Transthoracic Echocardiography in COVID-19

July 08,2021
2 Min Read

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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