تشخیص و درمان ایسکمی حاد میوکارد در بیماران مبتلا به COVID-19

نوع مقاله : مقاله مروری

نویسندگان

1 استاد، گروه قلب، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 بخش همودیالیز، بیمارستان نور و حضرت علی اصغر (ع)، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

در عفونت COVID-19، ایسکمی حاد میوکارد می‌تواند به دو صورت انفارکتوس حاد میوکارد (Acute myocardial infarction یا AMI) نوع 1 و 2 رخ دهد. در AMI نوع 1، عفونت می‌تواند سبب التهاب گردد و التهاب موجب ترشح و افزایش سیتوکین‌هایی مانند اینترلوکین (Interleukin یا IL) 1، 6 و 8 و نیز Tumor necrosis factor (TNF) در جریان گردش خون می‌شود. این مکانیسم منجر به ترشح کلاژناز از ماکروفاژهای فعال می‌شود و مجموع این واکنش‌ها، پیش‌درامد پارگی پلاک، افزایش انعقادپذیری و تشکیل ترومبوز است. این مکانیسم بر روی پلاک آترواسکلروز، ایجاد AMI نوع 1 می‌کند. در این بیماران، Primary Percutaneous Coronary Intervention (PPCI) (بر خلاف نظریه‌ی اولیه که لیتیک‌تراپی را درمان اصلی پیشنهاد کرده بود) روش اتنخابی درمان می‌باشد. در شرایط کرونایی، زمان انجام PPCI از 120 تا 180 دقیقه افزایش می‌یابد. اگر برای انجام PPCI به بیش از 180 دقیقه زمان لازم بود، در این صورت لیتیک‌تراپی پیشنهاد می‌گردد. در AMI نوع 2، بیماران از نظر بالینی اغلب آنژین ندارند و تروپونین به صورت ملایم (کمتر از 2 برابر حد طبیعی) بالا می‌رود و تغییرات الکتروکاردیوگرام که نشانه‌ی ایسکمی است را ندارند. البته بیماران مبتلا به COVID-19، درد قفسه‌ی صدری پایدار با و یا بدون نکروز میوکارد را دارند. در عفونت کرونایی حاد، به دلیل آزادی IL، Tumor necrosis factor (TNF)، کاتکول آمین‌ها و همچنین، وجود هایپوکسی، اسیدوز، پرفشاری خون و یا کاهش فشار خون، بین اکسیژن‌رسانی و نیاز به اکسیژن میوکارد، اختلال به وجود می‌آید و AMI نوع 2 رخ می‌دهد. در این بیماران، درمان‌های حمایتی انجام می‌شود و درمان بیماری حاد زمینه‌ای مانند درمان با داروهای ضد التهابی استروئیدی و ضد ویروسی، درمان اصلی است.

کلیدواژه‌ها

عنوان مقاله [English]

Diagnosis and Treatment of Acute Myocardial Ischemia in Patients with COVID-19 Infection

نویسندگان [English]

  • hassan shemirani 1
  • RAZIEH JAFARI 2
1 Professor, Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Hemodialysis, Noor and Hazrat-e-Ali Asghar Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Acute myocardial ischemia during coronavirus disease 2019 (COVID-19) infection can occur in two forms of acute myocardial infarction type І and II. In acute myocardial infarction type І, infection can cause inflammation, and inflammation causes the secretion and increase of cytokines such as interleukin 1, 6, and 8, as well as tumor necrosis factor (TNF) in the circulation. This mechanism causes the secretion of collagenase from activated macrophages, and the results of these reactions is a precursor to plaque rupture, increased coagulation, and thrombus formation. This mechanism causes acute myocardial infarction type І on atherosclerotic plaque. In these patients, primary percutaneous coronary intervention (PCI) is the treatment of choice, contrary to the initial theory that lytic therapy was the main treatment. In COVID conditions, the primary PCI time increases from 120 minutes to 180 minutes, and if the primary PCI takes more than 180 minutes, then lytic therapy is recommended. In acute myocardial infarction type II, patients usually do not have angina clinically, troponin rises slightly (less than 2 times normal), and do not have electrocardiogram changes as a sign of ischemia. However, patients with coronary heart disease have persistent chest pain with or without myocardial necrosis. During COVID-19 infection, due to release of interleukin, tumor necrosis alpha, and catecholamine, as well as hypoxia, acidosis, hypertension and/or hypotension, oxygen delivery and myocardial oxygen demand become disturbed, so acute myocardial infarction type II may occur. Supportive therapies are performed in these patients, and the treatment of acute underlying disease such as treatment with steroidal anti-inflammatory drugs and antiviral drugs is the main treatment.

کلیدواژه‌ها [English]

  • COVID-19
  • Myocardial Infarction
  • Myocardial Ischemia
  • Percutaneous Coronary Intervention
  • Troponin

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  • تاریخ دریافت: 19 تیر 1400
  • تاریخ بازنگری: 01 اردیبهشت 1403
  • تاریخ پذیرش: 17 فروردین 1401

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