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\begin{document}

\title{COVID-19 AND ISCHEMIC HEART DISEASE EMERGENCIES: WHAT CARDIAC SURGERY
SHOULD EXPECT?}



\author[1]{Emanuele Pilato}%
\author[1]{Rachele Manzo}%
\author[2]{Giuseppe Comentale}%
\affil[1]{Università degli Studi di Napoli Federico II Scuola di Medicina e Chirurgia}%
\affil[2]{Universita degli Studi di Napoli Federico II}%


\vspace{-1em}



  
  \date{June 01, 2024}


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\begin{abstract}
The incidence of mechanical complications of acute coronary syndromes
(ACS) needing cardiac surgery has reduced significantly in the last
years due to early diagnosis and treatments. Covid-19 pandemic, however,
would generate in the patients a sense of fear regarding access to the
ERs so they probably underestimate symptoms such as chest pain or angina
equivalents until situation does not became critical. In this way, this
behaviour could create a vast pool of patients who will enter the
hospital in much more critical situations and with mechanical
complications of an evolving ACS needing cardiac surgery treatment.%
\end{abstract}%



\sloppy


\textbf{Covid-19 and Ischemic Heart Disease Emergencies: What Cardiac
Surgery should expect?}

Running title: Cardiac surgery After covid 19

Pilato Emanuele, MD\textsuperscript{1}; Manzo Rachele,
MD\textsuperscript{1}; Comentale Giuseppe, MD\textsuperscript{1}

\textsuperscript{1}Division of Cardiac Surgery, ''Federico II''
University of Napoli (Italy)

\textbf{For Correspondence}

Comentale Giuseppe, MD

\emph{giuseppe.comentale@unina.it,}Division of Cardiac Surgery

''Federico II'' University - Via Sergio Pansini n\selectlanguage{ngerman}°5, 80131 - Napoli
(Italy)

Main Body

Back to the past? The incidence of mechanical complications of acute
coronary syndromes (ACS) needing cardiac surgery has reduced
significantly in the last years due to early diagnosis and treatments.
Primary coronary angioplasty of culprit lesions, indeed, allowed rescue
of vital myocardium after ACS with significant impact on the functional
recovery of the heart and long-term morbidity.

COVID-19 pandemic may oddly lead to a changing scenario and
significantly modify the cardiac surgery population that we will be
dealing with in the next weeks. The widespread demand for intensive and
sub-intensive care beds, as well as a cardiac tropism of SARS-COV-2
{[}1{]}, has brought to an extensive reassessment of hospitals and
emergency rooms (ERs) into COVID-dedicated structures, making them
potential contagion areas. In Italy, for example, more than 10\% of
COVID-patients are healthcare providers showing how a severe protection
policy among hospitals staff is mandatory to protect not only themselves
but all kinds of patients. In support of this, ``Cotugno''
Infectivological Hospital of Napoli, through the highest
protection/decontamination protocols, is the only Italian hospital
without healthcare SARS-COV-2 infections.

This phenomenon, therefore, would generate in the patients a sense of
fear regarding access to the ERs: the patient with an ACS, indeed,
especially diabetic ones, probably ends up underestimating symptoms such
as chest pain or angina equivalents and not going to the ER quickly,
relying on home remedies. This behaviour, contrary to what would be
expected given the current predilection of an endovascular treatment of
ACSs aimed at minimizing the impact on intensive care {[}2{]}, could
frustrate the prevention strategies based on the earliness of
intervention implemented in these years and thus creating a vast pool of
patients who will enter the hospital in more critical situations and
with mechanical complications of an evolving ACS. Papillary muscles
ruptures and acute mitral regurgitations, ruptures of the
interventricular septum or of the walls of the heart, in fact, together
with the aneurysmal dilations of untreated necrotic areas could became
an important part of the cardiac surgery population in the next weeks.

For this purpose, strategies concerning people education and a
centralization of cardiovascular care towards ``protected'' structures
could restore the patient's confidence in going to the ERs at an early
stage of symptoms and stem a phenomenon that could trigger an important
increase in cardiovascular morbidity and mortality.

References

\begin{enumerate}
\tightlist
\item
  Fried JA et al. The Variety of Cardiovascular Presentations
  of~COVID-19. Circulation.~2020 Apr 3.
\item
  Tarantini G et al. Italian Society of Interventional Cardiology (GISE)
  Position Paper for Cath lab-specific Preparedness Recommendations for
  Healthcare providers in case of suspected, probable or confirmed cases
  of~COVID-19. Catheter Cardiovasc Interv.~2020 Mar 29.
\end{enumerate}

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