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

 #unburdenhealthcare with us