Cory V. Noel, MD Pediatric Cardiology of Alaska - PowerPoint Presentation

Cory V. Noel, MD Pediatric Cardiology of Alaska
Cory V. Noel, MD Pediatric Cardiology of Alaska

Cory V. Noel, MD Pediatric Cardiology of Alaska - Description


Seattle Childrens Pediatric Cardiology Safe Return to competition after covid19 infection OBJECTIVES Why the concern for athletes after COVID19 What is the still missing information A proposed algorithm based upon the known information ID: 915743 Download Presentation

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cardiology myocarditis concern covid myocarditis cardiology covid concern 2020 myocardial athletes involvement ecg criteria abnormal lake information abnormalities louis

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Slide1

Cory V. Noel, MDPediatric Cardiology of AlaskaSeattle Children’s Pediatric Cardiology

Safe Return to competition after covid-19 infection

Slide2

OBJECTIVES

Why the concern for athletes after COVID-19?

What is the

still missing

information?

A proposed algorithm based upon the known information

Slide3

Why the concern in athletes?

Slide4

Why the concern in athletes?

Siripanthong

B, et al.,

Heart Rhythm; 2020 Vol 17; No 9.

Slide5

Why the concern in athletes?

Pirzada A, et al., CJC; 2020;05.005

Myocardial injury is relatively common in COVID-19

Accounting for 7-23%

Associated with higher morbidity and mortality

Slide6

Why the concern in athletes?

Guzik T, et al., European Society of Cardiology; 2020; 10.1093/cvr/cvaa106

Myocarditis typically occurred after a prolonged period (10-15 days) following symptom onset

Slide7

What is the missing information?

Niaz T, et al.,

Pediatric Cardiology; 2020; 10.1007/s00246-020-02476-y.

Slide8

What is the missing information?

What is the incidence of myocardial involvement in asymptomatic people?

What is

the incidence of myocardial involvement in

teenagers?

What is the incidence of myocardial involvement in

asymptomatic to mildly symptomatic teenagers

?

Slide9

Cardiac involvement in covid-19

If present, what is primary concern of myocardial involvement?

What is clinical presentation of myocarditis following other viral infections?

Slide10

Myocarditis & Sudden Cardiac Arrest

Harmon KG, et

al.

Mayo

Clin

Proc

. 2016;91(11):1493-1502

Slide11

Variable causes of SCA

Ackerman M, et

al.

Circulation

. 2016;133:1006-1026

Slide12

Variable causes of SCA

Ackerman M, et al. Circulation

. 2016;133:1006-1026

Slide13

myocarditis

Pollack A, et al., Nat Rev Cardiol.,2015 12 670-689.

Slide14

Myocarditis clinical presentation

Ali-Ahmed F., et al., Curriculum in Cardiology 

2019.08.007

Slide15

Myocarditis diagnostic algorithm

Eichorn C., et al., JACC: Cardiovascular Imaging

 

2019; 19 (2)494-507

Slide16

Myocarditis ecg

abnormalities

Eichorn

C., et al., JACC: Cardiovascular Imaging 2019; 19 (2)494-507

Slide17

Myocarditis ecg

abnormalities

Deluigi

C.C., et al., International Journal of Cardiology; 2013 165, 100-106.

Slide18

Myocarditis ecg

abnormalities

Deluigi

C.C., et al., International Journal of Cardiology; 2013 165, 100-106.

Slide19

Lake Louis Criteria

Slide20

Lake Louise criteria comprised of increased signal on T2-weighted images, EGE ratio, and LGE

Lake louis criteria

Slide21

Lake louis criteria

Banka P, et al., JCMR, 2015

13 centers, 143 patients, clinical diagnosis

LGE: 100% Abnormal in 81%

T2W: 69% Abnormal in 81%

EGE: 29% Abnormal in 55%

FPP: 48% Abnormal in 8%

LV EDV, LVEF, RVEF predictive of persistent dysfunction

Slide22

Sports fallout from covid-19

Puntmann VO, et al.,

JAMA Cardiology. 2020;5(11): 1265-1273

Rajpal

S, et al.,

JAMA Cardiology. 2020

Slide23

Sports fallout from covid-19

Slide24

Sports fallout from covid-19

Slide25

Data from large center

Over 60 patients (average age of 14 years)

Symptoms persist in ~ 60% (dyspnea, fatigue)

Minor ECG abnormalities in 55%

Average LVEF of 63% (small percentage with systolic dysfunction)

CMR with occasional edema and LGE

Slide26

Slide27

Slide28

Thank you

Shom More....