新型冠状病毒感染COVID-19恢复期心肌梗死病程特点

Q4 Medicine
N. A. Muradyan, I. M. Kuzmina, T. R. Gvindzhiliya, V. M. Balanyan, K. A. Popugaev
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引用次数: 0

摘要

急性心肌损伤是新型冠状病毒感染COVID-19的可能并发症之一,既可以在感染急性期诊断,也可以在患者病情稳定或临床好转后诊断。本文就新冠肺炎恢复期急性心肌梗死发展的实际问题进行综述。新冠肺炎恢复期急性心肌梗死的病理生理机制多种多样。关键的作用属于高凝状态和全身炎症反应,这可以引起不稳定的动脉粥样硬化斑块的不稳定和破裂。在冠状动脉完整的背景下,2型急性心肌梗死最常被诊断为COVID-19恢复期。在这种情况下,急性心肌梗死的发展是由于心肌需氧量增加(血液中细胞因子水平增加,高儿茶酚胺血症,高热和心动过速)与低氧血症和低血压导致心肌细胞供氧减少之间的不平衡。尽管冠状动脉造影显示正常,左心室射血分数完整,但亚临床心肌损伤仍可能存在。COVID-19恢复期急性心肌梗死的发生与感染的严重程度、初诊时间、患者是否存在心血管疾病的传统危险因素没有明确的关系。COVID-19恢复期的心脏不适通常被解释为后covid综合征,特别是考虑到许多患者没有冠心病史,这可能导致诊断较晚。需要进一步研究新冠肺炎恢复期急性心肌梗死的特点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Features of the myocardial infarction course in convalescents of the new coronavirus infection COVID-19
Acute myocardial injury is one of the possible complications of the new coronavirus infection COVID-19 and can be diagnosed both in the acute phase of the infection, and also after stabilization or clinical improvement of the patient's condition. This review is devoted to the actual problem of the acute myocardial infarction development during the period of COVID-19 convalescence. The pathophysiological mechanisms of acute myocardial infarction during recovery from COVID-19 are diverse. The key role belongs to the state of hypercoagulation and the systemic inflammatory response, which can provoke destabilization and rupture of unstable atherosclerotic cardiac plaques. Type 2 acute myocardial infarction is most often diagnosed in COVID-19 convalescents against the background of intact coronary arteries. In this case, acute myocardial infarction develops due to an imbalance between increased myocardial oxygen demand (increased levels of cytokines in the blood, hypercatecholaminemia, hyperthermia and tachycardia) and a decrease in oxygen supply to cardiomyocytes due to hypoxemia and hypotension. Subclinical myocardial injury may be present despite normal coronary arteries on angiography and intact left ventricular ejection fraction. There is no clear relationship between the development of acute myocardial infarction during the period of COVID-19 convalescence and the severity of the infection, the time from the initial diagnosis, and the presence of traditional risk factors for cardiovascular diseases in the patient. Cardiac complaints in COVID-19 convalescents are often interpreted as a post-COVID syndrome, especially given the absence of a history of coronary heart disease in many patients, which can lead to late diagnosis. Further study of the features of acute myocardial infarction during the period of COVID-19 convalescence is needed.
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来源期刊
Transplantologia
Transplantologia Medicine-Transplantation
CiteScore
0.50
自引率
0.00%
发文量
32
审稿时长
8 weeks
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