Raffaello Wilson Matthew, Huang Ian, Budi Siswanto Bambang, Pranata Raymond
Faculty of Medicine, Universitas Pelita Harapan, Tangerang 15810, Indonesia.
Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia.
World J Cardiol. 2021 Aug 26;13(8):298-308. doi: 10.4330/wjc.v13.i8.298.
Coronavirus disease 2019 infection has spread worldwide and causing massive burden to our healthcare system. Recent studies show multiorgan involvement during infection, with direct insult to the heart. Worsening of the heart function serves as a predictor of an adverse outcome. This finding raises a particular concern in high risk population, such as those with history of preexisting heart failure with or without implantable device. Lower baseline and different clinical characteristic might raise some challenge in managing either exacerbation or new onset heart failure that might occur as a consequence of the infection. A close look of the inflammatory markers gives an invaluable clue in managing this condition. Rapid deterioration might occur anytime in this setting and the need of cardiopulmonary support seems inevitable. However, the use of cardiopulmonary support in this patient is not without risk. Severe inflammatory response triggered by the infection in combination with the preexisting condition of the worsening heart and implantable device might cause a hypercoagulability state that should not be overlooked. Moreover, careful selection and consideration have to be met before selecting cardiopulmonary support as a last resort due to limited resource and personnel. By knowing the nature of the disease, the interaction between the inflammatory response and different baseline profile in heart failure patient might help clinician to salvage and preserve the remaining function of the heart.
2019冠状病毒病感染已在全球蔓延，给我们的医疗系统带来了巨大负担。最近的研究表明，感染期间多器官受累，心脏受到直接损害。心脏功能恶化是不良结局的一个预测指标。这一发现引起了高危人群的特别关注，例如那些有或没有植入式装置的既往心力衰竭病史的人。较低的基线水平和不同的临床特征可能会给管理因感染而可能出现的心力衰竭加重或新发带来一些挑战。仔细观察炎症标志物可为管理这种情况提供宝贵线索。在这种情况下，随时可能发生快速恶化，心肺支持似乎不可避免。然而，在这类患者中使用心肺支持并非没有风险。感染引发的严重炎症反应与心脏恶化和植入式装置的既往状况相结合，可能会导致一种不应被忽视的高凝状态。此外，由于资源和人员有限，在选择心肺支持作为最后手段之前，必须进行仔细的选择和考虑。通过了解疾病的性质，心力衰竭患者炎症反应与不同基线特征之间的相互作用可能有助于临床医生挽救和保留心脏的剩余功能。
