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心内科医生应该了解哪些关于 2019 冠状病毒病的知识?

What should a cardiologist know about coronavirus disease 2019?

机构信息

Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland

Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland.

出版信息

Kardiol Pol. 2020 Apr 24;78(4):278-283. doi: 10.33963/KP.15302.

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is the cause of coronavirus disease 2019 (COVID‑19). The most common symptoms of COVID‑19 are: fever (81.8%-100%), cough (46.3%-86.2%), myalgia and fatigue (11%-50%), expectoration (4.4%-72%), and dyspnea (18.6%-59%). The most common laboratory abnormalities in COVID‑19 include decreased lymphocyte count (35%-82.1%), thrombocytopenia (17%-36.2%), elevated serum C‑reactive protein (60.7%-93%), lactate dehydrogenase (41%-76%), and D‑dimer concentrations (36%-46.4%). Among comorbidities in patients with COVID‑19, cardiovascular disease is most commonly found. In addition, patients with concomitant cardiovascular diseases have worse prognosis and more often require admission to the intensive care unit (ICU), compared with patients without such comorbidities. It is estimated that about 20% of patients with COVID‑19 develop cardiac injury. Cardiac injury is more prevalent among patients with COVID‑19 who require ICU care. In a group of critically ill patients, 27.5% had an elevated N‑terminal pro-B‑type natriuretic peptide concentration, and increased cardiac troponin level was found in 10% of patients. One of the life‑threatening cardiac manifestations is coronavirus fulminant myocarditis, which may also occur without accompanying symptoms of pulmonary involvement. Early recognition and treatment is crucial in these cases. So far, data on the incidence of arrhythmias in patients with COVID‑19 are limited. Coronavirus disease 2019 impacts patients with cardiovascular comorbidities and affects daily practice of cardiologists. Thus, it is important to know typical COVID‑19 symptoms, possible clinical manifestations, complications, and recommended treatment.

摘要

严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)是导致 2019 年冠状病毒病(COVID-19)的病原体。COVID-19 的最常见症状为:发热(81.8%-100%)、咳嗽(46.3%-86.2%)、肌痛和乏力(11%-50%)、咳痰(4.4%-72%)和呼吸困难(18.6%-59%)。COVID-19 患者最常见的实验室异常包括淋巴细胞计数减少(35%-82.1%)、血小板减少(17%-36.2%)、血清 C 反应蛋白升高(60.7%-93%)、乳酸脱氢酶升高(41%-76%)和 D-二聚体浓度升高(36%-46.4%)。在 COVID-19 患者的合并症中,心血管疾病最为常见。此外,与无此类合并症的患者相比,合并心血管疾病的患者预后更差,更常需要入住重症监护病房(ICU)。据估计,约 20%的 COVID-19 患者会发生心脏损伤。COVID-19 需入住 ICU 的患者中心脏损伤更为常见。在一组危重症患者中,27.5%患者的 N-末端脑利钠肽前体浓度升高,10%的患者心肌肌钙蛋白水平升高。危及生命的心脏表现之一是冠状病毒暴发性心肌炎,即使没有肺部受累的伴随症状,也可能发生这种心肌炎。在这些情况下,早期识别和治疗至关重要。迄今为止,COVID-19 患者心律失常发生率的数据有限。COVID-19 对合并心血管疾病的患者有影响,并影响心脏病专家的日常实践。因此,了解 COVID-19 的典型症状、可能的临床表现、并发症和推荐的治疗方法很重要。

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