Cardiology
Prof S Price
COVID-19
- Myocarditis: relatively uncommon
- Myocardial injury: relatively common
- Resources from European Society of Cardiology – link
- COVID-19 is, in the end, an endothelial disease
- Admission of patients with STEMI since the outbreak of the COVID-19 pandemic: a survey by the European Society of Cardiology
- Survey: 3101 responses, 141 countries, 6 continents
- 88.3% total lockdown, 7.1% partial lockdown
- 78.8% stated reduction in numbers presenting with STEMI (65.2%>40% reduction)
- 58.5% that >40% STEMI admitted beyond optimal intervention window
- Rapid rule in/rule out algorithms now recommended to use ESC 0h/1h algorithm ( or 1h/2h algorithm (second best option) if a hs-cTn test with a validated algorithm is available
- If elective non-invasive/invasive imaging is needed after the rule-out of MI, invasive angiography is the best option in those with a very high clinical likelihood of UA. Stress testing with imaging or CCTA is best in those with low-to-modest clinical risk.
- Rhythm monitoring for up to 24 h or to PCI (whichever comes first) is recommended for those at low risk for arrhythmias and monitoring >24h if at increased risk
- Early routine invasive approach within 24 hours for NSTEMI based on hs-cTn measurements, GRACE score >140, dynamic/new STT changes.
Clinical application of the 4th Universal Definition of Myocardial Infarction
Temporary circulatory support for cardiogenic shock
Pulmonology
EJ Nossent
Potential therapies
Efficacy and Safety of Nintedanib in Idiopathic Pulmonary Fibrosis
Nintedanib for Systemic Sclerosis–Associated Interstitial Lung Disease
Nintedanib in Progressive Fibrosing Interstitial Lung Diseases
Take home message
- ILD is not one disease
- Acute excacerbation in every type of ILD
- The landscape is changing; finally…
- Position antifibrotic therapy fibrotic ILD not clear yet; immunosuppressants.
From the disease lung fibrosis to criteria, towards phenotyping, towards personalized medicine.
Neurology
Prof S Koch
COVID-19
- Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China
- Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study
- Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke
Conclusion
EID risk is increasing due to climate change and loss of biodiversity
-> we need to adress this now
Neurological manifestation of Covid-19 occur in ~ 36%
Cerebrovasculare Manifestions occur in ~ 5% of Covid-19 patients based on
–pathological coagulation or hyperinflammation
–includes younger patients or patients with typical riskfactors
–leads to more severe outcome
-> check carefully coagulation parameters and risk factors
Altered conscious state is seen in ~ 65% of Covid-19 ICU patients
–based on encephalopathy or seizures
-> EEG monitoring, MRI
Anaesthesiology
S Loer
Optimizing preoperative fluid therapy Encourage use of clear carbohydrate drinks up until 2 h prior to surgery!
- Less catabolism
- Less postoperative nausea and vomiting
- Less insulin resistance
- Less perioperative anxiety
Intraoperative fluids
Anesthesia-induced immune modulation
Post-op delirium
Postoperative delirium: perioperative assessment, risk reduction, and management
Post-op pain