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Central Asian Journal of Medicine

Abstract

The purpose is to study the occurrence of acute cardiovascular complications in COVID-19 infection and to compare their clinical manifestation with cases which are not connected with coronavirus disease. To choose the most compatible tactics for acute coronary syndrome during covid and post- covid period. Material and research methods. This study is a retrospective cohort study of 150 hospitalized patients with COVID-19 in a TMA multidisciplinary clinic and the cardiac intensive care unit of the Republican Scientific and Practical Medical Center of Cardiology from October, 2020 to September, 2021. A total of 106 patients with confirmed ACS (Acute coronary syndrome) were included. The average age of the patients was 63 ± 1.2 years. We collected clinical information and laboratory and instrumental test results of all enrolled patients, and analyze the treatment tactics and their outcome. Results. According to the discharge from hospitals, 34 patients (32%) suffered a severe course of COVID-19, 62 patients (58.5%) had moderate-severe coronavirus infection, the remaining 10 patients (9.4%) had a mild course. Compared with the patients in the non-myocardial injury group, the patients in the myocardial injury group were older, had a higher proportion of critically ill patients (79%), had a faster breathing rate on admission, and had a low percutaneous oxygen saturation (SpO2≈84-92%). A case series evaluated 39 COVID-19 patients with STEMI on ECG; of these patients, 13 (33%) presented with chest pain, 30 (78%) had focal ST-segment elevation, 14 (35%) had a regional wall motion abnormality on transthoracic echocardiogram, and 17 (44%) received a clinical diagnosis of myocardial infarction. A total of 22 (56.4%) patients underwent coronary angiography, of whom 18 (82%) showed obstructive disease. Patients with myocardial injury had higher levels of inflammation markers, poorer liver and kidney function, and more complications compared with patients without myocardial injury. Elevated levels of blood interleukin-6 (IL-6) (7,2%) were independent risk factors for acute myocardial injury in patients with COVID-19. Echocardiography data showed a relative decrease in ejection fraction up to 22.7-45%. Conclusion. COVID-19 can have numerous impacts on the cardiovascular system. Acute cardiovascular complications pose significant challenges and need a multidisciplinary Heart-Lung team to assess the need for invasive hemodynamic monitoring and device therapy. There remain several questions for future investigation to better understand the mechanism of myocardial injury and determine which therapies improve long-term survival.

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References

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