Faculty of Medicine School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
St Louis University School of Medicine, United States.
Hong Kong Med J. 2022 Jun;28(3):249-256. doi: 10.12809/hkmj209217. Epub 2022 May 31.
Cardiac injury associated with coronavirus disease 2019 (COVID-19) is associated with high fatality rates. We reviewed the literature on COVID-19-related cardiovascular complications to elucidate the putative causes, diagnosis, and management of cardiovascular complications of COVID-19. Putative causes of these cardiovascular complications include cytokine storm, myocarditis, coronary plaque rupture, hypercoagulability, stress cardiomyopathy or combinations thereof. Cardiac troponin, D-dimer, and N-terminal pro B-type natriuretic peptide levels all provide prognostic information on COVID-19-related cardiovascular complications: elevated levels correlate with poorer prognosis. Coronary thrombosis due to COVID-19 may be associated with a higher thrombus burden than that from other causes. Hypercoagulability can be extremely challenging to treat, and in the absence of contra-indications, thromboprophylaxis is generally indicated in intensive care unit patients. With the exception of percutaneous coronary intervention for acute myocardial infarction, there are no specific treatments for COVID-19-related cardiovascular complications and management is primarily supportive. Whether antiviral therapies, coupled with monoclonal antibodies administered early in the course of COVID-19 illness will prevent severe cardiovascular complications remains to be seen.
与 2019 年冠状病毒病（COVID-19）相关的心脏损伤与高死亡率相关。我们回顾了 COVID-19 相关心血管并发症的文献，以阐明 COVID-19 心血管并发症的推测原因、诊断和处理。这些心血管并发症的推测原因包括细胞因子风暴、心肌炎、冠状动脉斑块破裂、高凝状态、应激性心肌病或它们的组合。心脏肌钙蛋白、D-二聚体和 N 末端 B 型利钠肽前体水平均提供了 COVID-19 相关心血管并发症的预后信息：水平升高与预后较差相关。COVID-19 引起的冠状动脉血栓形成可能与其他原因引起的血栓负荷更高有关。高凝状态的治疗极具挑战性，在没有禁忌症的情况下，重症监护病房患者通常需要进行血栓预防。除了急性心肌梗死的经皮冠状动脉介入治疗外，COVID-19 相关心血管并发症没有特定的治疗方法，主要是支持性治疗。抗病毒疗法加上 COVID-19 发病早期给予的单克隆抗体是否会预防严重的心血管并发症，还有待观察。
