Clinical and Morphological Features of Myocardial Damage and the Course of Fulminant Myocarditis on the Background of СOVID-19, Diagnosis and Treatment Tactics

Abstract

In a review article based on my own clinical experience of managing patients with acute myocardial injury and fulminant myocarditis, taking into account expert recommendations on the clinical treatment of myocardial damage associated with novel coronavirus infection a National clinical geriatric medical research center, division of cardiovascular diseases, the Chinese geriatrics society, Department of cardiology, Beijing Medical Association and European clinics discusses the pathogenesis, diagnosis and treatment of myocardial damage and FM patients, infected with SARS-CoV-2 in the context of the COVID-19 pandemic. Clinical features and diagnostic criteria are presented, including screening tests of markers of myocardial damage in the form of a highly sensitive troponin test, a natriuretic peptide. The article discusses in detail the pathogenesis and mechanisms of myocardial damage, including immune mechanisms, cytokine storm, systemic inflammation with macro- and microvascular dysfunction and the development of myocardial dysfunction with acute heart failure, hypotension, cardiogenic shock and/or life-threatening heart rhythm disorders caused by hypoxia and metabolic disorders at the cellular level. Features of the clinical course of fulminant myocarditis in infected patients (SARS-CoV-2) in the conditions of the COVID-19 pandemic are presented. For the first time, a detailed histo-morphological analysis of pathological myocardial injuries and complications is presented on the basis of unique autopsy material on post-mortem diagnostics of various pathoanatomic autopsies of those who died from COVID-19 in Moscow. Based on the clinical, functional and morphological material, the Protocol of etiopathogenetic treatment is presented. The basis of standard therapy is considered antiviral drugs, immunoglobulin G, the use of monoclonal antibodies to interleukin-6, anticoagulants, glucocorticoids, depending on the clinical situation, cardioprotectors and symptomatic treatment are recommended to maintain the heart, which in combination can achieve a certain clinical effectiveness. As adjuvant cardioprotective targeted therapy, the sodium salt of phosphocreatine is considered in order to preserve the myocardium, maintain its contractility and vital activity.

The role of infectious and seasonal factors in the development of myocardial infarction in men under 60 years old

“…При инфекции, вызванной COVID-19, среди поражений сердца отмечают уменьшение доли ИМ I типа и преобладание ИМ II типа за счет тромбоза коронарных артерий и/или коронарита, вызванного инфекцией, а также развитие вторичного миокардита. Во всех случаях предпочтение отдается консервативной тактике ведения пациентов [18,19]. Экстренная реваскуляризация и хирургические методы коррекции осложнений рекомендуются только по абсолютным показаниям, при дестабилизации и/или угрожающих жизни состояниях [18,19].…”

“…Во всех случаях предпочтение отдается консервативной тактике ведения пациентов [18,19]. Экстренная реваскуляризация и хирургические методы коррекции осложнений рекомендуются только по абсолютным показаниям, при дестабилизации и/или угрожающих жизни состояниях [18,19].…”