某三级保健传染病医院COVID-19肺炎患者心血管累及的观察

Q4 Medicine Heart India Pub Date : 2022-01-01 DOI:10.4103/heartindia.heartindia_103_21
R. Roy, Baisakhi Maji, Y. Ray, Arijit Sinha
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摘要

背景:新型冠状病毒肺炎表现为多种心血管症状。我们提出的COVID-19参与心血管的机制包括病毒直接侵入心肌细胞、细胞因子风暴继发的高炎症状态、血管紧张素II升高、ACE2水平降低、抗磷脂抗体和血小板反应性增加,这些都是导致全身和肺血管血栓形成的重要因素。目的:了解新冠肺炎住院患者的各种心血管表现。方法:于2020年7月至2020年12月在某三级传染病医院进行回顾性观察研究,共纳入108例患者。结果:高血压合并糖尿病是最常见的危险因素(40.7%),其次是高血压(28.7%)和糖尿病(18.5%)。最常见的表现为无症状心肌炎37例,其次为窦性心动过速34例,窦性心动过缓18例,体位性低血压16例,心房颤动14例,脑血管意外9例,急性肢体缺血7例,急性冠状动脉综合征4例。无症状舒张功能障碍(2级或以上)17例患者无明显心衰特征(所有患者均有NTproBNP和HSTrop I升高以及临床特征)。CT严重程度评分显示D-二聚体水平与肺炎严重程度呈正相关。结论:早期发现心肌炎,预防并发症特别是致死性心律失常和心源性猝死,需要高度的怀疑和必要的检查。
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Cardiovascular involvement in patients with COVID-19 pneumonia: Observation from a tertiary care infectious disease Hospital
Background: Covid 19 pneumonia presents with various cardiovascular manifestations. The proposed mechanisms of cardiovascular involvement in COVID-19 are direct invasion of myocardial cell by the virus, hyper- inflammatory state secondary to cytokine storm, increased angiotensin II, low ACE2 levels, antiphospholipid antibodies and increased platelet reactivity which contribute significantly to thrombus formation in systemic and pulmonary vasculature. Objectives: To find out various cardiovascular manifestation of patients admitted with covid 19 pneumonia. Methodology: A retrospective observational study had been conducted in a tertiary care infectious disease hospital from July 2020 to December 2020 that included a total of 108 patients. Results: Most common risk factor were combination of hypertension and diabetes( 40.7%) followed by hypertension alone (28.7% )and diabetes in 18.5% patients. Most common presentation was asymptomatic myocarditis found in 37 patients followed by sinus tachycardia in 34, sinus bradycardia in 18, Orthostatic hypotensionin in 16, Atrial fibrillation in 14, cerebrovascular accident in 9, Acute limb ischemia in 7 , and acute coronary syndrome in 4 patients. Asymptomatic diastolic dysfunction (Grade 2 or more ) found in 17 patients without any overt features of heart failure (all have raised NTproBNP and HSTrop I along with clinical features ). A positive correlation was found between D- dimer level and severity of pneumonia by CT severity score. Conclusion: A high index of suspicion and necessary investigation may be needed for early detection of myocarditis and to prevent any complication particularly fatal arrhythmia and sudden cardiac death.
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