ESC Guidance For The Diagnosis And Management Of CV .
ESC Guidance for the Diagnosis andManagement of CV Disease during theCOVID-19 Pandemic1. Introduction . 102. Epidemiology. 112.1. Impact of Cardiovascular Comorbidities on COVID-19 Infection Outcomes . 112.2. Cardiovascular Manifestations and Clinical Course of COVID-19 Infection . 133. Pathophysiology - Mechanisms of Disease in Relation to the Cardiovascular System . 143.1. Relationships Between Hypertension, Angiotensin-Converting Enzyme 2 and COVID-19. 183.2. Acute Cardiac Injury and Myocarditis in COVID-19 . 183.3. Immune System Dysregulation and Cardiovascular Disease in COVID-19 . 184. Strategies for Diagnosing SARS-CoV-2 . 195. Protective Measures for Health Care Personnel and Patients in Cardiology . 215.1. General Risk Assessment and Protective Measures . 215.1.1. Risk of SARS-CoV-2 Infection in Health Care Providers. 215.2.1. Ambulatory Setting . 265.2.2. Ward Setting . 275.2.3. Emergency Department . 275.2.4. Intensive Care Unit. 285.2.5. Catheterization Laboratory . 285.2.5.1. ST-Segment Elevation Myocardial Infarction. 285.2.5.2. Non-ST-Segment Elevation Myocardial Infarction – Acute Coronary Syndrome . 285.2.6. Electrophysiology Laboratory . 295.2.7. Transesophageal Echocardiography, Continuous Positive Airway Pressure and OrotrachealIntubation Patients . 305.3. Patients . 306. Triage Systems (Reorganization and Redistribution) . 326.1. Overriding Principles of Triage . 326.2. Hospital and Ambulance Networks. 336.3. Emergency Department . 336.4. Intensive Care Unit and Intermediate Care Unit . 347. Diagnosis of Cardiovascular Conditions in COVID-19 Patients . 35The document is a guidance document. The recommendations are the result of observations and personal experience fromhealth care providers at the forefront of the COVID-19 pandemic. The European Society of Cardiology 2020. All rightsreserved.Page 1
7.1. Clinical Presentation . 357.1.1. Chest Pain. 357.1.2. Dyspnoea, Cough, Respiratory distress . 357.1.2.1. Dyspnoea . 357.1.2.2. Cough . 357.1.2.3. Acute Respiratory Distress Syndrome . 367.1.3. Cardiogenic Shock . 367.1.5. Hospitalization for Pneumonia and Time Course of Increased Subsequent Risk ofCardiovascular Death . 387.2. Electrocardiogram . 387.3. Biomarkers . 397.3.1. Biomarker Elevation Suggesting Cardiovascular Conditions in Patients with COVID-19Infection . 397.3.1.1. Cardiac Troponin I/T . 397.3.1.2. B-Type Natriuretic Peptide/N-Terminal B-Type Natriuretic Peptide . 417.3.1.3. D-Dimers . 417.3.2. Potential Mechanisms Underlying the Biomarker Elevation . 417.3.3. Which Biomarkers Should be Measured and When? . 427.4. Non-Invasive Imaging . 427.4.1. Transthoracic and Transesophageal Echocardiography . 437.4.2. Computed Tomography . 447.4.3. Nuclear Cardiology . 447.4.4. Cardiac Magnetic Resonance . 457.4.5. Exercise Testing . 457.5. Differential Diagnosis . 468. Categorization of Emergency/Urgency of Invasive Procedures. 469. Management/Treatment Pathways. 499.1. Non-ST-Segment Elevation Acute Coronary Syndromes . 499.2. ST-Segment Elevation Myocardial Infarction. 509.3. Cardiogenic Shock . 539.4. Chronic Coronary Syndromes . 569.4.1. Practical Considerations on Medical Therapy. 569.4.2. Non-Invasive Testing . 579.4.3. Invasive Assessment and Revascularization . 579.5. Heart Failure . 58Last updated on 10 June 2020. The European Society of Cardiology 2020. All rights reserved.Page 2
9.5.1. Acute Heart Failure . 599.5.2. Myocarditis . 609.5.3. Chronic Heart Failure . 609.5.3.1. Prevention of SARS-CoV-2 Infection . 619.5.3.2. Diagnostic Hints . 619.5.3.3. Chronic Heart Failure Treatment . 619.5.3.4. Telemedicine and Home Drug Delivery . 619.5.4. Left Ventricular Assist Device and Heart Transplantation . 629.6. Valvular Heart Disease . 629.6.1. Management of Aortic Stenosis. 639.6.2. Management of Mitral Regurgitation . 649.7. Hypertension. 659.7.1. Hypertension and COVID-19 . 669.7.2. Antihypertensive Treatment with Angiotensin Converting Enzyme Inhibitors orAngiotensin Receptor Blockers . 669.7.3. Remote Management of Hypertension in the Patient Isolated at Home . 679.7.4. Hypertension and the Hospitalized Patient with COVID-19 Infection . 679.9.1. Monitoring and Follow up of Patients with Cardiac Implantable Devices . 709.9.2. Considerations for Electrophysiological and Implantable Device Procedures . 719.9.3. Management of Cardiac Arrhythmias in Patients with COVID-19 Infections . 729.9.3.1. Tachyarrhythmias . 739.9.3.1.1. Supraventricular Tachycardia . 739.9.3.1.2. Atrial Fibrillation and Flutter . 739.9.3.1.3. Ventricular Arrhythmias. 759.9.3.1.4. Channelopathies . 789.9.3.2. Bradyarrhythmias. 7910. Treatment of SARS-CoV-2 infection . 7910.1. Arrhythmogenic and QTc Considerations of COVID-19 Therapies . 8010.1.1. QTc Evaluation to Prevent Drug-Induced Pro-Arrhythmia . 8310.1.2. Technical Aspects of QT Measurements . 8410.2. Considerations on the Use of Anticoagulants in COVID-19 Patients . 8511. Patient Information. 8711.1. Who is at Risk for Severe SARS-CoV-2?. 8711.2. My Treatment During the COVID-19 Pandemic? . 8711.3. Interactions with Others, Healthy Lifestyle and Medical Advice during COVID-19 Pandemic 89Last updated on 10 June 2020. The European Society of Cardiology 2020. All rights reservedPage 3
12. Contributors . 91Authors. 91Reviewers . 9513. List of Figures . 9714. List of Tables . 9815. List of References . 99Last updated on 10 June 2020. The European Society of Cardiology 2020. All rights reservedPage 4
How to cite this document:The European Society for Cardiology. ESC Guidance for the Diagnosis and Management of CV Diseaseduring the COVID-19 Pandemic. rdiology/ESCCOVID-19-Guidance. (Last update: 10 June 2020)Last updated on 10 June 2020. The European Society of Cardiology 2020. All rights reservedPage 5
List of abbreviationsAcronymsAAAAADACE2DefinitionAbdominal aortic aneurysmAntiarrhythmic drugsAngiotensin-converting enzyme 2ACEIACSADAMTS17AFAGPAMIAngiotensin-converting enzyme inhibitorAcute coronary syndrome (s)ADAM metallopeptidase with thrombospondin type 1 motif, 17Atrial fibrillationAerosol generation procedureAcute myocardial infarctionAngARBARDSASASDAVAngiotensinAngiotensin receptor blockerAcute respiratory distress syndromeAortic stenosisAtrial septal defectAtrioventricularAVAAVBBALBAVBNPBPAortic valve areaAtrioventricular blockBronchoalveolar lavageBalloon aortic valvuloplastyB-type natriuretic peptideBlood pressurebpmBSCABGCADCCBCCSBeats per minuteBrugada syndromeCoronary artery bypass graftCoronary artery diseaseCalcium channel blockerChronic coronary syndrome (s)CCTACD209CICIEDCKCoronary computed tomography angiogram/angiographyCluster of differentiation 209Score for AF stroke risk (congestive HF, hypertension, age, diabetes and previousstroke/transient ischaemic attack – vascular disease [peripheral arterial disease,preceding MI, aortic atheroma])Confidence intervalCardiovascular implantable electronic devicesCreatine kinaseCMRCOPDCOVID-19CPAPCPRCPVTCrClCardiac magnetic resonanceChronic obstructive pulmonary diseaseCoronavirus disease 2019Continuous positive airway pressureCardiopulmonary resuscitationCatecholaminergic polymorphic ventricular tachycardiaCreatinine clearanceCRSCytokine release syndromeCHA2DS2-VAScLast updated on 10 June 2020. The European Society of Cardiology 2020. All rights reservedPage 6
AcronymsCSCTCTOCVDefinitionCardiogenic shockComputed tomographyChronic total rdiovascular diseaseC-X-C motif chemokine 10Cytochrome P450 3A4Dual antiplatelet therapyDirect rporeal membrane oxygenationEmergency departmentEstimated glomerular filtration rateEnzyme-linked immunosorbent assayElectrophysiologyEmergency roomERIESCElective replacement indicatorEuropean Society of CardiologyESHFAERSFFP2/FFP3FoCUSGRACEEuropean Society of HypertensionFDA adverse event reporting systemFiltering face-piece Class 2/Filtering face-piece Class 3 (respirator mask)Focused cardiac ultrasound studyGlobal Registry of Acute Coronary EventsHCPHFHFAHFpEFHRhs-cTnHealthcare personnel, Healthcare professionalHeart failureHeart failure associationHeart failure with preserved ejection fractionHazard ratioHigh-sensitivity cardiac troponini.v.ICAICCUICDICUIEIntravenousInvasive coronary angiographyIntensive cardiac care unitImplantable cardiac defibrillatorIntensive care unitInfective Implantable loop recorderInternational normalized ratioGlobal organization developing and implementing evidence-based clinical practiceguidelines in kidney disease (Kidney Disease: Improving Global Outcomes)Left Atrial AppendageLADLAFBLDHLeft anterior descending (coronary artery)Left anterior fascicle blockLactate dehydrogenaseKDIGOLast updated on 10 June 2020. The European Society of Cardiology 2020. All rights reservedPage 7
AcronymsLMWHLQTSLVLVADDefinitionLow molecular weight heparinLong QT syndromeLeft ventricularLeft ventricular assist deviceLVEFMCSMERSMIMRMRILeft ventricular ejection fractionMechanical circulatory supportMiddle East respiratory syndromeMyocardial infarctionMitral regurgitationMagnetic resonance imagingMSNAATNGSNHCNOACNRMultiple sclerosisNucleic acid amplification testNext Generation SequencingNorthwest Community HealthcareNon-vitamin K antagonist oral anticoagulantNot roidal anti-inflammatory drugNon-ST-segment elevationNon-ST-segment elevation acute coronary syndromesNon-ST-segment elevation myocardial infarctionN-terminal B-type natriuretic peptideNew York Heart AssociationOD.OHCAORPAPRPCIPCROnce dailyOut-of-hospital cardiac arrestOdds ratioPowered air-purifying respiratorPercutaneous coronary interventionPolymerase chain reactionPEPETPFOP-gpPMPOCPulmonary embolismPositron emission tomographyPatent foramen ovaleP-glycoproteinPacemakerPoint of CarePOCUSPPEPSVTQTcRAASPoint of care focused ultrasoundPersonal protective equipmentParoxysmal supraventricular tachycardiaQT interval (the interval from the QRS complex to the end of the T wave on an ECGrepresenting ventricular depolarization and repolarization and indicating the timeduring which ventricular contraction and subsequent relaxation occurs)Corrected QT intervalRenin–angiotensin–aldosterone systemRASRBBBRNARenin–angiotensin systemRight bundle branch blockRibonucleic acidQTLast updated on 10 June 2020. The European Society of Cardiology 2020. All rights reservedPage 8
AcronymsRORrPARRRT-PCRDefinitionReporting odds ratioRecombinant plasminogen activatorRisk rateReverse transcriptase polymerase chain vere acute respiratory syndromeSevere acute respiratory syndrome coronavirus 2Surgical aortic valve replacementSudden cardiac deathSystemic Lupus ErythematosusSMRSOFASPECTSTEMISTSSVISecondary mitral regurgitationSequential Organ Failure AssessmentSingle photon emission computed tomographyST-segment elevation MISociety of Thoracic SurgeonsStroke volume indexT1MITAVITdPTEETISSTMPRSS2Type 1 myocardial infarctionTranscatheter aortic valve implantationTorsades de PointesTransesophageal echocardiographyTherapeutic intervention scoring systemTransmembrane protein serine 2TNKtPATTEUFHULNUSTenecteplaseTissue plasminogen activatorTransthoraci
ESC European Society of Cardiology ESH European Society of Hypertension FAERS FDA adverse event reporting system FFP2/FFP3 Filtering face-piece Class 2/Filtering face-piece Class 3 (respirator mask) FoCUS Focused cardiac ultrasound study GRACE Global Registry of Acute Coronary Events HCP Healthcare personnel, Healthcare professional
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About This Manual 1-2 Print Area Calculation 1-3 PROGRAMMING CONCEPTS Programming Language 2-2 Selecting Protocol Codes 2-3 Using Basic 2-4 Print Position Commands 2-6 COMMAND CODE QUICK REFERENCE A: ESC A Start Label 3-2 ESC A Cut, Label 3-2 ESC a Cut, Job3-2 ESC B Cut, Last 3-2 ESC AO Auto Online 3-2 ESC A1 Media Size 3-2 ESC & Form .
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Bruksanvisning för bilstereo . Bruksanvisning for bilstereo . Instrukcja obsługi samochodowego odtwarzacza stereo . Operating Instructions for Car Stereo . 610-104 . SV . Bruksanvisning i original
