Acs management during covid 19 pandemic

1. ACS MANAGEMENT DURING COVID-19 ERA
Dr. Awadhesh Kr Sharma ,
DM,FACC,FSCAI
Ass. Professor
LPS Institute of Cardiology , GSVM
Medical college ,Kanpur(UP)

2. COVID-19
The objective of todays presentation is to provide
recommendations for a systematic approach for the
care of patients with an AMI during the COVID-19
pandemic.

3. COVID-19
• The coronavirus has derived it’s name because of resemblance of its shape to a crown or solar corona
when imaged using an electron microscope.
• Human Coronaviruses (HCoVs) have long been considered inconsequential pathogens, causing the
"common cold" in otherwise healthy people.
• Coronavirus disease 2019, or "COVID-19"is the infectious disease caused by the most recently discovered
coronavirus called SARS-CoV-2.
• 2019-nCoV is 75 to 80% identical to the SARS-CoV.
“With 84,25,511 cases confirmed and more than 4,51,830 deaths worldwide , concerns over the latest
coronavirus outbreak continue to escalate. In India we have 3,68,648 cases and 12,275 deaths as on
18th June, 2020”

4. MOST COMMONLY OBSERVED CO-MORBIDITIES IN DECEASED COVID-19 PATIENTS
Reference: Characteristics of COVID-19 patients dying in Italy Report based on available data on March 26th, 2020

5. IMPACT OF COVID19 ON CVD PATIENTS
 Patients with Pre-existing CVD appear to have worse outcomes with COVID-19.
 CV complications include biomarker elevations, myocarditis, heart failure, and venous thromboembolism,
which may be exacerbated by delays in care.
 Therapies under investigation for COVID-19 may have significant drug-drug interactions with CV
medications.
Driggin.et.al J A C C V O L . 7 5 , NO . 1 8 , 2 0 2 0 MA Y 1 2 , 2 0 2 0 : 2 3 5 2 – 7 1

6. COVID-19

7. ISSUES WHICH REQUIRE SPECIAL ATTENTION FOR ACS MANAGEMENT DURING COVID-19
PANDEMIC
 Given the potential risk of aerosol generation during all emergency ACS procedures, personal
protection equipment (PPE) with aerosolization protection (including gowns, gloves, full face
mask, and an N95 respiratory mask) for the entire cardiac care unit staff.
 Delayed presenters of STEMI will significantly increase due to lack of proper transport, lack of
routine medical services, reluctance to attend hospital in present conditions and fear of getting
infection from healthcare systems.
 Even in a hospital equipped with cath lab, stipulated ‘door-to-balloon time’ for primary PCI may
not be maintained due to delay in ruling out the COVID-19 diagnosis. So thrombolysis is preferred
even in hospitals with CCL facilities.
 Training of medical and paramedical staffs regarding early recognition of COVID-19 infection,
disinfection measures for facilities and medical equipment and training for PPE are essential.
S. Guha et al. / Indian Heart Journal April 2020.

8. COVID-19 PRIMARY PCI.............BUT????
 Primary PCI is the standard of care for patients presenting to PCI centers (within 90 minutes of
first medical contact). This should remain the standard of care for STEMI patients during the
COVID-19 pandemic with some important caveats.
 Each primary PCI center will need to monitor the ability to provide timely primary PCI based on
staff and PPE availability, need for additional testing, as well as a designated CCL, which will
require terminal cleaning after each procedure.
 In the absence of these resources, a fibrinolysis first approach should be considered.

9. COVID-19
 COVID-19 testing should be routinely implemented in all ST-segment elevation myocardial
infarction (STEMI) patients to better characterize patient diagnosis and risk, optimize the
treatment plan for a given patient (for AMI ± COVID-19), and guide appropriate placement within
the hospital.
 Direct transport of the patient to the CCL is not felt to be prudent at this time.
 Not all COVID-19 patients with ST elevation with/without an acute coronary occlusion will benefit
from any reperfusion strategy or advanced mechanical support.
 In COVID-19 confirmed patients with severe pulmonary de-compensation (adult respiratory
distress syndrome) or pneumonia who are intubated in the intensive care unit and felt to have an
excessively high mortality, consideration for compassionate medical care may be appropriate.

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16. COVID-19
 Regarding non–ST-segment elevation acute coronary
syndrome, COVID-19 positive or probable patients should
be managed medically and only taken for urgent coronary
angiography and possible PCI in the presence of high-risk
clinical features (GRACE [Global Registry of Acute
Coronary Events] score >140) or hemodynamic instability.

17. COVID-19

18. RECOMMENDATIONS OF FIBRINOLYTIC THERAPY

19. EXPERT OPINION
Expert opinion expressed by Dr. Alaido Cheffo member of EAPCI from MILAN ITALY to ESC President Dr. Barbara Casadei
https://www.youtube.com/embed/WYx4xOn97aE?rel=0&autoplay=1

20. EXPERT OPINION
Expert opinion expressed by Dr. Alaido Cheffo member of EAPCI from MILAN ITALY to ESC President Dr. Barbara Casadei
https://www.youtube.com/embed/WYx4xOn97aE?rel=0&autoplay=1

21. EXPERT OPINION
Expert opinion expressed by Dr. Alaido Cheffo member of EAPCI from MILAN ITALY to ESC President Dr. Barbara Casadei
https://www.youtube.com/embed/WYx4xOn97aE?rel=0&autoplay=1

22. TAKE HOME MESSAGE
Make your hospital safe for ACS patients and for care providers.
Raise awareness that patients with chest pain need to come to the
hospital emergency as soon as possible.
It’s your responsibility-
TO TAKE CARE OF YOURSELF & YOUR
PATIENTS.

23. COVID-19
Thank You