key: cord-0931860-nqp84jdo authors: Gupta, Rakesh title: Cardiological Society of India Document on Safety Measure During Echo Evaluation of Cardiovascular Disease in the Time of COVID-19 date: 2020-05-26 journal: Indian Heart J DOI: 10.1016/j.ihj.2020.05.016 sha: c1d6de94c719d0fd51ec80e31e52bbea3c1095ab doc_id: 931860 cord_uid: nqp84jdo An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-à-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India. The global Coronavirus pandemic is an unprecedented, rapidly spreading public health emergency spread over 200 countries with 44,29,235 cases with 2,,98,165 deaths and 13,59,291 recovered patients as on 14th May 2020. Of the remaining 24,72,075 cases ,the major challenge is with 45,921 (2%) , who are hospitalized in serious and critical condition(1). With the so many 'don't knows' about the disease , it is difficult to come out with recommendations that can find appropriate scientific backing. Least of them is to have an evidence based guidelines. Though no significant data is available on the preventive role of non-invasive cardiologist , the guidance provided in this statement is based mainly on opinion of experts and the best currently available published information. The purpose of this position paper is to provide valuable guidance regarding various protective measures to be utilized during any echo evaluation in the current scenario. Based on the international experience and various national advisories, social distancing, personal hygiene, using appropriate personal protection equipment (PPE), and isolating the highest risk are most important in containing and mitigating COVID-19 infection. Despite all these preventive measures and precautions , many people still suffer from denovo cardiovascular ailments or exacerbation of existing one , leading to cardiac consultation and hospitalization. It becomes imperative for them to have echocardiography (Echo) for correct diagnosis and managements and hence these guidelines has an impact in current scenario. (17 ). The mechanism of these associations remains unclear at this time. Potential explanations include CVD being more prevalent in those with advancing age, a functionally impaired immune system, elevated levels of angiotensin converting enzyme 2 (ACE2), or a predisposition to COVID-19 for those with CVD. b. We suggest following views to be recorded and stored in 5 cardiac cycles in the following sequence: i. PLAX view with and without CFM. ii. AP4C view with and without CFM. iii. PSAX view (basal) and at great vessel level. can be done later on and not at patient's bedside. This in turn will save lot of time and will minimize health care workers (HCW) exposure and risk of infection. Remember even level III PPE is of no 100% guarantee. 6. Preparation of the cardiologist /echocardiographer : (Fig. 04-05) . a. Group A -category 1 and category 2 , Group B -Category 1 : Level III of complete protection ( preferably PPE gear of atleast 70 gsm) ( Fig. 04-05 ) . b. Group A -Category 3 , Group B -category 2 patients: 2nd level of PPE ( Fig.04-05 ). c. Group B -category 3 : Ist level of PPE ( Fig.04-05) . The present COVID-19 pandemic is a medical emergency of an unprecedented scale in recent human history. It has called into question, on a global scale, not only the medical preparedness to handle this contagious disease but has also changed the paradigm for management of everyday procedures. As we continue to handle the onslaught of this pandemic, strategies may continue to evolve .In any given patient with COVID-19, clinical assessment will be necessary to determine whether patient is experiencing a primary coronary event or other cardiac involvement. If there is a suspicion of cardiac involvement, the risk-tobenefit ratio of doing an echo becomes extremely helpful in deciding the need for the same. If echo is performed, it should be brief and target-oriented and should be performed following all the protocols as outlined above. Protection of healthcare workers is paramount so that workforce is not depleted in this pandemic and is available as the pandemic evolves. Social distancing and adequate sanitization are crucial. Adequate PPE's ( atleast level 2 ) are mandatory for all health workers engaged in the care of suspected or proven COVID-19 with pre-existing cardiac or new onset cardiac illness. COVID 19 has been quite a leveller and has made even most powerful of countries to crawl on their knees. One feels cheated by science and the fatalistic righteous and reformist will have a congratulatory rage for them for having seen sciencefail....! 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The Lancet Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan Clinical Characteristics of Coronavirus Disease 2019 in China COVID-19 and the cardiovascular system COVID-19) infection: a systematic review and meta-analysis Coronaviruses and the cardiovascular system:acute and long-term implications Citations to the figures: Abbreviations: COVID-19: Coronavirus disease -19 Intensive care unit NHC: National Health Commission CI: Confidence Interval ACE2: Angiotensin Converting Enzyme 2 TEE: Transesophageal Echo PPE: Personal Protection Equipment CT: Computed Tomography PLAX view: Parasternal long axis view CFM: Color Flow Mapping AP4C view: Apical 4 Chamber view PSAX view: parasternal short axis view AP2C view: Apical 2 chamber view RV Focussed view: Right ventricle Focussed view IVC Dynamic view: Inferior Vena Cava dynamic view PAT: Pulmonary artery acceleration time TR jet velocity: Tricuspid regurgitation jet velocity LVOT CW trace We would like to thank following cardiologist colleagues for their expert opinion