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VIDEO: Explaining Bicupid Aortic Valves

Heart Valve Technology | June 10, 2020

Jay Mohan, D.O., RPVI, interventional cardiology fellow at William Beaumont Hospital, Royal Oak, Michigan, created this video to briefly explain what is a bicuspid aortic valve.  

A bicuspid aortic valve (BAV) has two instead of the usual three leaflets of a normal tricuspid aortic valve. Usually two of the leaflets are fused together during fetal development. About one-third of patients with BAV develop valve complications during their lifetime. 

Mohan is board certified in cardiology, internal medicine, echocardiography and nuclear cardiology. He also serves as vice president of the Dr. Ramesh Kumar Foundation

Mohan shares regular updates on Twitter about recent cardiology technology devices, takeaway points from conferences and short educational videos he produces. Follow or contact him via Twitter or Instagram at @cardiologyoncall.

 

Related Cardiovascular Educational Videos Created by Jay Mohan, D.O.:

VIDEO: The Latest Data on COVID-19 and Cardiovascular Disease

VIDEO: Creating a Home COVID-19 Decontamination Area for the Clinician
 

Recent Video

Heart Valve Technology | June 10, 2020

Jay Mohan, D.O., RPVI, interventional cardiology fellow at William Beaumont Hospital, Royal Oak, Michigan, created this video to briefly explain what is a bicuspid aortic valve.  

A bicuspid aortic valve (BAV) has two instead of the usual three leaflets of a normal tricuspid aortic valve. Usually two of the leaflets are fused together during fetal development. About one-third of patients with BAV develop valve complications during their lifetime. 

Mohan is board certified in cardiology, internal medicine, echocardiography and nuclear cardiology. He also serves as vice president of the Dr. Ramesh Kumar Foundation

Mohan shares regular updates on Twitter about recent cardiology technology devices, takeaway points from conferences and short educational videos he produces. Follow or contact him via Twitter or Instagram at @cardiologyoncall.

 

Related Cardiovascular Educational Videos Created by Jay Mohan, D.O.:

VIDEO: The Latest Data on COVID-19 and Cardiovascular Disease

VIDEO: Creating a Home COVID-19 Decontamination Area for the Clinician
 

Hemodynamic Support Devices | June 05, 2020

This is a quick animation demonstrating how the new 9 French Abiomed Impella ECP expands to approximately 18 French and provides peak flows of 3.5 L/min. The device was approved for a U.S. FDA investigational device exemption (IDE) first-in-human trial in June 2020. Read more on the IDE. It uses a collapsible cannula instead of the fix size cannula used on the current generation of Impella devices. The design addresses issues with needing large bore vascular access and associated bleeding complications.

The Impella series of hemodynamic support devices from Abiomed are percutaneously delivered, catheter-based heart pumps that offer temporary ventricular assist support.  

 

Related Impella Video Content:

VIDEO: Demonstration of the Impella Percutaneous Hemodynamic Support Device

VIDEO: Door-to-Unloading (DTU) Trial May Change STEMI Care — Interview with Navin Kapur, M.D.

VIDEO: Hemodynamic Support Protocols at Henry Ford Hospital — Interview with William O'Neill, M.D.

VIDEO: Tufts Uses a Hemodynamic Support Algorithm to Determine What Devices to Use — Interview with Navin Kapur, M.D.

Photo Gallery of the Abiomed Impella Production Line

VIDEO: Justification for Hemodynamic Support in Complex PCI — Interview with Jeffrey J. Popma, M.D.

VIDEO: How to Reduce Cardiogenic Shock Mortality by 50 Percent — Interview with William O'Neill, M.D.

VIDEO: The Importance of Ventricular Unloading in AMI and Cardiogenic Shock — Interview with Navin Kapur, M.D.

VIDEO: Analysis of Outcomes for 15,259 U.S. Patients with AMICS Supported with the Impella Device — Interview with William O'Neill, M.D.

VIDEO: The Door-to-Unloading (DTU) STEMI Safety and Feasibility Trial — Interview with Navin Kapur, M.D.

VIDEO: Cardiogenic Shock Case with Impella CP Support — Case study with Michael Amponsah, M.D.

 

 

Coronavirus (COVID-19) | May 29, 2020

Jay Mohan, D.O., RPVI, interventional cardiology fellow at William Beaumont Hospital, Royal Oak, Michigan, created this video. It shows other clinicians how he set up his home COVID-19 decontamination area where he changes clothes, shoes and sterilizes before entering his house in order to protect his family. He has been involved with direct care of COVID-19 patients the past two months.

Since the start of the SAR-CoV-2 pandemic, clinicians and first-responders who are in contact with, or possible contact with, COVID-19 patients have developed ways to not bring and viral contamination home with them. This often includes on transition spot in the garage or designed room where they can change out of work clothing and shoes and into new clothing and shoes. Shoes and coats are separated into ones used for home and those dedicated for use at work only. Those who wear and reuse N95 masks also have developed ways to take the mask off by the straps only so they do not touch it and strapping it over a tupperware container that can then be sealed, or stored inside a disposable paper or plastic bag.

Mohan is board certified in cardiology, internal medicine, echocardiography and nuclear cardiology. He also serves as vice president of the Dr. Ramesh Kumar Foundation

Mohan shares regular updates on Twitter about recent cardiology technology devices, takeaway points from conferences and short educational videos he produces. Follow or contact him via Twitter or Instagram at @cardiologyoncall.

Watch a video animation he created — VIDEO: The Latest Data on COVID-19 and Cardiovascular Disease.
 

Find more cardiovascular related COVID-19 content

Coronavirus (COVID-19) | May 28, 2020

Interview with Andrew D. Krahn, M.D.,FHRS, head of the division of cardiology at St. Paul’s Hospital, and professor of medicine at the University of British Columbia, and vice president of the Heart Rhythm Society (HRS). He is an expert in long QT syndrome (LQTS) and is involved with the National Long QT Registry. He explains the issues with the drugs being used to treat coronavirus (COVID-19, SARS-CoV-2) patients and why these combined with the cardiac impact of the virus is causing prolonged ECG QT segment prolongation, leading to deadly arrhythmias. COVID-19 can cause myocarditis that causes QT prolongation and the front-line COVID drugs hydroxychloroquine and azithromycin also cause QT prolongation.

The U.S. Food and Drug Administration (FDA) issued a Drug Safety Communication April 23, 2020, reminding doctors there are serious side effects when using hydroxychloroquine and chloroquine in the off-label use to treat COVID-19 patients. This includes potentially life-threatening heart rhythm problems. The FDA said case reports from the FDA Adverse Event Reporting System database, published medical literature and the American Association of Poison Control Centers National Poison Data System are reporting serious heart-related adverse events and patient deaths. Read more about this alert.

The FDA warning confirmed fears from the American Heart Association (AHA), the American College of Cardiology (ACC) and the Heart Rhythm Society (HRS). These societies April 8 jointly published a new guidance, “Considerations for Drug Interactions on QTc in Exploratory COVID-19 (Coronavirus Disease 19) Treatment,” to detail critical cardiovascular considerations in the use of hydroxychloroquine and azithromycin for the treatment of COVID-19. The societies warned that use of  these agents in a large number of patients in combination would results in arrhythmias and deaths. Read more.

However, there are numerous advocates that argue hydroxychloroquine needs to be used in less sick patients who are not already hypoxic to treat COVID, but it is being used primarily in very sick patients where it is not effective. Advocates also argue the drug can be used to help prevent coronavirus, similar to the drug's effect in preventing malaria. In terms of drug safety, advocates argue the drug has been used in millions of patients for more than 50 years without a high risk of arrhythmias. Several trials are now underway in the United States to test its use against COVID-19, but enrollment has been hampered because of the FDA warning. There will likely be more interest in hydroxychloroquine after it was revealed May 18, 2020, that President Trump is taking the drug for prophylaxis against COVID-19.

 

Related Hydroxychloroquine Content:

FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine for COVID-19

WHO Database Shows Serious Health Impact of Hydroxychloroquine and Azithromycin Being Used to Treat COVID-19

VIDEO: Overview of Hydroxychloroquine and FDA Warning in its use to Treat COVID-19 — Interview with Marianne Pop, Pharm.D.

WHO Database Shows Serious Health Impact of Hydroxychloroquine and Azithromycin Being Used to Treat COVID-19

COVID-19 Hydroxychloroquine Treatment Brings Prolonged QT Arrhythmia Issues

 

FDA Reports of Deaths and Injuries From Use of Antimalarial hydroxychloroquine in COVID-19 Patients

VIDEO: Cardiologists Manage Trial Testing if Hydroxychloroquine Protects Clinicians From COVID-19 — Interview with William O'Neill, M.D.

First Large-scale U.S. Study on Hydroxychloroquine COVID-19 Prophylaxis Begins in Detroit

AHA, ACC, HRS Caution Use of COVID-19 Therapies Hydroxychloroquine and Azithromycin in Cardiac Patients

HRS | May 22, 2020

Interview with Andrew D. Krahn, M.D., FHRS, head of the division of cardiology at St. Paul’s Hospital, and professor of medicine at the University of British Columbia. He is also vice president of the Heart Rhythm Society (HRS). He moderated the late-breaking sessions at 2020 HRS virtual meeting and explains the highlights of the new technologies and data presented. 

Technologies include a nasal spray to stop supraventricular tachycardia, pulsed field ablation technology that may offer improvement over current technology, subcutaneous ICD (S-ICD) technology performing as well as traditional transvenous lead ICDs, contact force sensing ablation improves outcomes, use of smart watches to help atrial fibrillation patients adhere to oral anticoagulation therapy, and the first pacemaker to interface with the patient's smart phone.

Watch another interview with Krahn in the VIDEO: Insights Into How HRS Organized its Virtual Meeting.

Find a complete list of the Heart Rhythm 2020 meeting late-breaking studies with links to articles on each.

Find more news and video from the Heart Rhythm Society.
 

Cardiovascular Education | May 22, 2020

Andrew D. Krahn, M.D., FHRS, head of the division of cardiology at St. Paul’s Hospital, professor of medicine  at the University of British Columbia and vice president of the Heart Rhythm Society (HRS), explains how HRS organized its virtual meeting after its in-person meeting was cancelled by the COVID-19 pandemic.  

Due to the continued global escalation of the novel coronavirus (COVID-19, SARS-CoV-2), HRS has cancelled its large annual in-person electrophysiology meeting in late-March and began planning for a virtual meeting instead. HRS broke its annual meeting into three online learning sessions over the course of May June and July. The first, which included the late-breaking sessions, was held May 5-9, 2020. Others will be held June 12 and July 1.

Using its online learning platform, Heart Rhythm 365 available on the www.hrsonline.org website, HRS is offering all its sessions at no cost.

Watch another interview with Krahn in the VIDEO: Top New EP Technologies at Heart Rhythm Society 2020.
 

Find a complete list of the Heart Rhythm 2020 meeting late-breaking studies with links to articles on each.
 

 

Coronavirus (COVID-19) | May 18, 2020

Marianne Pop, Pharm.D., BCPS, a clinical pharmacist and clinical assistant professor with the regional pharmacy program, University of Illinois at Chicago College of Pharmacy. She specializes in emergency medicine pharmacy as part of the regional pharmacy program at OSF Saint Anthony Medical Center in Rockford, Ill. In this interview she offers an overview of using hydroxychloroquine to treat COVID-19 (SARS-CoV-2) in relation to the recent FDA warning about its use causing increase cardiac issues, and data on its effectiveness to date.

Cardiology societies issued warnings soon after hydroxychloroquine started to be used as a treatment and the prevention of COVID-19. The drug has been used for decades to prevent malaria and to treat rheumatoid arthritis and lupus. However, some case reports indicate it can cause ECG QT-interval prolongation, which causes cardiac arrhythmias. Cardiologists say COVID also can cause myocarditis, which can initiate arrhythmias. Other drugs being used to treat COVID, such as azithromycin, also cause arrhythmias. These drugs combined with myocarditis can compound the arrhythmia issue, leading to serious adverse effects, including some patients deaths. This is what the FDA reported in a warning to clinicians in late April. 

However, there are numerous advocates that argue hydroxychloroquine needs to be used in less sick patients who are not already hypoxic to treat COVID and it is being used primarily in very sick patients where it is not effective. Advocates also argue the drug can be used to help prevent coronavirus, similar to the drug's effect in preventing malaria. In terms of drug safety, advocates argue the drug has been used in millions of patients for more than 50 years without a high risk of arrhythmias. Several trials are now underway in the United States to test its use against COVID-19, but enrollment has been hampered because of the FDA warning. There will likely be more interest in hydroxychloroquine after it was revealed May 18, 2020, that President Trump is taking the drug for prophylaxis against COVID-19.

 

Related Hydroxychloroquine Content:

FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine for COVID-19

COVID-19 Hydroxychloroquine Treatment Brings Prolonged QT Arrhythmia Issues

VIDEO: Why QT-prolongation Occurs in COVID-19 Patients on Hydroxychloroquine — Interview with Andrew Krahn, M.D.

FDA Reports of Deaths and Injuries From Use of Antimalarial hydroxychloroquine in COVID-19 Patients

WHO Database Shows Serious Health Impact of Hydroxychloroquine and Azithromycin Being Used to Treat COVID-19

 

VIDEO: Cardiologists Manage Trial Testing if Hydroxychloroquine Protects Clinicians From COVID-19

First Large-scale U.S. Study on Hydroxychloroquine COVID-19 Prophylaxis Begins in Detroit

AHA, ACC, HRS Caution Use of COVID-19 Therapies Hydroxychloroquine and Azithromycin in Cardiac Patients

Coronavirus (COVID-19) | May 07, 2020

Interview with Geoffrey Rose, M.D., president of Sanger Heart and Vascular Institute with Atrium Health, in Charlotte, North Carolina, and a board member with the American Society of Echocardiography (ASE). He explains the impact of COVID-19 (SARS-CoV-2) on the cardiovascular service line and cardiac imaging. He said the virus has led to use of computed tomography (CT) not only as the frontline cardiovascular imaging modality to evaluate chest pain, but also for COVID-19 pneumonia imaging.

Rose said cardiac ultrasound is still used, but requires full personal protective equipment (PPE) and often abbreviated exams because of the close proximity of the sonographer and patient when performing echocardiograms. This has given rise to using dedicated point-of-care ultrasound (POCUS) systems to answer specific clinical questions quickly. Smart-phone based POCUS systems that use an app and a transducer plugged into the phone enable basic echo exams or evaluation of other parts of the anatomy quickly without the need to immediately sterilize an entire cart-based ultrasound system. These small systems also can be completely enclosed inside a transducer sheath and the phone and single transducer are much easier and faster to wipe down. He said the quality of the exams are not as good as fully enabled echocardiography systems, but it allows for quick assessments of ejection fractions and to triage if the patient needs more advanced imaging if the basic questions cannot be answered.

Since hospitals have shut down now for about two months, postponing normal checkups, and elective exams and procedures, Rose said doctors still need to visit with patients who have chronic conditions. Sanger and Atrium Heath modified its ambulatory electronic medical record (EMR) and is using video conferencing to perform virtual appointments now for the majority of these patients. He said telemedicine was not widely used before COVID-19 in his hospital system, but the pandemic will likely alter the care model for the future, with more telemedicine visits being used even after epidemic is over. He said use of POCUS and CT as frontline cardiac imaging modalities will also likely remain in place after the pandemic because of the efficiencies in care these technologies offer.

 

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VIDEO: Imaging COVID-19 With Point-of-Care Ultrasound (POCUS)

Cardiac Imaging Best Practices During the COVID-19 Pandemic

RSNA Publishes COVID-19 Best Practices for Radiology Departments

ASE Guidelines for the Protection of Echocardiography Providers During the COVID-19 Outbreak
 

New CT Scoring Criteria for Timely Diagnosis, Treatment of Coronavirus Disease

FDA Issues New Policy for Imaging Systems During COVID-19

VIDEO: COVID-19 Precautions for Cardiac Imaging —  Interview with Stephen Bloom, M.D.

A Review of Studies Cautions Against Chest CT for Coronavirus Diagnosis

 

New Research Finds Chest X-ray Not Reliable Diagnostic Tool for COVID-19

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University of Washington Issues Radiology Policies for COVID-19

VIDEO: Best Practices for Nuclear Cardiology During the COVID-19 Pandemic — Interview with Hicham Skali, M.D.

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CMS Offers Recommendations on Reopening Healthcare in Areas of Low COVID-19 Cases

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CT Imaging of the 2019 Novel Coronavirus (2019-nCoV) Pneumonia

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VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

The Cardiac Implications of Novel Coronavirus

 

 

 

Coronavirus (COVID-19) | May 01, 2020

Thomas Maddox, M.D., MSc, FACC, the chair of the American College of Cardiology (ACC) Science and Quality Committee, explains concerns by ACC in a large drop in ST-elevation myocardial infarction (STEMI) heart attacks and strokes since the U.S. spread of COVID-19. Maddox is also the executive director of the Healthcare Innovation Lab of BJC Healthcare and Washington University School of Medicine, St. Louis. He is also an assistant professor of cardiology at Washington University.

The ACC is concerned about the 35-40 percent drop in STEMI and stroke patients presenting to emergency rooms across the U.S. and internationally since the start of the novel coronavirus (COVID-19, SARS-CoV-2) pandemic. Maddox is alarmed by the drop in cases and suspects patients are deciding to stay home rather than go to the hospitals out of fear about catching COVID-19. ACC launched a public relations campaign April 14, 2020, aimed at the public to get them to call 911 or go to hospitals if they have symptoms of stoke of a heart attack. Maddox said hospitals are still seeing and treating non-COVID-19 patients and the cardiovascular departments are still activating their cath labs to handle and acute cardiac cases that come in. 

He said Spain, which was hit earlier than the U.S. by the virus, saw a STEMI case decrease of about 40 percent. Based on limited U.S. data, he said U.S. cath lab activations are down about 35 percent. A clearer picture of the actual numbers of STEMI and other PCI cases will not be known from the ACC National Cardiovascular Data Registry (NCDR) until later this year, since most hospitals pull this data quarterly.

ACC is offering resources for the public  at www.cardiosmart.org/Coronavirus to evaluate their symptoms and help decide it they should go to the hospital or call 911.

Read the related article "Rapid Drop in Heart Attacks and Stroke at Hospitals Concerns ACC."

Watch another interview with Maddox in the VIDEO: What Cardiologists Need to Know about COVID-19.

 

Coronavirus (COVID-19) | April 22, 2020

Ehtisham Mahmud, M.D., FSCAI, president of the Society for Cardiovascular Angiography and Interventions (SCAI) and chief, Division of Cardiovascular Medicine at UC San Diego Medical Center, explains the SCAI precaution guidelines for treating patients in the cath lab under the COVID-19 pandemic.

He explains the how cardiology departments in the U.S. are operating to treat acute patients during novel coronavirus (COVID-19, SARS-CoV-2) containment efforts. 

The guidelines are outlined in the document "Considerations for Cardiac Catheterization Laboratory Procedures During the COVID‐19 Pandemic" can be accessed online in the SCAI journal Catheterization and Cardiovascular Interventions.[1]

 

Other Impact of COVID-19 on Cardiology Content:

How to Manage AMI Patients During the COVID-19 Pandemic

VIDEO: Impact of COVID-19 on the Interventional Cardiology Program at Henry Ford Hospital — Interview with William O'Neill, M.D.

VIDEO: 9 Cardiologists Share COVID-19 Takeaways From Across the U.S.

VIDEO: Multiple Cardiovascular Presentations of COVID-19 in New York — Interview with Justin Fried, M.D.

Image Gallery Showing Impact of the COVID-19 Pandemic

ACC COVID-19 Clinical Guidance For the Cardiovascular Care Team

VIDEO: COVID-19 Precautions for Cardiac Imaging — Interview with Stephen Bloom, M.D.

Rapid Drop in Heart Attacks and Stroke at Hospitals Concerns ACC 

VIDEO: Cancelling Non-essential Cardiac Procedures During the COVID-19 Outbreak — an interview with SCCT President Ehtisham Mahmud, M.D.

VIDEO: Telemedicine in Cardiology and Medical Imaging During COVID-19 — Interview with Regina Druz, M.D.

The Cardiac Implications of Novel Coronavirus

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

Reference:

1. Molly Szerlip  Saif Anwaruddin  Herbert D. Aronow, et al. Considerations for Cardiac Catheterization Laboratory Procedures During the COVID‐19 Pandemic Perspectives from the Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship (SCAI ELM) Members and Graduates. Catheterization and Cardiovascular Interventions. First published:25 March 2020. https://doi.org/10.1002/ccd.28887.

 

Coronavirus (COVID-19) | April 22, 2020

Justin Fried, M.D., Attending cardiologist at Columbia University Irving Medical Center, New York City, and assistant professor at at Columbia University and lead author on a report that explains the cardiovascular presentations of COVID-19. The study looked at four patient cases where cardiology became involved in the patient's care.

Novel coronavirus (COVID-19, SARS-CoV-2) can present as a cardiovascular issue, or patients can develop myocarditis or cardiogenic shock as the virus progresses. SARS-CoV-2 has a much higher mortality rate in patients with comorbiditities, but is highest in patients with comorbidities like heart failure and coronary artery disease. Fried said these conditions are exacerbated by COVID-19.

"We tried to put together some of the observations we noted in our early experiences in these patients at out center with manifestations of COVID-19," explained Fried. "We are seeing significant cardiac involvement, but it is important to note that many of our patients with underlying cardiovascular disease, notably heart failure and coronary disease, are developing significant effects form COVID-19 that is destabilizing conditions, and that presents unique challenge. I worry most about our patients who have underlying cardiovascular disease, which can be exacerbated by COVID-19."

Read more details in the article "New York City Physicians Note Multiple Cardiovascular Presentations of COVID-19."

 

Other Impact of COVID-19 on Cardiology Content:

VIDEO: 9 Cardiologists Share COVID-19 Takeaways From Across the U.S.

VIDEO: Impact of COVID-19 on the Interventional Cardiology Program at Henry Ford Hospital — Interview with William O'Neill, M.D.

Image Gallery Showing Impact of the COVID-19 Pandemic

ACC COVID-19 Clinical Guidance For the Cardiovascular Care Team

VIDEO: COVID-19 Precautions for Cardiac Imaging — Interview with Stephen Bloom, M.D.

Rapid Drop in Heart Attacks and Stroke at Hospitals Concerns ACC 

VIDEO: Cancelling Non-essential Cardiac Procedures During the COVID-19 Outbreak — an interview with SCCT President Ehtisham Mahmud, M.D.

VIDEO: Telemedicine in Cardiology and Medical Imaging During COVID-19 — Interview with Regina Druz, M.D.

The Cardiac Implications of Novel Coronavirus

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

Coronavirus (COVID-19) | April 18, 2020

Stephen Bloom, M.D., FASNC, director of nonivasive cardiology (cardiac CT, nuclear cardiology and echocardiography) at Midwest Heart and Vascular Associates, Overland Park, Kansas. He is also a member of the American Society of Nuclear Cardiology (ASNC) Board of Directors, explains some of the issues involved and protocols used for cardiac imaging during the COVID-19 pandemic. His discussion includes computed tomography, cardiac ultrasound and nuclear imaging.

Right now, Bloom said it is difficult to test everybody and there is a shortage of masks, gowns and other personal protective equipment (PPE), and the imaging equipment needs to be sanitized each time it is used. He said it is just is not possible to image all the patients who need imaging right now. Hospitals also are trying to limit the number of healthy people people coming into hospitals for routine visits and tests to reduce their potential exposure to the novel coronavirus (COVID-19, SARS-CoV-2) and help containment efforts. 

"The tests should be done, very simply, if it changes the care of the patient. If it doesn't change the care of the patient, and it can be postponed, it should be postponed," Bloom explained. "I would say 80 percent of our cardiac imaging exams have stopped. It has been very dramatic."

 

Related Imaging Precautions During COVID-19 Content:

Cardiac Imaging Best Practices During the COVID-19 Pandemic

Best Practices for Nuclear Cardiology Laboratories During the Coronavirus (COVID-19) Pandemic

ASE Guidelines for the Protection of Echocardiography Providers During the COVID-19 Outbreak 

VIDEO: Best Practices for Nuclear Cardiology During the COVID-19 Pandemic — Interview with Hicham Skali, M.D.

VIDEO: Cancelling Non-essential Cardiac Procedures During the COVID-19 Outbreak — Interview with Ehtisham Mahmud, M.D. 

VIDEO: 9 Cardiologists Share COVID-19 Takeaways From Across the U.S.  

VIDEO: Telemedicine in Cardiology and Medical Imaging During COVID-19 — Interview with Regina Druz, M.D.

VIDEO: Use of Teleradiology During the COVID-19 Pandemic — an interview with radiologist John Kim, M.D.

Study Looks at CT Findings of COVID-19 Through Recovery

Experts Stress Radiology Preparedness for COVID-19

VIDEO: Imaging COVID-19 With Point-of-Care Ultrasound (POCUS) — Interview with emergency physician Mike Stone, M.D.,

VIDEO: How China Leveraged Health IT to Combat COVID-19 — Interview with Jilan Liu, M.D., CEO for the HIMSS Greater China

ACR Recommendations for the Use of Chest Radiography and CT for Suspected COVID-19 Cases

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

The Cardiac Implications of Novel Coronavirus

 

Coronavirus (COVID-19) | April 17, 2020

DAIC Editor Dave Fornell has conducted numerous video interviews remotely from his home office in March and April 2020 with nine cardiologists from around the United States. After each interview he asked how COVID-19 has impacted their hospital and them personally. This video offers a candid overview of their thoughts in the fight against the novel coronavirus.

Each was interviewed for other videos and some of the comments used here were from a questions after the main interview on how novel coronavirus (COVID-19, SARS-CoV-2) is impacting them, their patients or their cardiology departments. 

Insights include the following doctors. Click on the names to see their videos from March and April 2020:

   • Thomas Maddox, M.D., Washington University School of Medicine, St. Louis
   • Ehtisham Mahmud, M.D., UC San Diego Medical Center
   • William O’Neill, M.D., Henry Ford Hospital, Detroit
   • Regina Druz, M.D., Integrative Cardiology Center of Long Island, N.Y.
   • Justin Fried, M.D., Columbia University Irving Medical Center, New York City
   • Hicham Skali, M.D., Brigham and Women’s Hospital, Boston
   • Stephen Bloom, M.D., FASNC, Midwest Heart and Vascular Associates, Overland Park, Kansas
   • Michael Mack, M.D., Baylor Scott and White, Dallas, Texas
   • Basel Ramlawi, M.D, Heart and Vascular Center at Valley Health System in Virginia

Find more videos and news on the impact of COVID-19 on cardiology

 

 

Coronavirus (COVID-19) | April 14, 2020

Ehtisham Mahmud, M.D., FSCAI, president of the Society for Cardiovascular Angiography and Interventions (SCAI) and chief, Division of Cardiovascular Medicine at UC San Diego Medical Center, explains the new American College of Cardiology (ACC) and SCAI precaution guidelines for treating transcatheter aortic valve replacement (TAVR) patients in the cath lab during the COVID-19 pandemic.

He explains recommendations for how structural heart programs can continue to treat acutely ill patients during novel coronavirus (COVID-19, SARS-CoV-2) containment efforts. The key message in the guidelines is to defer patients who can wait until containemnt efforts loosen in the coming months, while acute patients who are very sick should be treated.

The guidelines are outlined in the document "Triage Considerations for Patients Referred for Structural Heart Disease Intervention During the Coronavirus Disease 2019 (COVID‐19) Pandemic: An ACC /SCAI Consensus Statement." can be accessed online in the SCAI journal Catheterization and Cardiovascular Interventions.[1]

 

Related COVID-19 Cardiology Content:

VIDEO: Impact of COVID-19 on the Cardiovascular Program at Henry Ford Hospital — Interview with William O’Neill, M.D.

First Large-scale U.S. Study on Hydroxychloroquine COVID-19 Prophylaxis Begins in Detroit

New York City Physicians Note Multiple Cardiovascular Presentations of COVID-19

VIDEO: Cancelling Non-essential Cardiac Procedures During the COVID-19 Outbreak — Interview with Ehtisham Mahmud, M.D.

ACC COVID-19 recommendations for the cardiovascular care team

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

AHA, ACC, HRS Caution Use of COVID-19 Therapies Hydroxychloroquine and Azithromycin in Cardiac Patients

FDA Approves ECMO to Treat COVID-19 Patients

COVID-19 STEMI Registry Created to Study Acute Cardiovascular Effects of the Virus

Image Gallery Showing Impact of the COVID-19 Pandemic

VIDEO: Best Practices for Nuclear Cardiology During the COVID-19 Pandemic

The Cardiac Implications of Novel Coronavirus

 

 

Reference:

1. Pinak B. Shah, Frederick G.P. Welt, Ehtisham Mahmud, et al. Triage Considerations for Patients Referred for Structural Heart Disease Intervention During the Coronavirus Disease 2019 (COVID‐19) Pandemic: An ACC /SCAI Consensus Statement. Catheterization and Cardiovascular Interventions. First published:06 April 2020 https://doi.org/10.1002/ccd.28910.

Coronavirus (COVID-19) | April 10, 2020

Cardiologist William O’Neill, M.D., medical director of the Center for Structural Heart Disease at Henry Ford Hospital, Detroit, is organizing COVID-19 clinical trials in Detroit with cardiologists at four hospitals. With cardiac trial enrollments at a standstill, Henry Ford's cardiology department offered its research capabilities in the fight against COVID-19.

The collaboration initiated its first 3,000 patient trials April 9 to test if hydroxychloroquine help prevent the onset of COVID-19 in front-line clinicians, first responders and other essential workers. can to bring large-scale novel coronavirus (COVID-19, SARS-CoV-2) drug trials to southeast Michigan. 

Four metropolitan Detroit hospital systems and a leading research university, Henry Ford Health System, Ascension, Detroit Medical Center (DMC), Beaumont and Wayne State University, are collaborating to bring large-scale COVID-19 drug trials to southeast Michigan.

The current WHIP COVID-19 Trial will include three arms in this randomized, blinded trial testing safety and efficacy of hydroxychloroquine in first-responder and front-line healthcare workers. They will be divided into a low-dose arm, high-dose arm and a placebo arm. 

Read more about the trials in the article First Large-scale U.S. Study on Hydroxychloroquine COVID-19 Prophylaxis Begins in Detroit

Read more about O'Neill and other cardiologists heading the COVID-19 trial collaboration.
 

 

Related COVID-19 Cardiology Content:

VIDEO: Overview of Hydroxychloroquine and FDA Warning in its use to Treat COVID-19 — Interveiew with Marianne Pop, Pharm.D.

FDA Reports of Deaths and Injuries From Use of Antimalarial hydroxychloroquine in COVID-19 Patients

VIDEO: Cardiologists Manage Trial Testing if Hydroxychloroquine Protects Clinicians From COVID-19 — Interview with Bill O'Neill, M.D.

FDA Reports of Deaths and Injuries From Use of Antimalarial Drugs in COVID-19 Patients

New York City Physicians Note Multiple Cardiovascular Presentations of COVID-19

AHA, ACC, HRS Caution Use of COVID-19 Therapies Hydroxychloroquine and Azithromycin in Cardiac Patients

FDA Approves ECMO to Treat COVID-19 Patients

COVID-19 STEMI Registry Created to Study Acute Cardiovascular Effects of the Virus

Image Gallery Showing Impact of the COVID-19 Pandemic

VIDEO: Best Practices for Nuclear Cardiology During the COVID-19 Pandemic

VIDEO: Cancelling Non-essential Cardiac Procedures During the COVID-19 Outbreak — Interview with Ehtisham Mahmud, M.D.

ACC COVID-19 recommendations for the cardiovascular care team

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

The Cardiac Implications of Novel Coronavirus

 

Coronavirus (COVID-19) | April 10, 2020

Detroit, Michigan, has been one the hardest hit regions with a large number of COVID-19 cases. William O’Neill, M.D., medical director of the Center for Structural Heart Disease at Henry Ford Hospital, explains the impact of novel coronavirus (COVID-19, SARS-CoV-2) on the cardiology program and his takeaways on COVID-19 cardiovascular involvement based on cases he has seen.

O'Neill said ST-elevated myocardial infarction (STEMI) cases have mysteriously dropped off significantly since quarantines began, a reflection of a nationwide trend. He also said he has not seen a lot of myocarditis or cardiogenic shock COVID-19 patients, except for a small handful. These conditions have been reported elsewhere in COVID-19 patients, but O'Neill said the patients he has seen die of COVID-19 usually have an onset of a cytokine storm, lose vascular integrity and then all their organs fail. He has not seen a primary cardiac component involved in most of the critically ill patients where hemodynamic support would have helped. 

 

Related COVID-19 Cardiology Content:

First Large-scale U.S. Study on Hydroxychloroquine COVID-19 Prophylaxis Begins in Detroit

New York City Physicians Note Multiple Cardiovascular Presentations of COVID-19

AHA, ACC, HRS Caution Use of COVID-19 Therapies Hydroxychloroquine and Azithromycin in Cardiac Patients

FDA Approves ECMO to Treat COVID-19 Patients

COVID-19 STEMI Registry Created to Study Acute Cardiovascular Effects of the Virus

Image Gallery Showing Impact of the COVID-19 Pandemic

VIDEO: Best Practices for Nuclear Cardiology During the COVID-19 Pandemic

VIDEO: Cancelling Non-essential Cardiac Procedures During the COVID-19 Outbreak — Interview with Ehtisham Mahmud, M.D.

ACC COVID-19 recommendations for the cardiovascular care team

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

The Cardiac Implications of Novel Coronavirus

 

 

Coronavirus (COVID-19) | April 04, 2020

Hicham Skali, M.D., a staff cardiologist and member of the Non-invasive Cardiovascular Imaging Program at Brigham and Women’s Hospital (BWH), and at Brigham and Women’s / Massachusetts General Health Care Center at Foxborough, explains the new recommendations from the American Society of Nuclear Cardiology (ASNC) and from imagers in China and Singapore. The ASNC created a best practices document for nuclear cardiology laboratories during the novel coronavirus (COVID-19, SARS-CoV-2) pandemic. The suggestions in the guidelines can ally to any imaging modality, including computed tomography (CT), MRI and ultrasound. 

Skali elaborates on the following points in his discussion, which are specific recommendations in the ASNC and SNMMI COVID-19 guidance document:
   • Rescheduling non-urgent visits
   • Rescheduling elective surgeries and procedures
   • Using separate spaces for patients with known or suspected COVID-19 to prevent spread
   • Ensuring supplies are available
   • Promoting use of telehealth
   • Screen staff, patients and visitors before they enter the department
   • Minimize non-essential visitors into the department
   • Record symptoms at the start of the shift
   • Use personal protective equipment (PPE)for healthcare personnel
   • If available, use PPE for patients due to concern of asymptomatic transmission of COVID-19
   • Maintain strict hand hygiene
   • Maintain 6 feet distance in all patient/staff interactions when possible
   • Work remotely whenever feasible, especially with ready studies
   • Rotating staff schedules for on-site and off-site work
   • Use of rest only studies if possible
   • Use of half-time SPECT to speed exam times
   • Use of PET if available to speed exam times

Skali served as the moderator in for the ASNC on demand webinar COVID-19 Preparedness for Nuclear Cardiology Labs: Insights from the US, China and Singapore.

VIDEO: Telemedicine in Cardiology and Medical Imaging During COVID-19 — Interview with Regina Druz, M.D., an ASNC Board member and also a speaker during the ASNC webinar.

Find more news and video on relating to COVID-19 and its impact on cardiology

Structural Heart | April 03, 2020

Basel Ramlawi, M.D., chairman of The Heart and Vascular Center at Valley Health System in Virginia, director of the Advanced Valve and Aortic Center, and co-principal investigator for an American College of Cardiology (ACC) 2020 Scientific Session late-breaking trial that looks at the clinical implications of TAVR in patients who have bicuspid aortic valve leaflets offers an overview of the data from ACC.20.

Patients with bicuspid, or two-leaflet, aortic valves who undergo transcatheter aortic valve replacement (TAVR) procedures had a high rate of success and low risk of death or disabling stroke at 30 days, according to new data presented at the ACC 2020. The session was part of the virtual, online late-breaking presentations, since the live meeting was cancelled due to the spread of COVID-19. 

TAVR has become increasingly popular in recent years as a less-invasive alternative to open-heart valve replacement surgery. However, few studies have examined its safety in patients with a bicuspid valve, a genetic variation of the aortic valve in some patients, rather than the typic three-leaflet valve. The condition affecting roughly 2-5 percent of people in which two of the three flaps in the aortic valve are fused together.

A bicuspid valve is more likely to become stenosis. Valve replacement, either through TAVR or open-heart surgery, is the main treatment option available for people with severe aortic stenosis, which causes fatigue and other symptoms and raises the risk of other heart problems when left untreated. The new study is the first to prospectively examine TAVR’s safety for treating severe aortic stenosis in relatively young, healthy patients—in whom open-heart surgery would pose a low risk—who have a bicuspid valve. It also is one of the first studies involving such patients in which doctors used a newer self-expanding artificial valve.

“This clearly has clinical implications with patients with bicuspid valves who want TAVR," said Basel Ramlawi, M.D., cardiothoracic surgeon at Valley Health System in Virginia and the study’s co-principal investigator. "TAVR with a self-expanding prosthesis is a very viable and safe procedure in low-risk bicuspid patients and achieved excellent early results. Though additional follow-up is necessary to determine long-term outcomes, early results suggest this procedure can be performed successfully in low-risk individuals with a good outcome.” 

The study prospectively tracked 150 patients who underwent TAVR at 25 medical centers in the U.S. 

Read the aricle on the study

 

Find more ACC news and video

 

 

Structural Heart | April 01, 2020

A review of the PARTNER 3 Low-Risk Trial with Michael Mack, M.D., chairman, cardiovascular service line,  Baylor Scott and White Health, Dallas Texas, chairman of the board of the BSW Health Research institute, Dallas, and co-principal investigator of the trial. The PARTNER 3 Low-Risk Trial two-year data were presented as a late-breaking study at the virtual American College of Cardiology (ACC) 2020 annual meeting. The trial offers additional evidence that TAVR performs as well as surgery in select low-risk patients. 

Mack said the trial included patients over the age of 65, and there is still a question about long-term durability of the Sapien 3 TAVR valve used in trial before it is used in younger patients. He said patients in this trial will be tracked out to 10 years, which will offer a lot of information on durability of the current iteration of this valve. In the video, he also elaborates on TAVR issues involved with bicuspid aortic valves and other patient selection issues.

PARTNER 3 enrolled 1,000 patients with severe aortic stenosis and a Society of Thoracic Surgeons (STS) risk score of less than 4 percent. All patients had a tricuspid aortic valve. Half of the participants were randomly assigned to undergo TAVR and half underwent surgery. At two years, 11.5 percent of patients receiving TAVR and 17.4 percent of those receiving surgery died, suffered a stroke or were rehospitalized for cardiovascular problems, a difference in the composite primary endpoint that researchers reported as showing non-inferiority, meaning neither treatment was superior to the other.

In a secondary analysis, rates of death and stroke were found to be not significantly different between the two groups. Death occurred in 2.4 percent of those receiving TAVR and 3.2 percent of those receiving surgery, while stroke occurred in 2.4 percent of those receiving TAVR and 3.6 percent of those receiving surgery. Rehospitalization rates showed a significant difference in favor of TAVR; 8.5 percent of those receiving TAVR and 12.5 percent of those receiving surgery were rehospitalized for cardiovascular reasons during the study period. 

Read more details about this trial 

Read the one year trial results from ACC 2019

Find other ACC news and videos
 

Coronavirus (COVID-19) | March 26, 2020

Regina Druz, M.D., FASNC, a member of the American Society of Nuclear Cardiology (ASNC) Board of Directors, chairwomen of the American College of Cardiology (ACC) Healthcare Innovation Section, and a cardiologist at Integrative Cardiology Center of Long Island, N.Y., explains the rapid expansion of telemedicine with the U.S. spread of novel coronavirus (COVID-19, SARS-CoV-2).

Druz spoke on the unprecedented expansion of telemedicine in the U.S. under COVID-19, seeing more use in the last two months, as opposed to the past two decades. The Centers for Medicare and Medicaid Services (CMS) previously only reimbursed for Telehealth in rural areas it determined had a shortage of doctors. However, in early March 2020, CMS dropped the geographic requirements and allowed Telehealth usage across th country as a way to mitigate person-to-person contact and keep vulnerable, older patients at home for routine check ups with doctors.

Druz has subspecialty certifications in nuclear cardiology, adult echocardiography and cardiac computed tomography (CT) and explains how Telehealth can be used to pre-screen patients and get patient sign off on procedures prior to coming in for an exam, helping speed the process in the hospital and limit personal contact.

Concerns about the rpaid spread of COVID-19 also has driven many radiology departments to convert to wider use of teleradiology to allow more radiologists to work from home and reduce person-to-person contact within the hospitals. 

The U.S. Federal Communications Commission (FCC) adopt a $200 million telehealth program to support healthcare providers responding to the
ongoing coronavirus pandemic on April 2, 2020. Read more from the FCC.

CMS Expand Medicare Telehealth Benefits During COVID-19 Outbreak, including dropping requirements for rural health locations only, opening telehealth for use across the United States.

Watch the related VIDEO: Use of Teleradiology During the COVID-19 Pandemic — an interview with John Kim, M.D., chairman, Department of Radiology, THR Presbyterian Plano, Texas, and chief technology officer at Texas Radiology Associates.

Recommendations from Druz are also included in the Best Practices for Nuclear Cardiology Laboratories During the Coronavirus (COVID-19) Pandemic
 

 

Related COVID-19 Content:

VIDEO: Imaging COVID-19 With Point-of-Care Ultrasound (POCUS) — Interview with emergency physician Mike Stone, M.D.,

VIDEO: How China Leveraged Health IT to Combat COVID-19 — Interview with Jilan Liu, M.D., CEO for the HIMSS Greater China

Study Looks at CT Findings of COVID-19 Through Recovery

Experts Stress Radiology Preparedness for COVID-19

ACR Recommendations for the Use of Chest Radiography and CT for Suspected COVID-19 Cases

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

The Cardiac Implications of Novel Coronavirus

 

 

FFR Technologies | March 26, 2020

James Udelson, M.D., chief of the division of cardiology, Tufts Medical Center, explains how cardiac computed tomography (CT) scans are being used to create image-derived fractional flow reserve (FFR) values to determine if a coronary lesion is flow limiting. The FFR-CT can help determine if the patient needs a stent, or if the disease can be treated with medication. Tufts uses FFR-CT evaluations on non-emergency chest pain patients to reduce the need for diagnostic catheterizations. 

 

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6 Hot Topics in Interventional Cardiology at TCT 2019

FFR-CT: Is It Radiology or Cardiology?

 

Find more news and video from Tufts Medical Center

 

 

Structural Heart Occluders | March 24, 2020

Interview with Carey Kimmelstiel, M.D., FACP, FACC, director, cardiac catheterization laboratory, director, interventional cardiology, Tufts Medical Center, discusses the patent foramen ovale (PFO) closure program at Tufts.  

Tufts was the lead enrollment site in the Gore and Amplatzer PFO closure device trials. The center works closely with both neurology to select patients who might benefits from PFO closure to help prevent cryptogenic stroke and or migraine headaches. Tufts uses structural heart transcatheter occuders in various anatomical positions and in the left atrial appendage (LAA).

 

Related PFO Closure Content:

VIDEO: How Transcatheter PFO Closure Can Reduce Cryptogenic Stroke — Interview with John Rhodes, M.D.

SCAI Offers Recommendations for Safe Use of PFO Closure Technologies

VIDEO: An Overview of PFO Closure to Treat Cryptogenic Stroke — Interview with Karen Orjuela, M.D.

VIDEO: Demonstration of a Transcatheter PFO Occluder Implantation

VIDEO: Addressing Adult Congenital Heart Referrals — Interview with Ami Bhatt, M.D.

VIDEO: Transcatheter Closure of Holes in the Heart — Interview with Ziyad Hijazi, M.D.
 

Find more videos and content on the Tufts Medical Center

 

Coronavirus (COVID-19) | March 20, 2020

An interview with Ehtisham Mahmud, M.D., FSCAI, chief, Division of Cardiovascular Medicine, executive director of medicine, Cardiovascular Institute, director of  interventional cardiology and cardiac cath lab at UC San Diego Medical Center, and president of the Society for Cardiovascular Angiography and Interventions (SCAI). He explains the how cardiology departments in the U.S. are now postponing cardiovascular procedures due to novel coronavirus (COVID-19, SARS-CoV-2) containment efforts and new guidelines from Medicare calling for delay of all elective procedures in the country. 

Mahmud explains how patients are being prioritized, with acute myocardial infarction patients or others with acute, life-threatening conditions, or at high risk for a near term hospital admission, will still receive cardiac catheterizations, cardiovascular surgery or structural heart procedures for MitraClip and transcatheter aortic replacement (TAVR) under certain circumstances. All other procedures are being postponed until further notice based in the spread and infection rates of COVID-19. He said most hospitals, including his own, are moving to telehealth visits via phone or online to continue clinic work with patients, including those with chronic conditions such as heart failure.

The Centers for Medicare and Medicaid Services (CMS) announced March 18, 2020, that all elective surgeries, and non-essential medical, surgical and dental procedures should be delayed during the coronavirus outbreak. This move is three-fold. 
   1. It is to help with containment efforts by reducing patient and family travel to hospitals, which are at the center of the COVID-19 outbreak. 
   2. Delaying procedures will help preserve and inventory of personal protective equipment (PPE), hospital beds and ventilators and other medical supplies. 
   3. With the start of social distancing and the shut down of all large gatherings, this has severely impacted blood drives and other blood donations, so the nation's blood banks have severely limited supplies.

“The reality is clear and the stakes are high — we need to preserve personal protective equipment for those on the front lines of this fight,” said CMS Administrator Seema Verma.

This will not only preserve equipment but also free up the healthcare workforce to care for the patients who are most in need. Additionally, as states and the nation as a whole work toward limiting the spread of COVID-19, healthcare providers should encourage patients to remain home, unless there is an emergency, to protect others while also limiting their exposure to the virus. 

Read Mahmud's SCAI President's letter The Evolving Pandemic of COVID-19 and Interventional Cardiology

 

Related Cardiology Related COVID-19 Content:

ACC COVID-19 recommendations for the cardiovascular care team

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

The Cardiac Implications of Novel Coronavirus

ESC Council on Hypertension Says ACE-I and ARBs Do Not Increase COVID-19 Mortality

VIDEO: Imaging COVID-19 With Point-of-Care Ultrasound (POCUS)

CT Provides Best Diagnosis for Novel Coronavirus (COVID-19)

Radiology Lessons for Coronavirus From the SARS and MERS Epidemics

Deployment of Health IT in China’s Fight Against the COVID-19 Epidemic

Emerging Technologies Proving Value in Chinese Coronavirus Fight

Radiologists Describe Coronavirus CT Imaging Features

Coronavirus Update from the FDA

CT Imaging of the 2019 Novel Coronavirus (2019-nCoV) Pneumonia

CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)

Chest CT Findings of Patients Infected With Novel Coronavirus 2019-nCoV Pneumonia 

 

Additional COVID-19 Resources for Clinicians:

   ACC COVID-19 Hub page   

   Johns Hopkins Coronavirus Resource Center with inteavtive map of cases in U.S. and worldwide 

   World Health Organization (WHO) COVID-19 situation reports

   World Health Organization (WHO) coronavirus information page

   U.S. Food and Drug Administration (FDA) COVID-19 information page

   Centers for Disease Control (CDC) COVID-19 information page

   Centers for Medicare and Medicaid Services (CMS) frequently asked questions and answers (FAQs) for healthcare providers regarding COVID-19 related payments
 

 

Coronavirus (COVID-19) | March 18, 2020

This is a quick overview of clinical data on the novel coronavirus (COVID-19) as of March 17, 2020. It offers a brief overview on how the virus works, death rates by comorbities (with cardiovascular disease being the most lethal), lessons from the frontlines on coronavirus, and what to watch to determine if patient care should be escalated

Watch the related VIDEO: What Cardiologists Need to Know about COVID-19, an interview with Thomas Maddox, M.D., MSc, FACC, the chairman of the American College of Cardiology (ACC) Science and Quality Committee, which recently created the ACC document on novel coronavirus (COVID-19) clinical guidance for the cardiovascular care team.

Editor's Note: This video was created by Jay Mohan, D.O., RPVI, interventional cardiology fellow at William Beaumont Hospital (Royal Oak). He is cardiology and internal medicine, echocardiography and nuclear cardiology board certified. He also serves as vice president of the Dr. Ramesh Kumar Foundation. He created this video with downtime March 17 because of elective cases being cancelled due to COVID-19 containment efforts.

 

Coronavirus (COVID-19) | March 17, 2020

Interview with Thomas Maddox, M.D., MSc, FACC, the chairman of the American College of Cardiology (ACC) Science and Quality Committee, which recently created the ACC document on novel coronavirus (COVID-19) clinical guidance for the cardiovascular care team. He explains the document and what cardiologists and the cardiac care team needs to know about caring for COVID-19 patients. The document points out COVID-19 combined with the comorbidity of cardiovascular disease has the mortality of any comorbidity, as high as 10.5 percent.

He explains the need for more serious attention to protective equipment, cardiovascular complications seen in COVID-19 (SARS‐CoV‐2) patients, suggestions on how to mitigate exposure if an echo or cath is required, and other considerations for the CV care team. He said the document will be updated on a regular bases and the committee is drafting other sets of related COVID-19 guidelines for cardiology departments.

Updates regarding COVID-19 and cardiology will be posted on the ACC COVID-19 Hub page.

Maddox is also the executive director of the Healthcare Innovation Lab of BJC Healthcare and Washington University School of Medicine, St. Louis. He is also an assistant professor of cardiology at Washington University.

Read more on ACC COVID-19 recommendations for the cardiovascular care team.

 

Additional COVID-19 Resources for Clinicians:

   World Health Organization (WHO) COVID-19 situation reports

   World Health Organization (WHO) coronavirus information page

   U.S. Food and Drug Administration (FDA) COVID-19 information page

   Centers for Disease Control (CDC) COVID-19 information page

   Centers for Medicare and Medicaid Services (CMS) frequently asked questions and answers (FAQs) for healthcare providers regarding COVID-19 related payments
 

 

Related COVID-19 Content:

The Cardiac Implications of Novel Coronavirus

ESC Council on Hypertension Says ACE-I and ARBs Do Not Increase COVID-19 Mortality

CT Provides Best Diagnosis for Novel Coronavirus (COVID-19)

Radiology Lessons for Coronavirus From the SARS and MERS Epidemics

Deployment of Health IT in China’s Fight Against the COVID-19 Epidemic

Emerging Technologies Proving Value in Chinese Coronavirus Fight

Radiologists Describe Coronavirus CT Imaging Features

Coronavirus Update from the FDA

CT Imaging of the 2019 Novel Coronavirus (2019-nCoV) Pneumonia

CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)

Chest CT Findings of Patients Infected With Novel Coronavirus 2019-nCoV Pneumonia 

Coronavirus (COVID-19) | March 17, 2020

Interview with Mike Stone, M.D., an emergency physician at Northwest Acute Care Specialists in Portland, Ore., director of point of care ultrasound education at Butterfly Network Inc., and and former chief of the division of emergency ultrasound at Brigham and Women's Hospital, Boston. He explains what clinicians look for in lung ultrasound to evaluate patients for plural wall thickening and areas of congestion inside the lung typical of pneumonia and seen in patients with novel coronavirus (COVID-19, also referred to clinically as SARS-COV-2). 

Small hand-held ultrasound systems may offer advantages over X-ray or computed tomography (CT), because the entire system can be contained inside a protective sheath, making it easier to disinfect the device rather than an entire imaging room. Point of care ultrasound (POCUS) systems also allow triage of patients in tents or other areas outside of the hospital where other imaging modalities are not available. 

Stone shares examples of COVID-19 ultrasound images from Butterfly Network POCUS system technology, which turns an iPhone into an FDA-cleared ultrasound device for multiple POCUS exam types. It is the first POCUS system reported to be used for triage and monitoring COVID-19 patients. 
 

Related Content:

VIDEO: Point of Care Ultrasound (POCUS) in Cardiology and Critical Care — Interview with Michael Lanspa, M.D.

VIDEO: Automated Cardiac Ejection Fraction for Point-of-care-ultrasound Using Artificial Intelligence

The Cardiac Implications of Novel Coronavirus

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

ESC Council on Hypertension Says ACE-I and ARBs Do Not Increase COVID-19 Mortality

Find more related clinical content Coronavirus (COVID-19)

Study Looks at CT Findings of COVID-19 Through Recovery

Experts Stress Radiology Preparedness for COVID-19

ACR Recommendations for the Use of Chest Radiography and CT for Suspected COVID-19 Cases

Wuhan CT Scans Reliable for Coronavirus Diagnosis, Limited for Differentiation

Heart Failure | March 13, 2020

Interview with Navin Kapur, M.D., FAHA, FACC, FSCAI, executive director, The CardioVascular Center for Research and Innovation (CVCRI), and director of Cardiac Biology Research Center, Molecular Cardiology Research Institute (MCRI), Tufts Medical Center, Boston. He explains how temporary occlusion of the superior vena cava (SVC) appears to help reset the heart to normal function in heart failure patients. Kapur is currently involved in a trial using the PreCardia device pioneered at Tufts Medical Center.

Read more about the first late-breaking presentation of this technology at SCAI 2019 — Novel Therapeutic Approach Effective at Reducing Pressure for Heart Failure Patients
 

Find more videos and content on the Tufts Medical Center

Structural Heart | February 27, 2020

Charles D. Resor, M.D., MSc, assistant director, cardiac catheterization lab, Tufts Medical Center and assistant professor of medicine, Tufts University School of Medicine, explains the structural heart program at Tufts Medical Center. He outlines the centers' use of a variety of transcatheter interventional devices, including the MitraClip to repair mitral valve and tricuspid valve; occluders to seal congenital holes in the heart; PFO closure to prevent cryptogenic stroke; and the Watchman device to close the left atrial appendage (LAA) in atrial fibrillation patients.

 

VIDEO: Overview of the TAVR Program at Tufts Medical Center — Interview with Andrew Weintraub, M.D.

VIDEO: The Expansion of TAVR Following the FDA Clearing its Use in All Patients — Interview with Torsten Vahl, M.D.

 

Find more content on Tufts Medical Center

 

Tufts Medical Center | February 26, 2020

Lara Reyelt, veterinary technician and preclinical surgeon at the Interventional Research Laboratories (SIRL) at Tufts Medical Center, Boston, explains how research at her lab has helped advance human cardiovascular device technologies. 

Tufts Medical Center is unique in that it has a preclinical cath lab at the hospital, which allows for very close working relationships between the preclinical and the clinical teams, speeding up the collaboration and translational procedures. An example of this collaboration was the development of a new technique to treat congestive heart failure by temporarily occluding the SVC, which helps "reset" the heart. The lab also pioneered a novel approach now being used in the FDA DTU Trial to treat STEMI heart attacks with Impella hemodynamic support first, followed by 30 minutes of hemodynamic support prior to revascularizing the patient with percutaneous coronary intervention (PCI). The lab also performed preliminary work with the HeartMate PHP System to determine protocols for the now ongoing SHIELD II clinical trial. The lab also was used to test several new device technologies prior clinical trials, including the Impella 5.5 device. 

Find more videos and content on the Tufts Medical Center

 

Heart Valve Technology | February 18, 2020

Andrew Weintraub, M.D., FACC, associate director, of the Interventional Cardiology and Vascular Center, medical director of the Vascular and Structural Heart Center, Tufts Medical Center, discusses the use of temporary pacing in transcatheter aortic valve replacement (TAVR) patients. Implantation of TAVR valves can cause pressure from the valve against the septal wall of the heart, causing conduction delays. These delays do not necessarily mean the patient needs a permanent pacemaker.

Instead, Tufts Medical Center uses temporary pacing leads, a small catheter with two electrodes, placed in the right ventricle of the heart through a vein in the groin or neck. The lead is then connected to an external pacemaker allowing a physician to monitor and control a patient’s heart rate for up to several days.  The center uses the BioTrace Medical Tempo Lead, which incorporates a novel active fixation mechanism, bipolar electrodes and a soft tip. Stabilizers provide secure fixation and maintain stable pace capture. An elastomeric balloon may be inflated to aid passage of the lead through the venous vasculature and into the right ventricle, and  aids in wall apposition during deployment of the stabilizers. This design helps secure and stabilize the cardiac pacing lead with the goal of reducing complications and allowing patients to ambulate sooner after procedures.

 

Related Content:

VIDEO: Overview of the TAVR Program at Tufts Medical Center — Interview with Andrew Weintraub, M.D.

VIDEO: The Expansion of TAVR Following the FDA Clearing its Use in All Patients — Interview with Torsten Vahl, M.D.

VIDEO: Overview of the Structural Heart Program at Tufts Medical Center — Interview with Charles D. Resor, M.D.,

 

Find more content on Tufts Medical Center

 

 

 

Antiplatelet and Anticoagulation Therapies | February 18, 2020

Carey Kimmelstiel, M.D., FACP, FACC, director, interventional cardiology, director, cardiac catheterization lab, Tufts Medical Center, explains research on platelet inhibition agents used in the interventional lab. He discusses research and optimization of GP IIb IIIa inhibitors, changing protocols for tirofiban and the use of bivalirudin. 

Watch another interview with Kimmelstiel — VIDEO: Septal Ablation to Treat Hypertrophic Cardiomyopathy.
 

Find more content on Tufts Medical Center 

Pacemakers | February 13, 2020

This video illustrates how the Micra AV leadless pacemaker is delivered via catheter and enables atrioventricular (AV) synchrony. The device was cleared by the U.S. Food and Drug Administration (FDA) in January 2020, expanding the number of potential candidates who can receive leadless, catheter delivered pacemakers in the U.S.

The device is the world’s smallest pacemaker with atrioventricular (AV) synchrony. It is indicated for the treatment of patients with AV block, a condition in which the electrical signals between the chambers of the heart (the atria and the ventricle) are impaired. It is similar to the single chamber Micra TPS pacemaker that has been on the market since 2016. However, the Micra AV has several additional internal atrial sensing algorithms which detect cardiac movement, allowing the device to adjust pacing in the ventricle to coordinate with the atrium, providing “AV synchronous” pacing therapy to patients with AV block. The device senses when blood is flowing through the right ventricle. 

 

Related Micra Leadless Pacemaker Content:

FDA Clears Medtronic Micra AV to Treat AV Block

VIDEO: Current State of Leadless Pacemaker Technology — Interview with Vivek Reddy, M.D.

Novel Mechanical Sensor in Medtronic Micra Transcatheter Pacing System Detects Atrial Contractions, Restores AV Synchrony

VIDEO: How to Implant the Micra Leadless Pacemaker

New Algorithms in Medtronic Micra Pacemaker May Improve Synchrony and Cardiac Function in AV Block

FDA Approves World's Smallest Pacemaker for U.S. Patients

Safety, Performance of the World's Smallest Pacemaker Reinforced in Real-world Patients

One-Year Results for Micra TPS Pacemaker Trial Presented at ESC 2016

Leadless Pacemaker Gains Medicare Reimbursement

Wireless and Leadless Pacemaker Being Developed by Texas Heart Institute With Federal Grant
 

 

 

Heart Failure | February 10, 2020

Interview with James Udelson, M.D., chief of the division of cardiology at Tufts Medical Center, Boston. The hospital created a team of heart failure experts to work together to provide the best care options for patients to help improve outcomes.

The Tufts heart failure program offers various levels of hemodynamic support, up to left ventricular assist devices (LVAD) and heart transplants. The center is also using several cutting edge device technologies, including intra-atrial shunt device and controlling baroreceptors with a pacemaker type device. Tufts is also using devices in clinical trials, including a short term aortic pump to augment blood flow, and balloon occlusion of the superior venacava (SVC) to mitigate some heart failure symptoms. 

Find more content on Tufts Medical Center

Hemodynamic Support Devices | February 07, 2020

Interview with Navin Kapur, M.D., FAHA, FACC, FSCAI, executive director, The CardioVascular Center for Research and Innovation (CVCRI), director, Acute Mechanical Circulatory Support Program; director, interventional research laboratories; director of Cardiac Biology Research Center, Molecular Cardiology Research Institute (MCRI), Tufts Medical Center. He explains the Door-to-Unloading (DTU) Trial, which is using Impella hemodynamic support to unload the heart 30 minutes prior to percutaneous coronary intervention (PCI) in ST-elevated myocardial infarction (STEMI) patients. 

Data from a pilot trial and pre-clinical testing shows early hemodyanmic support prior to PCI helps reduce or eliminate the ischemia and limits myocardial damage due to ischemia. It also appears to help reduce the no-reflow phenomenon, reperfusion injury that  occurs in some heart attack patients who are revascularized, but the restoration of blood flow does not immediately help the patient. The DTU Trial is investigating if immediate hemodynamic support improves outcomes in STEMI patients. If it does, this could be a paradigm shift in therapy for these patients.

 

Related Door-to-unloading Content:

FDA Approves Initiation of STEMI DTU Pivotal Randomized Controlled Trial

VIDEO: The Door-to-Unloading (DTU) STEMI Safety and Feasibility Trial — Interview Nevin Kapur, M.D.

VIDEO: The Importance of Ventricular Unloading in AMI and Cardiogenic Shock — Interview Nevin Kapur, M.D.

VIDEO: Tufts Uses a Hemodynamic Support Algorithm to Determine What Devices to Use — Interview Nevin Kapur, M.D.

VIDEO: Hemodynamic Support Protocols at Henry Ford Hospital — Interview with William O'Neill, M.D. 

Find more content on Tufts Medical Center 

 

Heart Valve Technology | January 28, 2020

Interview with Andrew Weintraub, M.D., FACC, associate director, of the Interventional Cardiology and Vascular Center, medical director of the Vascular and Structural Heart Center, Tufts Medical Center, and assistant professor of medicine, Tufts University School of Medicine. He explains the Tufts Medical Center transcatheter aortic valve replacement (TAVR) program.

Weintraub said TAVR usage has been increasing the past few years, and in 2019 the U.S. Food and Drug Administration (FDA) cleared the use of TAVR in all patient surgical risk categories, opening the procedure to all patients. He explained this will increase TAVR volumes in the coming years. 

Tufts Medical Center has been using the balloon-expandable Edwards Lifesciences Sapien valve for several years, but is plans to start using the self-expanding Medtronic Corevalve as well, because it may offer better outcomes in some types of patients. 

Learn how the pacemaker implant rate was reduced at Tufts Medical Center in the VIDEO: Use of a Temporary Pacing Lead in TAVR.

Watch the related VIDEO: The Expansion of TAVR Following the FDA Clearing its Use in All Patients — Interview with Torsten Vahl, M.D.

 

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Cath Lab | January 24, 2020

Interview with Carey Kimmelstiel, M.D., FACP, FACC, director, cardiac catheterization laboratory, director, interventional cardiology, Tufts Medical Center, and professor of medicine at Tufts University School of Medicine. He explains how septal ablation is used to treat hypertrophic cardiomyopathy (HCM). The Tufts Medical Center HCM program is the largest in New England. 

Tufts Medical Center performs septal ablation to treat medication-refractory HCM. They use a heart team approach to determine which patients are best served by surgical septal myectomy or alcohol septal ablation.

When drug treatments are ineffective, the center offers several procedures to treat HCM:
   
   • Implantable cardioverter defibrillators (ICDs) to prevent sudden cardiac death in high risk patients. 

   • Surgical septal myectomy for patients who experience significant limitation during physical activity and are unresponsive to medical drug treatment. This operation may be performed along with the Maze procedure to lessen the chances of recurrent atrial fibrillation.

   • Alcohol septal ablation for patients who are generally not ideal candidates for the myectomy operation. This procedure takes place in the catheterization laboratory without general anesthesia, and mimics the beneficial effects of surgery. 

   • Ablation for recurrent atrial fibrillation performed in the catheterization laboratory to lessen the likelihood for additional episodes.

   • Heart transplant for the some patients without obstruction who experience severe symptoms and are unresponsive to drug treatment.

 

Find more content on Tufts Medical Center 

 

 

 

Hemodynamic Support Devices | January 24, 2020

Navin Kapur, M.D., FAHA, FACC, FSCAI, director, Acute Mechanical Circulatory Support Program and executive director of The CardioVascular Center for Research and Innovation (CVCRI), Tufts Medical Center, explains how Tufts determines the level of hemodynamic support a patient needs. They use an algorithm to determine if low levels of support are needed with an intra-aortic balloon pump (IABP), or incrementally high levels with a percutaneous Impella pump, TandemHeart, extracorporeal membrane oxygenation (ECMO), or a surgically implanted ventricular assist device (VAD).


Watch the related VIDEO: Hemodynamic Support Protocols at Henry Ford Hospital
 

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Robotic Systems | January 20, 2020

This video shows the first robotic percutaneous coronary interventions (PCI) performed in Germany with the Robocath R-One robotic catheter guidance system. The first procedures were performed by Professor Michael Haude, director of Medical Clinic I at Rheinland Klinikum Neuss Lukaskrankenhaus, and his team. read more in the article First Robotic Coronary Angioplasties Performed With Robocath System in Germany.

 

Related Robocath Content:

Robocath Successfully Carries Out First Robotic Coronary Angioplasties in Humans

Robocath Receives $1.5 Million in Capital for Advancement of R-One Robotic System 

 

RSNA | January 13, 2020

DAIC/ITN Editor Dave Fornell takes a tour of some of the most innovative new medical imaging technologies displayed on the expo floor at the Radiological Society of North America (RSNA) 2019 meeting. 

Technology examples include a robotic arm to perform remote ultrasound exams, integration of artificial intelligence (AI) to speed or automate radiology workflow, holographic medical imaging display screens, a new glassless digital radiography (DR) X-ray detector, augmented reality for transesophageal echo (TEE) training, moving DR X-ray images, 3-D printed surgical implants created from a patient's CT imaging, DR X-ray tomosynthesis datasets, radiation dose management and analytics software, and new computed tomography (CT) technologies.

 

Find more videos and news from RSNA 2019

 

Wearables | January 09, 2020

The Consumer Electronic Show (CES) is the world's gathering place for consumer technologies, with more than 175,000 attendees and more than 4,400 exhibiting companies. New healthcare technologies are among the top trends at CES. This video offers a quick look at the trends specific to healthcare technology.

Artificial intelligence (AI) is one of the hottest technology trends across all product across the CES floor this year. There is also discussion by key note speakers that the internet-of-things (IOT) concept introduced at CES nearly a decade ago is now morphing into a new meaning for the interconnectivity-of-things. This can be seen in healthcare products shown here and across all types of consumer and business products. 

The device technology at CES include many examples of how integrated wearables can digitally enable healthcare. The future of healthcare will include system where consumers are continuously monitored with sensors, software and services that can pinpoint digital biomarkers — earlier warning signs that predict health events. This is the prediction of Leslie Saxon, M.D., executive director of the University of Southern California (USC) Center for Body Computing (CBC), is speaking as a panelist about digital health trends and challenges in the session “Proving the Impact of Transformative Technology.” 

Saxon is a board-certified cardiologist and digital health expert who understands how developing technologies can more accurately assess wellness and human performance among elite athletes, military personnel and patients. She explained this digital healthcare model of the future is a vast contrast to the current point-of-care model.