Caution recommended on COVID-19 treatment with hydroxychloro
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The global impact of COVID-19 continues to surge, and every day, the scientific community learns more about the impact and interaction of cardiovascular diseases with COVID-19. Together, the American Heart Association (AHA), the American College of Cardiology (ACC) and the Heart Rhythm Society (HRS) jointly published this new guidance to detail critical cardiovascular considerations in the use of hydroxychloroquine and azithromycin for the treatment of COVID-19.

The antimalarial medication hydroxychloroquine and the antibiotic azithromycin are currently gaining attention as potential treatments for COVID-19, and each have potential serious implications for people with existing cardiovascular disease. Complications include severe electrical irregularities in the heart such as arrythmia (irregular heartbeat), polymorphic ventricular tachycardia (including Torsade de Pointes) and long QT syndrome, and increased risk of sudden death. The effect on QT or arrhythmia of these two medications combined has not been studied.

The AHA, the ACC and the HRS guidance for health care professionals includes additional mechanisms to reduce the risk of arrhythmias. Steps outlined:

-- Electrocardiographic/QT interval monitoring

-- Withhold hydroxychloroquine and azithromycin in patients with baseline QT prolongation (e.g. QTc ≥500 msec) or with known congenital long QT syndrome

-- Monitor cardiac rhythm and QT interval; withdrawal of hydroxychloroquine and azithromycin if QTc exceeds a present threshold of 500 msec

-- In patients critically ill with COVID-19 infection, frequent caregiver contact may need to be minimized, so optimal electrocardiographic interval and rhythm monitoring may not be possible

-- Correction of hypokalemia >4mEq/L and hypomagnesemia >2mg/dL

-- Avoid other QTc prolonging agents whenever feasible.

“The urgency of COVID-19 must not diminish the scientific rigor with which we approach COVID-19 treatment. While these medications may work against COVID-19 individually or in combination, we recommend caution with these medications for patients with existing cardiovascular disease,” said Robert A. Harrington, president of the American Heart Association.

Source: https://newsroom.heart.org/news/caution-recommended-on-covid-19-treatment-with-hydroxychloroquine-and-azithromycin-for-patients-with-cardiovascular-disease-6797342
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