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Noninvasive Imaging for Patients with COVID-19 and Acute Chest Pain Cover

Noninvasive Imaging for Patients with COVID-19 and Acute Chest Pain

Methodist DeBakey Cardiovascular Journal
Volume 17 (2021): Issue 5
By: ,  ,  ,  ,   and    
Open Access
|Dec 2021
Figures & tables

Figures & Tables

Table 1

Differential diagnosis of chest pain in patients with COVID-19. ECG: electrocardiogram; STEMI: ST-elevation myocardial infarction; NSTEMI: non-ST-elevation myocardial infarction; ICA: invasive coronary angiogram; CAD: coronary artery disease; TTE: transthoracic echocardiogram; POCUS: point-of-care ultrasound; CCTA: coronary computed tomography angiography; JVP: jugular venous pressure; COVID-19: coronavirus disease 2019; PNA: pneumonia; CT: computed tomography; CTPA: computed tomography pulmonary angiography; LV: left ventricle; RWMA: regional wall motion abnormalities; MINOCA: myocardial infarction with nonobstructive coronary arteries; CMR: cardiac magnetic resonance imaging; LGE: late gadolinium enhancement; DVT: deep vein thrombosis; ACS: acute coronary syndrome

DISEASE PROCESSPRESENTATIONIMAGING FOR INITIAL AND SUBSEQUENT ASSESSMENT
Acute coronary syndromeIschemic chest pain with typical ECG changes and elevation of cardiac biomarkers

  • STEMI-ICA to evaluate for obstructive CAD

  • NSTEMI/unstable angina: urgent TTE or POCUS followed by CCTA in low risk or ICA if high risk

Cardiac tamponadeDyspnea, tachypnea, elevated JVP, hypotension, pulsus paradoxus, electrical alternans on ECG

  • Stat TTE to evaluate for large pericardial effusion with chamber collapse/respiratory variation in volumes and flows

COVID-19 pneumoniaCough, fever, myalgia, headache, dyspnea, loss of smell/taste, worsening hypoxemia

  • CT to simultaneously evaluate for PNA (chest CT), PE (CTPA), and obstructive CAD (CCTA), depending on suspicion

Heart failure, new onset, without hypotensionProgressive dyspnea, signs of congestion, S3 heart sound

  • TTE to evaluate LV function

  • If RWMA present and suspicion of chronic ischemia, consider CCTA in lower risk or ICA in higher risk

MINOCAIschemic chest pain with ECG changes and modest elevation of cardiac biomarkers

  • ICA shows no obstructive CAD

  • CMR to evaluate for subendocardial or transmural pattern corresponding to vascular territory

MyocarditisVariable but may include presentation of acute heart failure with new arrhythmias

  • CMR to evaluate for LGE with myocardial edema

PericarditisPleuritic chest pain, diffuse ST elevations and PR depressions on ECG, pericardial friction rub

  • TTE to evaluate for pericardial effusion

Pulmonary embolismDyspnea, pleuritic chest pain, signs and symptoms of DVT

  • CT to simultaneously evaluate for PNA (chest CT), PE (CTPA), and obstructive CAD (CCTA), depending on suspicion

Stress cardiomyopathySimilar to ACS with signs of heart failure

  • ICA to evaluate for obstructive CAD

  • TTE to evaluate for wall motion abnormalities

Figure 1

Coronary computed tomography (CT) angiography in a 34-year-old woman who presented with COVID-19 pneumonia. The patient had chest pain and minimal troponin elevation. (A) Coronaries were free of atherosclerosis or stenosis. (B) Chest CT shows advanced COVID-19 pneumonia.

Figure 2

(A) Severe pulmonary infiltrates in a patient with recent COVID-19 infection referred for positive emission tomography myocardial perfusion imaging. (B) There is rubidium uptake in these pulmonary infiltrates.

Figure 3

Flowchart for noninvasive imaging in patients with COVID-19 presenting with acute chest pain. ACS: acute coronary syndrome; ECG: electrocardiogram; CAD: coronary artery disease; ICA: invasive coronary angiography; POCUS: point-of-care ultrasound; TTE: transthoracic echocardiogram; CCTA: coronary computed tomography angiography; CT: computed tomography; CTPA: computed tomography pulmonary angiography; CMR: cardiac magnetic resonance imaging

DOI: https://doi.org/10.14797/mdcvj.1040 | Journal eISSN: 1947-6108
Journal RSS Feed
Language: English
Page range: 5 - 15
Submitted on: Sep 17, 2021
Accepted on: Oct 15, 2021
Published on: Dec 15, 2021
Published by: Houston Methodist DeBakey Heart & Vascular Center
In partnership with: Paradigm Publishing Services
Keywords:
COVID-19,
coronavirus,
cardiovascular disease,
acute coronary syndromes,
noninvasive imaging

© 2021 Awad Javaid, Yehia Saleh, Ahmed Ibrahim Ahmed, Jean Michel Saad, Maan Malahfji, Mouaz H Al-Mallah, published by Houston Methodist DeBakey Heart & Vascular Center
This work is licensed under the Creative Commons Attribution-NonCommercial 4.0 License.

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