COVID-19 NICE Guidance - patients with Acute Myocardial Injury
The purpose of this guideline is to help healthcare professionals who are not cardiology specialists identify and treat acute myocardial injury and its cardiac complications in adults with known or suspected COVID-19 but without known pre-existing cardiovascular disease
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Communicating with patients
- Communicate with patients, their families and carers and support their mental wellbeing to help alleviate any anxiety they may have about COVID-19
- Provide patients, their families and carers with information that meets their communication needs
2. Minimising the risk for patients and healthcare workers
- When patients with known or suspected COVID-19 have been identified, follow appropriate UK government guidance
- If COVID-19 is later diagnosed in a patient not isolated from admission or presentation, follow UK government guidance
- All healthcare workers involved in receiving, assessing and caring for patients who have known or suspected COVID-19 should follow UK government guidance.
3. Diagnosing acute myocardial injury in patients with suspected or confirmed COVID-19
- Be aware that acute myocardial injury and its complications:
- Were observed in 9.5% of all patients dying in Italy with COVID-19 (up to 13 April 2020)
- Display symptoms and signs similar to respiratory complications of COVID-19
- May develop at any stage of COVID-19
- Be aware that acute myocardial injuries in patients with COVID-19 include:
- Acute coronary syndromes
- Arrhythmias
- Cardiac arrest
- Cardiogenic shock
- Cardiomyopathy
- Heart failure
- Myocarditis
- Pericarditis and pericardial effusion
- Be aware that symptoms suggesting acute myocardial injury in patients with COVID-19 include:
- Chest pain
- Palpitation
- Severe fatigue
- Shortness of breath
4. Managing myocardial injury in patients with suspected or confirmed COVID-19
- For all patients with a suspected or confirmed acute myocardial injury:
- Monitor in a setting where cardiac or respiratory deterioration can be rapidly identified
- Perform continuous ECG monitoring
- Monitor blood pressure, heart rate and fluid balance
- For patients with a clear diagnosis of a myocardial injury:
- Seek specialist cardiology advice on treatment, further tests and imaging
- Follow local treatment protocols
- For patients with a high clinical suspicion of myocardial injury but without a clear diagnosis:
- Repeat troponin levels daily
- Seek specialist cardiology advice on further investigations
- Discuss the risks, benefits and possible likely outcomes of different treatment options with patients, families and carers using decision support tools
- Be aware that treatments that may be used in COVID-19 such as azithromycin and hydroxychloroquine, may prolong the QTc interval and lead to arrhythmia
- Start all critical care treatment with a clear plan of how the treatment will address the diagnosis and lead to agreed treatment goals
- Review critical care treatment regularly and when the patient’s clinical condition changes
- Stop critical care treatment when it is no longer considered able to achieve the desired overall goals
