ЦельCOVID-19, как и другие респираторные вирусы, имеет внелегочные проявления. В частности, воздействие вируса приводит к поражению сердечно-сосудистой системы (ССС), патофизиологические механизмы которого до конца не ясны; не сформировано полноценное понимание механизмов взаимодействия COVID-19 и ССС. В статье проанализированы современные представления о COVID-19, рассмотрены возможные звенья патогенеза, предпринята попытка систематизации патофизиологических механизмов поражения ССС и их осложнений, проанализирована связь с сердечно-сосудистой коморбидностью, описаны особенности патоморфологии и предположительный долгосрочный прогноз. Представленные сведения могут способствовать пониманию двустороннего взаимодействия кардиоваскулярных заболеваний и эффектов COVID-19 для разработки эффективных профилактических мер и принятия верного решения в выборе терапевтической тактики для пациента в рамках системного подхода.
The main purpose of the following article is to highlight one of the most pressing and poorly studied issues both for cardiology and endocrinology – treatment and prognosis for patients with severe coronary pathology and subclinical hypothyroidism (SH). Pathophysiological mechanisms of type 2 myocardial infarction (MI) development with SH as a background and hormone replacement therapy issues are considered. SH is a modifiable risk factor (RF) for cardiovascular diseases (CVD) and mortality that does not depend on traditional cardiovascular RF. SH is associated with high risk of developing coronary artery disease, MI, heart failure, and CVD mortality. SH incidence of morbidity increases with age, usually the course is oligo- or asymptomatic. SH leads to a number of pathological conditions that cause an imbalance between the myocardial oxygen demand and delivery with a possible development of type 2 MI. Clinical case of type 2 MI development in a patient with severe coronary atherosclerosis and SH is presented. The key point of type 2 MI development mechanism is insufficient oxygen (O2) supply to cardiomyocytes due to multivessel coronary artery atherosclerotic stenosis and sharp increase in O2 demand as a result of cardiomyocyte hypertrophy. Older patients with severe cardiac pathology and SH should refrain from treatment with levothyroxine or start treatment after myocardial revascularization, selecting the dose of the drug individually.
ong-term consequences of COVID-19 remain the subject of active research interest. In this article the Post-COVID-19 syndrome (PCS) main features and symptoms are considered, its incidence and link with comorbidity is presented and the possible mechanisms are discussed. Due to the damage COVID-19 has on lungs, heart, brain and other systems, patients with PCS require multidisciplinary management.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.