Internal Medicine, Cardiology., Patan Academy of Health sciences, Lalitpur, Nepal
Nephrology, Nepal Medical College Teaching Hospital, Kathmandu, Nepal.
Postgrad Med J. 2021 Oct;97(1152):655-666. doi: 10.1136/postgradmedj-2020-138284. Epub 2020 Sep 17.
Since the outbreak of COVID-19 or coronavirus disease caused by severe acute respiratory syndrome coronavirus 2 from Wuhan, China, the cardiology fraternity's interest has been drawn towards the pandemic with a high case fatality rate of 10.5% and 6% in patients with heart disease and hypertension, respectively. One of the postulated mechanisms for this high fatality rate is the possible abundance of ACE type 2 receptor in the cardiovascular system that strongly binds with the spike protein of COVID-19 and helps internalise into the cell resulting in acute cardiac injury (ACI). More than 7% of cases with COVID-19 are reported to have this type of ACI. A tenfold rise in mortality has been observed in patients with COVID-19 who experience a rise in high-sensitivity (hs)-troponin. All most half of the patients who died of COVID-19 had a rise in hs-troponin. More than 15% of cases with COVID-19 experienced different types of arrhythmias. All these statistics denote how important cardiovascular pathology is in patients with COVID-19. Controversies of renin-angiotensin-aldosterone system inhibitors usage in patients with COVID-19 and meticulous handling of case with acute coronary syndrome categorically stresses cardiologists to bust the myths hovering around and set a standard guideline to counterfeit the fatality with timely diagnosis and treatment of COVID-19-induced ACI. In this review, we sought to summarise the current evidence of COVID-19-associated cardiac injury and suggest the implications for its proper diagnosis and treatment.
自中国武汉爆发由严重急性呼吸系统综合征冠状病毒 2 引起的 COVID-19 或冠状病毒病以来，心脏病学领域对这一高病死率（分别为 10.5%和 6%的心脏病和高血压患者）的大流行产生了浓厚的兴趣。这种高病死率的一种推测机制是心血管系统中可能存在大量 ACE 型 2 受体，该受体与 COVID-19 的刺突蛋白强烈结合，并帮助其内化到细胞中，导致急性心脏损伤 (ACI)。超过 7%的 COVID-19 病例报告存在这种类型的 ACI。在 COVID-19 患者中，hs-肌钙蛋白升高的患者死亡率增加了十倍。超过一半死于 COVID-19 的患者 hs-肌钙蛋白升高。超过 15%的 COVID-19 患者经历了不同类型的心律失常。所有这些统计数据都表明心血管病理学在 COVID-19 患者中的重要性。关于 COVID-19 患者使用肾素-血管紧张素-醛固酮系统抑制剂的争议以及对急性冠状动脉综合征病例的细致处理，都明确要求心脏病专家打破围绕 COVID-19 相关心脏损伤的神话，并制定标准指南，及时诊断和治疗 COVID-19 引起的 ACI，以降低病死率。在这篇综述中，我们试图总结 COVID-19 相关心脏损伤的现有证据，并提出对其进行正确诊断和治疗的影响。
