Health

5 cardiovascular complications after Covid – VnExpress


nCoV attacks on the body can cause acute and chronic myocardial damage, leading to many cardiovascular diseases after recovering from Covid-19.

Master and specialist doctor 2 Tran Thi Tuyet Lan (specialist in Cardiology, Ho Chi Minh City Heart Institute) said that common post-Covid-19 cardiovascular injuries include: myocarditis, myocardial interstitial fibrosis, endothelial cell dysfunction and vasculitis, thromboembolism, cardiac arrhythmias.

Statistics at Gia Dinh People’s Hospital from December 1, 2021 to January 10, 2022 show that there were 140 patients with post-Covid heart problems out of a total of 1,021 patients who came to the clinic, accounting for the percentage of patients with cardiovascular disease. 13.7%.

Myocarditis

nCoV infects host cells through angiotensin-converting enzyme receptor 2 (ACE2), leading to pneumonia caused by Covid-19; At the same time, it causes acute myocardial damage such as myocarditis, chronic damage to the cardiovascular system such as myocardial interstitial fibrosis, vasculitis, thromboembolism and arrhythmia.

“Myocardial damage directly caused by nCoV and indirectly caused by a cytokine storm causes inflammation and necrosis of cardiac muscle cells, leading to myocarditis and consequent heart failure,” said Doctor Tuyet Lan.

Symptoms of myocarditis can range from mild to very severe such as fatigue, shortness of breath depending on the degree of heart failure, heart palpitations, chest pain. Echocardiogram showed dilated heart, reduced heart wall dynamics, decreased left ventricular ejection fraction, and pulmonary hypertension. Blood tests showed elevated cardiac enzymes, increased heart failure biomarkers.

Myocardial Interstitial Fibrosis

Lan said that regional or diffuse myocardial fibrosis in the heart of Covid-19 patients can be seen in even F0 without cardiovascular symptoms. Typically, a 45-year-old female patient with diffuse interstitial fibrosis presents with palpitations and chest pain three months after contracting Covid-19 despite no history of myocarditis. Similar findings of diffuse fibrosis were observed in a 49-year-old man presenting with dyspnea 6 weeks after symptom onset. Myocardial interstitial fibrosis contributes to left ventricular dysfunction leading to heart failure.

Heart arrhythmia

When heart failure is severe, it can cause dangerous arrhythmias such as ventricular tachycardia, ventricular fibrillation, possibly cardiac arrest. In addition, side effects of antiviral drugs, antibiotics, hypoxemia, and electrolyte disturbances aggravate existing arrhythmias. Common cardiac arrhythmias are atrial fibrillation, intermittent episodes of ventricular tachycardia, cardiac arrest, and bradycardia. In particular, atrial arrhythmias are more common in critically ill patients treated in ICUs.

Thromboembolism

The process of endothelial cell damage and vasculitis caused by nCoV increases the risk of thrombosis (blood clots) in the blood vessel lumen and thromboembolism. The presence of thrombosis increases the severity and mortality of the disease. Thrombotic events are also commonly observed in critically ill Covid-19 patients, admitted to the ventilatory ICU, prolonged immobilization, and venous stasis.

According to Dr. Lan, thromboembolism in dangerous locations can lead to sudden death such as pulmonary embolism, acute myocardial infarction. Signaling symptoms are palpitations, fatigue with exertion, shortness of breath, chest pain, elevated heart enzymes… Depending on the suspicion of the diagnosis of pulmonary embolism or acute myocardial infarction, the patient is shown determine MSCT (multi-slice computed tomography) pulmonary artery contrast or coronary angiography. From there, the doctor has an appropriate and timely anticoagulant treatment plan according to the cause of the disease, helping to reduce the mortality rate.

Endothelial cell dysfunction and vasculitis

Direct viral infection of endothelial cells via the ACE2 receptor leads to impaired endothelial cell function and disruption of vascular integrity, causing vascular leakage. In addition, according to Dr. Lan, inflammation and increased blood clotting are also complications of endothelial cell dysfunction in Covid-19 patients.

F0 has endothelial cell dysfunction manifested by a 6% reduction in flow-mediated vasodilation. A 1% reduction in flow-mediated vasodilatation was associated with a 13% higher risk of cardiovascular events.

According to Dr. Lan, post-Covid-19 patients must always pay attention to their body, if they feel tired, short of breath, nervous, fast heart, dizzy, fainted… they should immediately visit a doctor for an appointment. timely tests such as electrocardiogram, echocardiogram, lower extremity vein ultrasound to find deep vein thrombosis… in order to detect and treat promptly.

When blood clotting is detected, depending on the level of D-dimer increased and the presence of venous thrombosis in the lower extremities, the doctor will prescribe anticoagulants according to the appropriate dose and time. If heart failure is present, the patient is treated with drugs to improve heart failure, reduce dyspnea, leg swelling and monitor the improvement of myocarditis with medical treatment. Antiarrhythmic drugs appropriate for each type of arrhythmia will also be carefully considered.

Le Cam

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