Myocardial infarction and the COVID-19 pandemic
The pandemic of the new coronavirus infection has affected each of us. In a short time, the usual way of life has changed, we had to adapt to the new, constantly changing conditions of the world around us, which will never be the same. Information about the causes, manifestations and complications of a new deadly disease, from a thin stream turned into a stream of constantly updated knowledge, assumptions and hypotheses. This could not but affect patients suffering from cardiovascular diseases. And the reason is not only in the direct impact of coronavirus infection on the heart and blood vessels. A huge role in the deterioration of the situation was played by the need for isolation, the reallocation of medical resources in favor of covid hospitals, the fear of some patients to seek medical help and get infected with the coronavirus, and general, unmeasurable, psychosocial tension.
GUZ "Lipetsk City Emergency Hospital No. 1", being one of the largest hospitals in the region, providing emergency care to patients with a number of serious diseases, was one of the first to be converted to treat patients with COVID-19. And although the vascular center, as before, saved patients with strokes and myocardial infarctions, many of the algorithms that have developed over the years had to be revised, and something had to be reinvented. Well, of course, it became clear to us quite early that, no matter how dangerous the acute period of a new coronavirus infection is, no less dangerous is the so-called "post-ovoid period", which is characterized by the formation of blood clots in the arteries and veins of any organs and systems of the body.
To better understand the processes that occur in the body after suffering from COVID-19, let's look at how the coronavirus affects the heart and blood vessels. And we will immediately stipulate that COVID-19 of a mild course that does not require hospitalization, despite the fact that the residual symptoms last up to six months, causes complications from the cardiovascular system extremely rarely. People who have suffered severe coronavirus pneumonia and have at least one of the risk factors: arterial hypertension (this is an increase in the "upper" - systolic blood pressure of more than 140 mm Hg and/or an increase in the "lower" - diastolic pressure of more than 90 mm Hg), diabetes mellitus and obesity.
Currently, a fairly common finding in patients with COVID-19 is coronavirus myocarditis – an inflammation of the heart muscle caused by the direct impact of the virus on the heart. However, more serious and "long-lasting" consequences are caused by the impact of the virus on the vascular wall. So, the coronavirus, invading the body, affects the endothelium of blood vessels – this is the inner lining of the arteries and veins, thanks to which the liquid state of the blood is maintained, and which prevents clogging of the arteries and veins with blood clots. There is an "endothelial dysfunction" - a violation of the normal functioning of the endothelium and, as a result, its main function is disrupted. Because of this, microthrombs are formed in different parts of the circulatory system, and in some areas – blood clots that reach gigantic sizes.
Thus, the literature describes cases of aortic thrombosis – this is the main and largest artery in the human body, up to 4 cm in diameter. Thrombosis of smaller arteries leads to strokes (if the brain artery is thrombosed) and to heart attacks (if the artery supplying blood to the heart is thrombosed). Similarly, veins can also be thrombosed: most often in the lower extremities, especially if the patient is forced to stay on bed rest for a long time. We have seen several cases of simultaneous arterial and venous thrombosis in our clinic. A frequent and sometimes fatal complication in such patients in the post-ovoid period is pulmonary embolism – a condition when a blood clot formed in a vein fragments and clogs the lumen of the pulmonary artery. In such patients, dyspnea increases sharply and resistance to stress decreases.
Endothelial dysfunction leads to other negative consequences. Thus, the endothelium is responsible for the transport of oxygen and nutrients from the blood to the tissue cells. Against the background of coronavirus infection and in the post-ovoid period, this function does not work in full force, hence the long-term pronounced weakness and weakness in patients who seem to have recovered from the coronavirus. Also, the vascular endothelium is responsible for the normal immune response, for primary contact with foreign organisms. In endothelial dysfunction, this response is often inadequate, which is why we see such a severe course of coronavirus infection.
The manifestations of a myocardial infarction that occurred on the background of or after a coronavirus are no different from those without it. This is primarily a characteristic pain syndrome in the form of pain behind the sternum, which often increases with small physical exertion. If this threatening sign appears, you should immediately seek medical help and record an ECG.
Treatment of myocardial infarction that occurred in the post-ovoid period does not yet differ from similar treatment in patients who did not have COVID-19. Although it is possible that many approaches to the management of this group of patients will be revised in the near future. Let's leave it up to the professionals.
But the prevention of the negative consequences of COVID-19 is quite within our power. I will immediately note that we can not yet guess which of the patients will develop a blood vessel thrombosis. And to give everyone anticoagulants (drugs that make the blood more liquid and have the expected side effect in the form of bleeding) according to large studies is impractical. What else can we do? It's simple! Do not interrupt the treatment of existing cardiovascular diseases, even if you have a coronavirus.
There is a lot of evidence that those who did not stop taking statins (cholesterol-lowering drugs that stabilize atherosclerotic plaques) survived COVID-19 much better than those who refused such treatment due to infection. The same applies to most cardiovascular drugs (of course, we only take drugs with proven effectiveness in large studies). And acetylsalicylic acid (the well-known aspirin) at a minimum, it reduces the need for artificial lung ventilation in patients. Once again, this is very important! Do not stop taking cardiovascular therapy for the duration of coronavirus infection!
And if there is no cardiovascular pathology? Everything is simple: prevention – smoking cessation, physical training, a sufficient amount of fresh vegetables in the diet and a stable psyche will allow you to survive the pandemic with minimal losses!
Head of the Cardiology Department
for patients with acute myocardial infarction and acute coronary syndrome
regional Vascular Center No. 2 GUZ " LGB SMP No. 1»
Lyubavin Alexander Vladimirovich
