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 the research being done by the Cardiogenic Shock Working Group, which is headed by Tufts. 

The Cardiogenic Shock Working Group (CSWG) has created a patient registry now includes 15-20 centers in the United States and data on more than 2,000 patients who suffered shock either from heart failure or acute myocardial infarction (MI). It also includes hemodynamic data on more than 1,100 patients. It also includes all types of mechanical circulatory support devices, from intra-aortic balloon pump (IABP),  incrementally higher levels with a percutaneous Impella pump, TandemHeart, and extracorporeal membrane oxygenation (ECMO).

Research last year showed three types of phenotype profiles in cardiogenic shock patients, including non-congested, cardio-renal and cardio-renal-hepatic. Kapur also said there is evidence that there is venous involvement that needs to be considered in future research.

The large amount of variables in the patient data from the CSWG is partly examined by artificial intelligence (AI), which helped identify the three shock phenotype profiles.

Related Cardiogenic Shock and Hemodyanmic Support Content:

VIDEO: Door-to-Unloading (DTU) Trial May Change STEMI Care

VIDEO: Tufts Uses a Hemodynamic Support Algorithm to Determine What Devices to Use

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VIDEO: Cardiogenic Shock Initiative Continues to Reduce Mortality by 50 Percent

VIDEO: How to Reduce Cardiogenic Shock Mortality by 50 Percent

SCAI Releases New Consensus Document on Classification Stages of Cardiogenic Shock

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VIDEO: The Importance of Ventricular Unloading in AMI and Cardiogenic Shock

VIDEO: Escalation of Support and Algorithms for Cardiogenic Shock

10 Reasons Why it is Time to Learn More About Cardiogenic Shock

New Approaches to Reduce Cardiogenic Shock Mortality

Find more content on Tufts Medical Center 

The Vieussens’ arterial ring (VAR) is a connection between the conus artery and the left anterior descending (LAD) coronary artery’s proximal right ventricular branch. VAR is present in about 48 percent of the population as an embryonic conotruncal ring remnant. This ring can be exploited as an alternative coronary artery revascularization route in patients where this anatomy is present. Guidewires can be navigated from the right coronary artery through the conus to the LAD.

Jay Mohan, D.O., RPVI, interventional cardiology fellow at William Beaumont Hospital, Royal Oak, Michigan, created this video to briefly explain the use of the Vieussens’ arterial ring in interventional cardiology.  

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

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.

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.

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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

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.
 

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

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

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

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The Cardiac Implications of Novel Coronavirus

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.

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

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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

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.

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

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

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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

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

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.,

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The Cardiac Implications of Novel Coronavirus

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 very closely with neurology to select patients who might benefits from PFO closure to help prevent cryptogenic stroke and or migraine headaches. Tufts uses structural heart transcatheter occluders 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

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
 

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
 

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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.

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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

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:

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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 showed early hemodynamic 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

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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 

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.

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