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Transthoracic Echocardiography in COVID-19

  • July 08,2021
  • 2 Min Read
Transthoracic Echocardiography in COVID-19

Echocardiography can identify left and right ventricular dysfunction, intracardiac thrombus, high filling pressures, particularly on the right side, as indicated by a distended inferior vena cava that does not collapse with inspiration and elevated right ventricular systolic pressures.

Indications for transthoracic echocardiography in COVID-19 patients: 

  • Those with moderate or severe COVID-19 disease and cardiac troponin or BNP elevation or pre-existing disease combination with high inflammatory markers

  • Hemodynamic instability, suspicion of left ventricular or right ventricular dysfunction

  • Pulmonary embolism

  • Dedicated echocardiography in significantly elevated troponin or ECG abnormalities and/or concern for congestive heart failure

Abnormalities observed in COVID-19 patients: 

  • Left ventricular dysfunction (diffuse or segmental)

  • Increased wall thickness (pseudohypertrophy-myocarditis)

  • Intracardiac thrombosis

  • Pericardial effusion

  • Reduced Tricuspid annular plane systolic excursion (TAPSE) and right ventricular function

  • Elevated right ventricular systolic pressures, Inferior vena cava distension without respiratory variation (not valid for patients in ventilation)

  • Raised right ventricular filling pressures

  • Evidence of stress cardiomyopathy

Significance in COVID-19 patients:

Focused echocardiography should be performed ONLY in those where management is likely to be influenced. 

  • Limited studies to address specific clinical questions

  • Left ventricular hypertrophy and left ventricular dysfunction, and pericardial effusion may indicate myocarditis

  • Combination of congestion on lung ultrasound with high right ventricular filling pressures may signal imminent cardiovascular decline; consider ICU admission/intubation

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