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Management of Heart Failure, Durable Left Ventricular Assist Device, and Heart Transplant Patients in the COVID-19 Era Cover

Management of Heart Failure, Durable Left Ventricular Assist Device, and Heart Transplant Patients in the COVID-19 Era

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

Figures & Tables

Figure 1

Interfaces of mechanisms of injury in heart failure and COVID-19. ACE2: angiotensin-converting enzyme 2; ANGII: angiotensin 2; ACE: angiotensin-converting enzyme; ARBs: angiotensin receptor blockers; CRP: C-reactive protein; MI: myocardial infarction; BNP: B-type natriuretic peptide; NT-proBNP: N-terminal pro-BNP

Table 1

Recommendations for heart failure (HF) patient management to enhance safety and mitigate risk in the setting of COVID-19. MCS: mechanical circulatory support; IABP: intra-aortic balloon pump; ECMO: extracorporeal membrane oxygenation; VAD: ventricular assist device; LVAD: left VAD; INR: international normalized ratio.

RISKSRECOMMENDATIONS

  • Patients with HF are at high risk of major complications

  • HF may predispose to pulmonary complications in COVID-19

  • COVID-19 directly and indirectly increases the risk of cardiovascular complications

  • All HF patients should receive vaccination

  • Guideline-directed medical therapy for HF should be continued when possible

  • Beware of drug-to-drug interactions

  • Multidisciplinary decision making is required for patients in shock needing MCS – IABP, temporary VAD or ECMO

  • LVAD patients with COVID-19 need close monitoring of INR because of COVID-19–associated coagulopathy

  • Heart transplant patients with COVID-19 need their immunosuppression regimen adjusted, monitoring for hematological abnormalities, and close follow-up

Figure 2

Evaluation of patients with heart failure (HF) and COVID-19. CVD: cardiovascular disease; URI/LRI: upper respiratory tract infection/lower respiratory tract infection; JVD: jugular vein distention; EKG: electrocardiogram; CAD: coronary artery disease; BNP: B-type natriuretic peptide; CXR: chest x-ray; CT: computed tomography; MRI: magnetic resonance imaging; RHC: right heart catheterization

Figure 3

Suggested algorithm for the management of patients with heart failure (HF) and COVID-19. VA-ECMO: veno-arterial extracorporeal membrane oxygenation; VV-ECMO: veno-venous; NIV: noninvasive ventilation; RAAS: renin-angiotensin-aldosterone system; ARDS: acute respiratory distress syndrome; SaO2: arterial oxygen saturation

DOI: https://doi.org/10.14797/mdcvj.651 | Journal eISSN: 1947-6108
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Language: English
Page range: 63 - 72
Submitted on: Aug 31, 2021
Accepted on: Nov 11, 2021
Published on: Dec 15, 2021
Published by: Houston Methodist DeBakey Heart & Vascular Center
In partnership with: Paradigm Publishing Services
Keywords:
COVID-19,
heart failure,
heart transplant,
left ventricular assist device

© 2021 Nadia Fida, published by Houston Methodist DeBakey Heart & Vascular Center
This work is licensed under the Creative Commons Attribution-NonCommercial 4.0 License.

Volume 17 (2021): Issue 5
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