COVID-19 infection quickly became a problem of global value and emergency situation in the field of health care. Today it is very important that cardiologists knew this pathology in its epidemiological, pathophysiological and therapeutic aspects to have an opportunity better to cope with the arisen emergency situation by means of the protocols offered on the basis of exchange of experience.
The reasons which do COVID-19 by the infection important for cardiologists, the following:
It is a pandemic which strikes all patients, with involvement in broader value of patients with cardiovascular diseases what cases already testify to;
At patients with COVID-19 warm complications, though not really frequent can develop;
Cardiovascular diseases still dominate at the population in general, and the same patients at whom the acute coronary syndrome (ACS) is observed can be at the same time infected or act as COVID-19 carriers.
In this article as an example we will consider approaches which are applied in Italy to ensuring rendering the cardiological help to patients in the conditions of a pandemic. From the point of view of developers of the Italian recommendations for cardiologists, work with patients who demand participation of the specialist in cardiac pathology in the treatment can be optimized as follows.
The patient hospitalized with COVID-19 without the previous anamnesis confirming cardiovascular pathology does not demand cardiological consultations but only implementation of the ECG which can be transferred in the remote way. Remote consultations can be also used for the solution of possible questions on the medicines having cardiological value.
The patient hospitalized with COVID-19 and having history of heart diseases, who is already at a stage of drug treatment has to pass an ECG and possible remote consultations on therapeutic indications. For example, in case of use by the patient of drugs which can interact with those which will be applied at this patient to treatment of a koronavirusny infection.
If the patient is hospitalized with COVID-19 and has the known heart diseases and heart failure, being already under medicamentous therapy, then it needs an ECG, correction of doses of the taken drugs and remote consultation for the solution of specific therapeutic questions.
If the patient, is hospitalized with COVID-19 and kliniko-electrocardiographic signs directing at NSTEMI, then neotolozhny treatment in connection with coronary pathology and remote cardiological consultation is shown it. If the cardiologist, in the presence of a favorable ratio of risk and advantage, considers it expedient to execute an echocardiography, then the operator has to be protected by individual protection equipment and FFP3 (the maximum degree of protection).
Also relatively often meet at patients with arrhythmia COVID-19. The cardiological assessment has to be carried out by remote consultation, after possible telephone contact with the doctor, for obtaining recommendations about maintaining the patient.
Developers of the Italian recommendations consider that at patients with COVID-19 at which cardiological complications develop (from arrhythmias to STEMI) the place of treatment still has to be in "a red zone" according to requirements them in treatment (a usual or intensive care), but not to be transferred to other divisions specializing in treatment of possible complications. In other words, the "red zone" for patients of COVID-19 structured on assistance levels has to accept patients with COVID-19 irrespective of existence at them the accompanying pathology.
If consultation of the cardiologist in office of emergency medical service or other offices is necessary for the hospitalized patients, then it is recommended to conduct a preliminary operational telephone interview about existence of symptoms of flu and/or disturbances of breath at the patient. If there are suspicious symptoms, and consultation cannot be postponed until test result of PTsR, the patient has to be considered how positive on COVID-19 and it is necessary to take the maximum measures of protection. In all other cases it is recommended to hold consultation with use of disposable protective suits, respirators, hats, gloves and points.