Challenging clinical and organizational scenarios in cardiovascular diseases during the SARS-CoV-2 pandemic in Poland. Can we do better?

摘要

During the current SARS-Cov-2 pandemic, the management of patients with cardiovascular disease (CVD) should be focused not only on the improvement of outcomes but also the safety of both medical staff and patients, as well as limited healthcare resources and high demand for intensive care beds. Based on the previous experience from China, Italy, as well as other countries, all cardiology societies have issued guidelines for medical professionals to guide them through this challenging period. The Association of Cardiovascular Interventions of the Polish Cardiac Society (AISN PTK) on March 19, 2020, at the very beginning of the epidemic in Poland, published guidelines for the treatment of patients with acute coronary syndromes (ACS) in this setting. In addition, AISN PTK initiated numerous educational initiatives for healthcare professionals and information for patients disseminated on TV, radio, and social media. What clinical and organizational issues are we facing when taking care of patients with ACS and high risk chronic coronary syndromes during the SARS-CoV-2 pandemic? Two interesting articles published in the current issue of Advances in Interventional Cardiology address these problems. Broadly there are two categories of challenges. First, the clinical scenarios differ from what we are used to diagnose and treat. The presentation of ACS is different, with more patients presenting with symptoms suggestive of ACS. Registries show that a substantial number of patients with ST-segment elevation have no obstructive coronary disease. The increase of cardiac troponins is widespread and can represent myocardial inflammation rather than ischemia in a large percentage of cases. This can be related to diffuse inflammatory reaction involving the heart and is consistent with myocarditis, often with decompensated heart failure with high in-hospital mortality [1, 2]. The article of Bujak et al. describes the acute presentation of a patient with chest pain and ST-segment elevation, who was found to have no obstructive coronary lesions and proved to have COVID19 [3]. Therefore a low threshold for alternative diagnosis has to be taken. Also, given the high incidence of myocarditis mimicking ST-segment elevation acute myocardial infarction (MI), one has to be careful with advocating thrombolytic therapy instead of primary percutaneous coronary intervention (PCI). Secondly, there are profound changes in the way we diagnose and treat the patients...