Objective of the Paper: To demonstrate a clinical case of a severe course of the novel coronavirus infection with the development of cardiovascular complications against the background of concomitant comorbid diseases. Key points. A case of a novel coronavirus infection is presented with a description of the clinical course and the results of laboratory and instrumental examination. In the clinical picture, in addition to massive damage of the lung tissue, according to computed tomography, firsttime ischemic stroke, atrial fibrillation, and type 2 myocardial infarction were observed, which occurred against the background of obesity, type 2 diabetes mellitus and autoimmune thyroiditis. Conclusion. The polymorphism of the clinical picture and the various variants of manifestation of a novel coronavirus infection, taking in some cases a polysystemic character, require doctors to diagnose the disease in a timely manner and identify its potential complications at an early stage, developing in the acute period, especially in the older age group. Keywords: novel coronavirus disease, SARS-CoV-2, atrial fibrillation, ischemic stroke, type 2 myocardial infarction.
РезюмеМиокардиальный «мостик» (ММ) -врожденная аномалия развития коронарных артерий (КА), при которой эпикардиальный сегмент сосуда проходит в толще миокарда. При данной аномалии могут поражаться любые КА, однако наиболее часто она затрагивает переднюю межжелудочковую артерию. Большинство ММ ассоциировано с бессимптомным течением, однако в доступной научной литературе, посвященной проблеме ММ, имеется большое число публикаций, описывающих и доказывающих связь между ММ и симптомами ишемии миокарда, включая случаи развития острого коронарного синдрома и внезапной сердечной смерти.В настоящем обзоре авторами обобщены и представлены современные данные о частоте распространения, патофизиологических механизмах, анатомо-функциональной и клинической оценке, а также лечению ММ. У пациентов с симптомными ММ медикаментозное лечение обычно является эффективной терапией. При ее неэффективности должна проводиться комплексная анатомическая и функциональная оценка ММ для выбора наиболее безопасной и эффективной методики реваскуляризации. Чрескожное коронарное вмешательство с помощью стентов нового поколения в настоящее время рассматривается как стратегия лечения ММ. Аортокоронарное шунтирование проводится при глубоком залегании туннельного сегмента КА под миокардом или при осложнениях, связанных со стентированием. Миотомия является высокоэффективным методом лечения пациентов с ММ при поверхностном залегании интрамиокардиального сегмента КА и выполнении операции в условиях специализированных кардиохирургических центров.Отсутствие общепринятых рекомендаций, очевидно, делает необходимым проведение дальнейших исследований в области рассматриваемой проблемы для разработки и валидизации единых алгоритмов по диагностике и лечению пациентов с ММ.
The data of the modern literature describing the long-term consequences of infection of the body with SARS-CoV-2 on the cardiovascular system in the framework of postcovid syndrome are analyzed. To date, postcovid syndrome refers to a condition in which symptoms continue to persist for more than 12 weeks from the moment of diagnosis of COVID-19. Various complaints of patients after undergoing a new coronavirus infection are described, the distinguishing feature of which is their versatility, where cardiovascular manifestations are assigned one of the leading roles. Postural orthostatic tachycardia syndrome, cardiac arrhythmia and conduction disorders are considered. The role of SARS-CoV-2 in the formation of de novo and decompensation of pre-existing cardiovascular diseases has been demonstrated. The possibility of developing heart failure in patients with COVID-19 as an outcome of inflammation of the heart muscle is shown. Particular attention is paid to the analysis of the incidence of myocarditis after 3 months or more from the diagnosis of COVID-19, as well as thrombotic complications, in the genesis of which the main role belongs to the formation of endothelial dysfunction resulting from the interaction of SARS-CoV-2 with vascular endothelial cells. The autoimmune component of the pathogenesis of damage to the cardiovascular system as a result of the formation of endothelial dysfunction in COVID-19 is also considered. The authors present a laboratory-instrumental algorithm for determining cardiovascular complications in people who have undergone COVID-19, including the determination of the N-terminal fragment of the brain natriuretic peptide B-type prohormone, the level of anticardial antibodies, electrocardiography, echocardiography, as well as magnetic resonance imaging of the heart with contrast.
OBJECTIVE: Assess the connection between clinical, laboratory and radiological manifestations of the new coronavirus infection.MATERIALS AND METHODS: The study conducted a retrospective analysis of 100 patient medical histories, treated in Saint Petersburg State Budgetary Healthcare Institution «the Holy Martyr George Hospital» with confirmed diagnosis «Coronavirus infection COVID-19, the virus is identified». A statistical analysis of clinical laboratory values was carried out based on severity of COVID-19 course and infiltrative changes of lung tissue by computed tomography data. Statistics. Statistical analysis of the data was held using PC and set of software StatPlus 8.0. RESULTS: Depending on the nature of COVID-19 course, the comparison of clinical laboratory data among patients (average age 63,5 [19–98]) found that with increase in severity of the disease (mild – moderate − severe) there were changes in the following clinical laboratory values: erythrocyte sedimentation rate 15,4 ± 6,3 mm/h − 18,5 ± 13,5 mm/h – 31 ± 17 mm/h (positive correlation); lymphocyte level 1,49 ± 0,67 x 109 /l − 0,86 ± 1,45 x 109 /l − 0,68 ± 0,31 x 109 /l (negative correlation); C-reactive protein 8,4 ± 4,7 mg/l − 47,3 ± 18,7 mg/l − 148,7 ± 53,1 mg/l (positive correlation); ferritin 43,4 ± 24,8 µg/l − 743,9 ± 50,3 µg/l – 1425 ± 485,4 µg/l (positive correlation) and the degree of pulmonary tissue lesion according by computed tomography 0 % − 32 ± 13 % − 56 ± 11 % (positive correlation). DISCUSSION: In the course of this study it was found that mild course of COVID-19 is characterized by minor changes of laboratory values, compared to the group of severe and moderate course. There was a strong correlation between the level of COVID-19 severity and lymphocyte level (negative) as well as ferritin (positive) and the degree of infiltrative changes in lungs according on the computed tomography (positive). CONCLUSION: The revealed correlations do not allow a full planning of patient management tactics and to predict the course of COVID-19. Developed diagnostic and treatment algorithm should be based on clinical laboratory and instrumental assessment of the patient’s condition.
Aim: To study the correlation of laboratory and instrumental indicators with the severity of the COVID-19 and to assess the dynamics of changes of the lipid profile and the electrical axis of the heart of patients in the acute period of the disease and after recovery. Design: Retrospective observational study. Materials and Methods. A retrospective analysis of medical histories of 30 young patients (18–44 years) without cardiovascular diseases, who underwent two-stage treatment at the Military Medical Academy named after S.M. Kirov with diagnoses: «COVID-19, virus identified» (U07.1, ICD-10) and «Post COVID-19 condition» (U09.9, ICD-10) in the period from April to December 2021. Results. The study found that individuals after COVID-19 had an increase in total cholesterol concentrations (6.51 [5.62–6.79] mmol/l), lowdensity lipoprotein (3.89 [3.34–4.52] mmol/l) and very low-density lipoprotein (1.06 ± 0.72 mmol/l) as opposed to acute period of COVID-19, where the lipid spectrum remained within normal values. In addition, an electrocardiogram analysis showed dynamics of the alpha angle changed from 42 ± 11 to 25 ± 17 degrees of patients after the elimination of SARS-CoV-2, with the deviation of the electrical axis of the heart to the left was detected of the first time in 5 (17%) patients after COVID-19. Conclusion. Individuals after COVID-19, who have been identified for the first time as having dyslipidemia and deviation of the electrical axis of the heart to the left, as well as high levels of inflammation markers can be considered by candidates for high-tech imaging techniques to eliminate damage of the cardiovascular system. Keywords: novel coronavirus disease; SARS-CoV-2; electrocardiography; electrical axis of the heart; dyslipidemia; cardiovascular complications.
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