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

Olga S. Oynotkinova; Ойноткинова Ольга Шонкоровна; Evgenii L. Nikonov; Никонов Евгений Леонидович; Oleg V. Zayratyants; Зайратьянц Олег Вадимович; Elena V. Rzhevskaya; Ржевская Елена Васильевна; Evgenii V. Krukov; Крюков Евгений Владимирович; Michail I. Voevoda; Воевода Михаил Иванович; Olga M. Maslennikova; Масленникова Ольга Михайловна; Vera N. Larina; Ларина Вера Николаевна; Tatiana Y. Demidova; Демидова Татьяна Юльевна; Evgenii I. Dedov; Дедов Евгений Иванович

doi:10.15690/vramn1433

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

作者: Oynotkinova O.S.¹, Nikonov E.L.², Zayratyants O.V.³, Rzhevskaya E.V.⁴, Krukov E.V.⁵, Voevoda M.I.⁶, Maslennikova O.M.⁷, Larina V.N.², Demidova T.Y.², Dedov E.I.²
隶属关系:
1. Research Institute of Healthcare Organization and Medical Management
2. Pirogov Russian National Research Medical University
3. A.I. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian Federation
4. Polyclinic No. 1 of the Office of the President of the Russian Federation
5. Main Military Clinical Hospital Named after N.N. Burdenko
6. Federal Research Center for Fundamental and Translational Medicine
7. Central State Medical Academy
期: 卷 75, 编号 5S (2020)
页面: 414-425
栏目: INFECTIOUS DISEASES: CURRENT ISSUES
URL: https://ogarev-online.ru/vramn/article/view/125722
DOI: https://doi.org/10.15690/vramn1433
ID: 125722

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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.

关键词

COVID-19, SARS-CoV-2 virus, myocardial damage, fulminant myocarditis, cytokine storm, cardioprotective therapy, phosphocreatine

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MD, PhD

俄罗斯联邦, Moscow

参考

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