What are the indications for handheld ECHO in a patient with COVID-19?

7th Jan 2021

Handheld echocardiography (HHE) has a unique role in acute cardiology, as well as in the management of critically ill patients in intensive care. But, when should you use HHE for in-patients during the COVID-19 era?  

 

Cardiac manifestations in patients infected with COVID-19

Our understanding of the pathophysiology of COVID-19 continues to evolve as we learn more about this infectious disease. It is becoming more apparent that the SARS-CoV-2 virus causes a multi-system disease.  

Appreciation of the proposed cardiac manifestations can help us better understand the indications for handheld cardiac ultrasound. Published case reports have shown that cardiac manifestations of COVID-19 are a result of four main pathways: 

  1. Direct viral effect causing myocardial injury 
  2. Thrombotic complications that lead to pulmonary embolism and right heart strain 
  3. The host’s inflammatory response causing a cytokine storm that leads to myocarditis 
  4. Complications of therapy such as positive pressure ventilation and fluid balance on hemodynamics  

Multi-component illustration of myocardial injury, pulmonary embolism, inflammatory response, and patient with COVID-19 on a ventilator.

Figure 1. The cardiac manifestations of COVID-19 are the result of four main pathways, which include, direct viral effect causing myocardial injury, thrombotic complications causing pulmonary embolism of the right strain, host inflammatory response causing a cytokine storm that leads to myocarditis, complications of therapy such as positive-pressure ventilation and fluid balance on hemodynamics. 

 

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Indications for handheld echocardiography (HHE) in patients with COVID-19 

With the above-mentioned cardiac manifestations in mind, there are five commonly requested indications of HHE: 

  1. Assessment of left ventricular size and function 
  2. Assessment of right ventricular size and function 
  3. Assessment of valve structure and function (i.e., identification of gross valvular pathology) 
  4. Assessment of pericardial effusion (where present)
  5. Assessment of the patient’s filling status 

Multi-component illustration of left ventricle, right ventricle, valvular pathology, pericardial effusion, and IV bag.

Figure 2. Common components of a handheld echocardiography (HHE) exam in patients with COVID-19 include assessments of left ventricular size and function, right ventricular size and function, gross valvular pathology, pericardial effusion, and filling status. 

 

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Recommended reading

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