Latest Covid-19 update for cardiac patients by Professor Sanjay Sharma at the CRY Centre for Inherited Cardiac Conditions

If you have symptoms suggestive of the virus that you feel are not controlled at home, please be guided by the NHS 111 website at 111.nhs.uk/covid-19 or call 111 stating the condition you have.

If you do not have symptoms, please follow NHS guidelines for preventing spread as detailed here: www.gov.uk/government/publications/coronavirus-action-plan.

The following patients are at increased risk of complications of infection and will require strict self-isolation to reduce the chance of contracting the virus:

1. Dilated, arrhythmogenic and hypertrophic cardiomyopathy patients with LV impairment and/or symptomatic left heart failure.

2. Arrhythmogenic cardiomyopathy patients with RV impairment and/or symptomatic right heart failure.

3. Symptomatic hypertrophic cardiomyopathy with or without significant obstruction.

The following patients may require special instructions:

1. All patients with Brugada syndrome and/or sodium channel disease should self-treat with paracetamol immediately if they develop signs of fever and self-isolate.

2. If patients with Brugada syndrome and/or sodium channel disease without an ICD, especially those with a spontaneous type 1 pattern, develop a high fever (above 38.5C) despite paracetamol, they should contact 111 by phone, stating their condition, and may need to attend A&E. A&E will need to be advised either by 111 or by the patient that they will attend to allow assessment by staff with suitable protective equipment. Assessment should include an ECG* and monitoring for arrhythmia. If an ECG shows the type 1 Brugada ECG pattern, then the patient will need to be observed until their fever and/or the ECG pattern resolves. If all ECGs show no sign of the type 1 ECG pattern, then they can go home to self-isolate. Patients with fever who have an ICD can isolate at home and follow guidance provided by 111.

* A&E attendance may be regulated according to the capacity of service and risk of COVID-19 infection.

** ideally three different ECGs with V1 and V2 in the 4th, 3rd and 2nd intercostal spaces should be taken.

3. Long QT syndrome patients infected with COVID-19 who receive antivirals and/or chloroquine/hydroxychloroquine will require ECG monitoring in case of exacerbation of QT prolongation and increased risk of arrhythmias during therapy.

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