Care of patients with pulmonary arterial hypertension during the coronavirus (COVID‐19) pandemic

Abstract

The COVID-19 pandemic presents many unique challenges when caring for patients with pulmonary hypertension. The COVID-19 pandemic has altered routine standard of care practice and the acute management particularly for those patients with pulmonary arterial hypertension, where pulmonary arterial hypertension-specific treatments are used. It is important to balance the ongoing care and evaluation of pulmonary arterial hypertension patients with ''exposure risk'' to COVID-19 for patients coming to clinic or the hospital. If there is a morbidity and mortality benefit from starting pulmonary arterial hypertension therapies, for example in a patient with high-likelihood of pulmonary arterial hypertension, then it remains important to complete the thorough evaluation. However, the COVID-19 outbreak may also represent a unique time when pulmonary hypertension experts have to weigh the risks and benefits of the diagnostic work-up including potential exposure to COVID-19 versus initiating targeted pulmonary arterial hypertension therapy in a select high-risk, high likelihood World Symposium Pulmonary Hypertension Group 1 pulmonary arterial hypertension patients. This document will highlight some of the issues facing providers, patients, and the pulmonary arterial hypertension community in real-time as the COVID-19 pandemic is evolving and is intended to share expected common clinical scenarios and best clinical practices to help the community at-large.

Observations on echocardiographic findings in patients with COVID-19

“…A case series also noted elevated PASP in their patients, which could be explained by pulmonary hypertension or recurrent pulmonary-embolic disease (37,40). High PASP relates to pulmonary hypertension, whether underlying or as a consequent result of SARS-CoV-2-related lung injury, pulmonary hypercoagulable state or cardiomyopathy, confers signi cant mortality and morbidity (41,42).…”

<strong>New Coronavirus (COVID-19) Pandemic: Complexities Resulting in a Tragedy.</strong>

“…In those groups, SARS-CoV-2 infection can occur but there is a substantial percentage of sub-clinical or mild infection 72,73 . Additionally, among patients affected with chronic lung diseases, some are not over-proportionally represented among COVID cases, these include asthma 74 , and pulmonary arterial hypertension 75 . A search for studies demonstrating clear anti-viral activity of common drugs taken for these conditions has not yielded clear positive data.…”

The Potential Role of Inhaled Nitric Oxide in Managing COVID-19 Associated Lung Complications Review of Literature

“…In a recently published consensus report by Ryan, et al [18] on the care of patients with Pulmonary Arterial Hypertension (PAH) during the COVID-19 pandemic, the authors suggest that in patients with shock, related or unrelated to COVID-19, PAH-specific therapies should be continued during hospitalization and patients unable to tolerate oral or inhaled medications may need to be transitioned from oral to intravenous medications to get through severity of a COVID-19 infection [19]. The authors state that it is important to consider Nitric Oxide (NO) during clinical decompensation in lieu of agents that have the potential to lower blood pressure [18].…”