have not been borne out in clinical practice and have not stood up to epidemiological scrutiny. From limited data available on COVID-19 in pregnancy, the outcomes are mostly favourable. While cardiac disease and hypertension are independent predictors of hospital admission with COVID-19 in pregnancy, the prevalence of cardiac disease in the pregnant COVID-19 population is low. Pregnant women are younger, and asymptomatic SARSCoV-2 infection and favourable outcomes are reported in those below 55 years of age. Indeed, large numbers of asymptomatic cases have been reported in pregnancy, suggesting that pregnant patients with more severe disease courses may be over-represented in the current literature, particularly the early case reports and case series. Cardiovascular involvement in pregnancy includes new-onset hypertension, myocarditis, cardiomyopathy, pulmonary embolism and a pre-eclampsia-like syndrome.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80627671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Meel, B. Cupido, A. Pecoraro, Anton Doubell, W. Lubbe, N. Ntusi
{"title":"COVID-19 and cardiovascular imaging: a guide for the practising clinician","authors":"R. Meel, B. Cupido, A. Pecoraro, Anton Doubell, W. Lubbe, N. Ntusi","doi":"10.24170/17-3-4377","DOIUrl":"https://doi.org/10.24170/17-3-4377","url":null,"abstract":"In the ongoing COVID-19 pandemic, patients with cardiac disease have been the worst afflicted with a high mortality. Cardiac imaging forms an integral part of the armamentarium in the management of these patients. This review focuses on providing a general guide to cardiac imaging in the COVID-19 context for the practising clinician in Africa. These recommendations are likely to be modified as further data emerge on the effect of the SARS-CoV-2 virus on the cardiovascular system.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82555174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pratiksha Valera, P. Letuka, Nontobeko Mathenjwa, N. Ntusi
{"title":"Angiotensin converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists and SARS-CoV-2 infection","authors":"Pratiksha Valera, P. Letuka, Nontobeko Mathenjwa, N. Ntusi","doi":"10.24170/17-3-4383","DOIUrl":"https://doi.org/10.24170/17-3-4383","url":null,"abstract":"Angiotensin converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs) and mineralocorticoid receptor antagonists (MRAs) reduce morbidity, mortality and hospitalisations from hypertension, chronic kidney disease and heart failure. Patients and clinicians will be aware of the recently publicised interaction between the renin-angiotensin-aldosterone system (RAAS) and SARS-CoV-2, the orthocoronavirus responsible for coronavirus disease 2019 (COVID-19). Consequently, concern has abounded in regard to whether prescribed blockers of the RAAS like ACE-Is, ARBs and MRAs may, in fact, increase or decrease susceptibility to SARS-CoV-2 infection. Limited scientific evidence has been contradictory. Scientists have postulated both potentially harmful and potentially beneficial effects of these drugs on the natural history of COVID-19. Membrane-bound angiotensin-converting enzyme 2 (ACE2) participates in the entry of SARSCoV-2 into human cells, and animal studies show that ACE-Is and ARBs upregulate ACE2 expression, which would theoretically increase risk for or severity of COVID-19. Conversely, RAAS blockers could benefit patients with COVID-19 through various mechanisms: ACE2 converts angiotensin II to angiotensin, which has potentially beneficial vasodilatory and anti-inflammatory properties. Observational studies have failed to provide compelling data on whether COVID-19 patients on RAAS blockers fare better or worse than otherwise similar patients, though there is emerging evidence that RAAS inhibitors may be protective in COVID-19 and are associated with lower cardiovascular and all-cause mortality. Most professional societies, including the World Health Organization and the South African Heart Association and the South African National Department of Health have recommended that patients on RAAS blockers with COVID-19 should continue taking them. In this article, we review the existing evidence for the interplay between RAAS blockers and SARS-CoV-2 infection.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91094842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Arrhythmias and COVID-19 infection","authors":"A. Chin, Jane Moses, A. Thornton","doi":"10.24170/17-3-4384","DOIUrl":"https://doi.org/10.24170/17-3-4384","url":null,"abstract":"Arrhythmias can be a clinical manifestation of COVID-19 infection. COVID-19 infection can also be a precipitant of known arrhythmias which can increase the risk of morbidity and mortality. Management of arrhythmias should generally follow standard guidelines of arrhythmia management. Catheter ablation in the midst of the COVID-19 pandemic should be limited to arrhythmias that are immediately life-threatening or which may affect prognosis in the short-term. Some novel treatments like chloroquine, hydroxychloroquine and azithromycin can prolong the QT interval and predispose patients to life-threatening arrhythmias.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75687008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evolving concepts of myocardial phenotypes, myocardial injury, cardiovascular consequences and management in patients with SARS-CoV-2 infection","authors":"N. Ntusi, A. Herrey","doi":"10.24170/17-3-4392","DOIUrl":"https://doi.org/10.24170/17-3-4392","url":null,"abstract":"The COVID-19 pandemic is undoubtedly the greatest public health crisis, the most crucial global health calamity of the century, and the most profound biopsychosocial dilemma for humankind since the Second World War. In December 2019, a novel coronavirus strain causing an interstitial pneumonia and acute respiratory distress syndrome (ARDS) emerged from Wuhan, Hubei Province, China; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for occurrence of this disease. The World Health Organization named the clinical syndrome caused by SARS-CoV-2 the coronavirus disease 2019 (COVID-19).(1)","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76154922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Reddy, R. Kleinloog, J. Janson, Rogers Manganyi, J. Brink, P. Zilla
{"title":"COVID-19 and cardiothoracic surgery: A risk-adjusted approach in the context of a global pandemic","authors":"D. Reddy, R. Kleinloog, J. Janson, Rogers Manganyi, J. Brink, P. Zilla","doi":"10.24170/17-3-4382","DOIUrl":"https://doi.org/10.24170/17-3-4382","url":null,"abstract":"In the face of the novel coronavirus pandemic, the impact of COVID-19 infection has disrupted cardiothoracic surgical services globally. A risk-adjusted approach to restructuring the delivery of cardiothoracic surgical services has been proposed in accordance with international guidance to ensure that the surgical standard of care is maintained in the practice of adult and paediatric cardiac surgery, as well as thoracic surgery. The potential influx of COVID-19 patients with cardio-respiratory complications requiring intensive care management and associated surgical procedures falling within the gamut of the thoracic surgeon, is considered. Finally, the protection of healthcare workers, in particular the surgical team exposed to aerosolising procedures, is outlined.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73344758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Weich, J. Hitzeroth, Sajidah Khan, D. Kettles, A. Vachiat, M. Ntsekhe
{"title":"Interventional cardiology during the COVID-19 epidemic","authors":"H. Weich, J. Hitzeroth, Sajidah Khan, D. Kettles, A. Vachiat, M. Ntsekhe","doi":"10.24170/17-3-4376","DOIUrl":"https://doi.org/10.24170/17-3-4376","url":null,"abstract":"The impact of the COVID-19 pandemic on our lives is unprecedented and major adjustments to our practices as physicians are required. Although our comments are applicable at the time of writing, the situation changes daily and the content of this article should be adjusted accordingly. Cath lab: An unambiguous cath lab protocol should be drawn up for each facility, appropriate to local circumstances. This should include standard procedures in preparation for arrival at the lab, in the performance of procedures, and, importantly, in maintaining due diligence when removing protective gear. All team members should be well trained in these procedures. Acute coronary syndromes: Standard timing for the invasive management of patients should not change during the pandemic. Due to delays often unavoidable during the pandemic, alternative strategies such as thrombolysis may be more readily available and therefore more appropriate. Drugs: The sick COVID-19 patient often represents a pro-thrombotic state and operators should ensure adequate anti-thrombotic therapy. Knowledge of interactions between cardiac drugs and investigational antiviral treatments is important. Elective procedures: Patients with chronic cardiac conditions are at high risk and may require non-urgent procedures to avert major complications. Selecting these cases requires consideration of multiple risks and benefits.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75997586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Zühlke, Stephen C. Brown, A. Cilliers, E. Hoosen, J. Lawrenson, Hopewell N. Ntsinjana
{"title":"Direct and indirect effects of the COVID-19 pandemic on children with cardiovascular disease","authors":"L. Zühlke, Stephen C. Brown, A. Cilliers, E. Hoosen, J. Lawrenson, Hopewell N. Ntsinjana","doi":"10.24170/17-3-4381","DOIUrl":"https://doi.org/10.24170/17-3-4381","url":null,"abstract":"Coronavirus 2 (SARS-CoV-2) the causative agent of what we now know as “Coronavirus Disease 2019” (COVID-19), is the most serious global health crisis of our generation, with a significant and far-reaching impact upon health, economy, social cohesion and emotional and mental wellbeing. Although children do not bear the brunt of direct mortality, they are significantly affected in terms of morbidity and interruption to access, continuity and complexity of care, as well as the indirect social and financial effects impacting on their health outcomes. In this review we present some of the most recent data relevant to children with congenital and acquired heart disease, and consider some of the cardiac presentations noted. We discuss the necessary protections to staff in the echo and cardiac catherisation laboratories and present some general recommendations to general paediatricians and communities to ensure the continued health of our patients. Finally, we encourage ongoing registries and biorepositories and support clinical trials to ensure that children also receive new technologies and therapeutics as these become available.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80464627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}