The overall incidence of acute cardiac injury varies between 8% and 12% of the positive cases.

Acute cardiac injury has been consistently shown to be a strong negative prognostic marker in patients with COVID-19. The severity of COVID-19 is associated with acute cardiac injury, and acute cardiac injury is associated with death.

Both tachy– and brady-arrhythmias are known to occur in COVID-19. A study describing clinical profile and outcomes in 138 Chinese patients with COVID-19 reported 16.7% incidence of arrhythmia. The incidence was much higher (44.4%) in those requiring ICU admission as compared to those not requiring ICU admission (8.9%).

CV co-morbidities increase the mortality rate. Chinese Center for Disease Control and Prevention described clinical outcomes in 44672 confirmed cases of COVID- 19; overall mortality rate = 2.3%; in patients with hypertension = 6%; patients with CVD = 10%.

These data highlight the need to effectively monitor heart health in order to limit cardiac complications in patients infected with COVID-19.

Cardiac ultrasound

Monitoring of left heart function in patients with acute cardiomyopathy, presumably secondary to viral myocarditis.

Monitoring of right heart function in patients who are at risk of suffering acute cor pulmonale secondary to.

• hypoxic vasoconstriction
• ventilator induced lung injury
• pulmonary embolism ➡ patients with COVID are at a higher risk of disseminated intravascular coagulation¹⁴
• thrombotic complications in ICU patients with COVID is 31%

(a) left ventricular diameter was enlarged and ejection fraction was decreased

(b) edema of left ventricular wall and improvement of ejection fraction;

(c) normal left ventricular ejection fraction and wall thickness

Apical 4-chamber view to assess the right/left ventricle ratio

Strain echocardiography to detect left ventricular segmental contraction abnormalities

Measurement of tricuspid regurgitation velocity to estimate pulmonary artery pressure

Indications

• A focused cardiac ultrasound study (FoCUS) is recommended to reduce the duration of exposure
• The need for echocardiography might expand further as we understand more about COVID-19, with early reports indicating that patients with established cardiovascular disease and cardiovascular risk factors have worse prognosis than others, and are more likely to be admitted to hospital and need respiratory support
• Echocardiography should be restricted to patients with cardiovascular instability or signs of right ventricular dysfunction or pulmonary hypertension.
• Lung ultrasound to detect COVID-19 pneumonia is also useful. Thickening of the pleurae, the appearance of B-lines, and lung consolidation indicate pneumonia, with pleural effusions rarely reported. Due to its bedside availability, scanning of the lungs by ultrasound can be performed as a quick diagnostic tool

Procedure & Cleaning

• The echocardiographic study will usually be performed in the ICU or in emergency rooms in critically ill patients. Less critical patients are usually examined in their ward rooms. Dedicated room(s) may be prepared in the echocardiographic lab, where unnecessary equipment can be removed to facilitate cleaning of the room.
• Protecting the echocardiographic machines with custom-made covers may be possible if available, but, if not, other protective equipment can be fashioned using local businesses and some ingenuity. It is, however, important not to cover the screen in a way that reduces the view for the echocardiographer.
• To facilitate cleaning of the scanner, all additional 3-D and single-Doppler probes should be removed before scanning starts, if they are not needed for proper diagnosis. ECG leads should also be removed.
• Moderately warm water and a mild detergent are the basis for equipment cleaning in all cardiac imaging machines, including the echocardiographic probe. An ordinary water-soluble disinfectant should also be added, but not on the membrane. A non-alcoholic disinfectant should be used on the echocardiographic probe
• Patients placed in the left lateral position with the scanner positioned on the right side of the bench will result in the longest possible distance. A surgical mask on the patient will also reduce contamination by air droplets

• Autopsies of patients with COVID-19 infection revealed infiltration of the myocardium by interstitial mononuclear inflammatory cells.
• COVID-19 infections are associated with increased cardiac biomarker levels due to myocardial injury that are associated with infection-induced myocarditis and ischaemia.
• Myocarditis appears in COVID-19 patients several days after initiation of fever.

• Mechanisms of SARS-CoV-2-induced myocardial injury may be related to upregulation of ACE2 in the heart and coronary vessels.
• Echocardiography can be performed bedside to screen for CV complications and guide treatment. POCUS, FoCUS and critical care echocardiography are probably the preferred modalities to image patients with COVID-19.
• In COVID-19 infected patients, echocardiography should focus solely on the acquisition of images needed to answer the clinical question in order to reduce patient contact with the machine and health-care personnel.

Complete

• High performance in all the applications
• Large probes portfolio, convex, linear and phased-array
• Advanced configurations, including TE probe or Strain package

Fast

• 2 probes connectors Up to 4 with multiconnector
• Touchscreen with intuitive menus
• Long-duration battery and quick boot-up time (15”)

Compact

• Full screen mode
• Swivelling monitor
• Agile trolley easy with 4 swivelling wheels

Connected

• Follow-up & Multi-modality options to retrieve other imaging modalities
• eStreaming for real-time imaging streaming
• eTablet & MyLab^™Remote for remote storage and control