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

2020 Acute Coronary Syndromes (ACS) in Patients Presenting without Persistent ST-Segment Elevation (Management of) Guidelines

• 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

Pirfenidone for idiopathic pulmonary fibrosis: analysis of pooled data from three multinational phase 3 trials

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

Impact of intraoperative goal-directed fluid therapy on major morbidity and mortality after transthoracic oesophagectomy: a multicentre, randomised controlled trial

Perioperative goal-directed therapy: what’s the best study design to investigate its impact on patient outcome?

Anesthesia-induced immune modulation

Post-op delirium

Postoperative delirium: perioperative assessment, risk reduction, and management

Post-op pain