Practical Cardiology Editorial Staff 

An all-female panel of American Heart Association experts will be available to answer questions on the COVID-19 pandemic and the changes it has made to resuscitation and patient care.

The event will take place on Reddit in a Reddit Ask Me Anything event.

The AHA panel will focus on how the COVID-19 pandemic has led to fewer 911 calls, and why hospitals are still the safest place to be if a medical emergency such as a heart attack or stroke occurs. Drs. Sasson and Topjian will be available to answer questions on specific ways medical experts are addressing patients’ health during the pandemic, or questions about COVID-19 and emergency cardiovascular care. 
	
	What:             Ask Me Anything Q&A Session on Reddit
	
	When:            Friday, June 12, 1:00-2:00 p.m. CT
	
	Where:          

  
	
	Who:               Comilla Sasson, M.D., Ph.D., FAHA, FACEP, is vice president of emergency cardiovascular care science and innovation for the American Heart Association and an associate clinical professor of emergency medicine at the University of Colorado, Denver, where she is a practicing ER physician. She worked for one month on the front lines in New York City caring for patients with COVID-19.
	
	                        Alexis Topjian, M.D., M.S.C.E., FAHA, is a pediatric critical care medicine physician at Children's Hospital of Philadelphia and an assistant professor in the department of anesthesia, critical care and pediatrics at Perelman School of Medicine at the University of Pennsylvania.

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American Heart Association Experts Will Answer Questions About COVID-19 and Emergency Cardiovascular Care 

A 40-year-old woman went to the doctor after petechia and palpable purpura appeared on the palms of her hands, fingers, and toes. She appeared chronically ill and had significant weight loss. Her doctor also noted the presences of Osler nodes. She did not have any recent injuries or skin punctures and reported she had been in good health until the last few weeks.  Based on these clues, how would you diagnose this patient?

A. Leukocytoclastic vasculitis
	B. Subacute bacterial endocarditis
	C. Candida sepsis
	D. Thrombotic thrombocytopenic pupura (TTP)

Not sure? Use the Differential Builder in 

To learn more about this diagnosis, visit the 

Image IQ: Petechia and Palpable Purpura on the Palms of Hands, Fingers, and Toes

In the face of the worldwide coronavirus (COVID-19) pandemic, 4 of the largest cardiology organizations are advising patients receiving treatment with ACE inhibitors (ACE-i) and angiotensin receptor blockers (ARBs) they should not be discontinuing treatment unless it is recommended by their physician.

The European Society of Cardiology (ESC) Council on Hypertension announced their stance in a positioning statement on March 13, and the American College of Cardiology (ACC), American Heart Association (AHA), and Heart Failure Society of America (HFSA) published a joint statement days later on March 17-a move which showed solidarity in opinion between cardiologists, whose patient populations are among the most vulnerable during the outbreak.

“We understand the concern-as it has become clear that people with cardiovascular disease are at much higher risk of serious complications including death from COVID-19," AHA president Robert A. Harrington, MD, said in a statement. "However, we have reviewed the latest research-the evidence does not confirm the need to discontinue ACE-i or ARBs, and we strongly recommend all physicians to consider the individual needs of each patient before making any changes to ACE-i or ARB treatment regimens."

While research surrounding the topic is still limited, the discussion on whether ACE-i and ARBs should be discontinued as part of therapy has mostly been waged by cardiologists on social media. With evidence angiotensin-converting enzyme 2 identified as a functional receptor for SARS-CoV-2, which leads to COVID-19, many have raised the question as to whether it is appropriate to discontinue the aforementioned therapies.

The statement from the ESC Council on Hypertension, which was penned by Giovanni de Simone, MD, Chair of the ESC Council on Hypertension, references the debate taking place on social media and notes the concern this can cause for patients who may read it. The statement goes on to discredit the speculation, citing work in animal studies that suggests these medications might have benefit for preserving lung function.

“This speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it,” Simone and colleagues wrote. “Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there is no data in humans.”

In the event a clinician has a patient with cardiovascular conditions that contracts COVID-19, the joint HFSA/ACC/AHA statement recommends delaying changes in treatment until after a full evaluation is complete. The statement also recommends shared-decision making with the rest of the patient’s care team before going forward with changes to treatment.

“While the primary symptoms of COVID-19 include respiratory symptoms, the latest evidence demonstrates some patients with COVID-19 may also have severe cardiovascular damage," said Biykem Bozkurt, MD, PhD, HFSA president, in the joint statement. "We must ensure we fully evaluate and treat patients with cardiovascular disease."

HFSA/ACC/AHA statement addresses concerns re: using RAAS antagonists in COVID-19

,” was published online in the AHA Newsroom.

Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers

,” was published online in the Council of Hypertension News.
	 

Cardiology Organizations Advise on ACE Inhibitors, ARBs Use During COVID-19

A 42-year-old man went to the ED complaining of acute onset of dizziness, heart palpitations, and a racing heartbeat. He's been working overtime at two jobs and has been drinking multiple energy drinks with high amounts of caffeine to stay awake. He reported multiple episodes of faintness over a short period of time and sought treatment. An ECG showed a wide QRS complex.

A. Ventricular tachycardia
	B. Vasovagal syncope
	C. Generalized anxiety disorder
	D. Myocardial ischemia

The correct answer is (A) ventricular tachycardia.

A cardiac arrhythmia originating from the ventricles. May be asymptomatic or may present with dizziness, palpitations, chest pain, shortness of breath, syncope, or sudden cardiac arrest. Characterized by a wide QRS complex (duration >120 msec), although supraventricular tachyarrhythmias may also exhibit a wide QRS complex when abnormal intracardiac conduction (aberrancy) is present. Distinction between these arrhythmias may be helpful for long-term treatment, although it may not be necessary for treatment of an unstable patient.

Ventricular tachycardia (VT) may be classified as:

Sustained or nonsustained – Sustained VT is defined as persistence for ≥30 seconds. Nonsustained VT is defined as duration of >3 beats but spontaneous termination within 30 seconds.

Monomorphic or polymorphic – Morphology of all QRS complexes is the same in monomorphic VT, whereas beat-to-beat variation in QRS morphology is seen in polymorphic VT.

VT is most commonly observed in patients with underlying structural cardiac abnormalities (including coronary artery disease, hypertrophic cardiomyopathy, dilated cardiomyopathy, and ion channel mutations such as Brugada syndrome and long QT syndrome), although some patients will present with idiopathic VT, which is defined by occurrence of VT in a structurally normal heart.

Treatment varies depending on the presenting symptoms and hemodynamic stability. Options may include cardiopulmonary resuscitation, electrical defibrillation, or use of antiarrhythmic drugs (eg, amiodarone). Patients with a history of life-threatening or recurrent VT will often undergo radiofrequency catheter ablation and/or placement of an implantable cardioverter defibrillator.

To learn more about this diagnosis and for ICD10 codes, visit 

A 42-year-old man visited the ED complaining of acute onset of dizziness, heart palpitations, and a racing heartbeat. He's been working overtime and drinking caffeinated energy drinks to stay awake. He said he had multiple episodes of faintness over a short period of time. Can you diagnose this patient?

Author | Practical Cardiology Editorial Staff

Articles

American Heart Association Experts Will Answer Questions About COVID-19 and Emergency Cardiovascular Care

Image IQ: Petechia and Palpable Purpura on the Palms of Hands, Fingers, and Toes

Cardiology Organizations Advise on ACE Inhibitors, ARBs Use During COVID-19

Image IQ: 42-year-old man with dizziness and racing heartbeat