COVID-19 ve Kardiyovasküler Sistem: Erişkin ve Pediyatrik Kardiyoloji Yaklaşımı

Year 2020, Volume: 1 Issue: 1, 24 - 30, 30.06.2020

Meltem Refiker Ege Feyza Ayşenur Paç

Abstract

Ciddi akut respiratuvar sendrom coronavirus-2 SARS-CoV-2 ’nin neden olduğu Coronavirus hastalığı-19 COVID-19 , dünyada Mayıs 2020 itibari ile ortalama 9 milyon 270 bin hasta ve 470 bin ölümle yüzyılın pandemisini yapmıştır. Başlıca akciğerleri etkileyerek interstisiyel pnömonitis ve ciddi akut respiratuvar distrese ARDS neden olmakla birlikte, kardiyovasküler sistem başta olmak üzere birçok organı etkilemektedir. Adrenerjik uyarı, sistemik inflamasyon, sitokin fırtınası, miyokardiyal ve endotelyal hücrelerin direk virüsle invazyonu, respiratuvar yetmezliğe bağlı hipoksi, elektrolit imbalansları, sıvı yükü ve COVID-19 tedavisinde kullanılan ilaçların yan etkileri COVID-19 görülen kardiyak klinik tabloların nedenleri arasında sayılabilir. En sık görülen kardiyak komplikasyonlar aritmiler atrial fibrilasyon, ventriküler taşikardi ve ventriküler fibrilasyon , kardiyak hasar yüksek duyarlıklı troponin I ve kreatin kinaz yüksekliği , fulminan miyokardit, kalp yetersizliği ve miyokardiyal enfarktüstür. Mekanik olarak, SARS-CoV-2 serin proteaz tarafından S proteinin proteolitik ayrımını takiben transmembran anjiotensin-dönüştürücü enzim2 ACE2 ‘ye bağlanarak tip 2 pnömositlere, makrofajlara, perivasküler perisitlere ve kardiyomiyositlere bağlanır. Viral invazyon için ACE2 gerekse de ACE inhibitörlerinin veya anjiotensin reseptör blokerlerinin ARB prognozu olumsuz etkilediğine dair kanıt yoktur. Bundan dolayı hastalar bu grup ilaçları kullanmayı bırakmamalıdır. Bu derlemede kardiyovaküler hastalarda COVID-19’un önemi, COVID-19’un kardiyovasküler komplikasyonları, COVID-19’da artmış kardiyak biyobelirteçlerin önemi, COVID-19 ve reninanjiotensin-aldosteron sistemine etki eden ilaçların birlikteliği ile COVID-19 tedavisinde kullanılan ilaçların kardiyovasküler sistem üzerine olan etkileri özetlenmeye çalışıldı.

Keywords

SARS-CoV-2 , COVID-19 , hipertansiyon , reninanjiotensin-aldosteron , kalp yetersizliği , miyokardit , troponin

COVID-19 and Cardiovascular System: Approach of Adult and Pediatric Cardiology

Abstract

The Coronavirus disease 2019 COVID-19 , caused by severe acute respiratory syndrome coronavirus-2 SARS-CoV-2 , represents the pandemic of the century, with approximately 9 million 270 thousand cases and 470 thousand deaths worldwide as of May 2020.While COVID-19 primarily affects the lungs, causing interstitial pneumonitis and severe acute respiratory distress syndrome ARDS , it also affects multiple organs, particularly the cardiovascular system. The cardiac manifestations of COVID-19 might be related to the adrenergic drive, systemic inflammatory milieu and cytokine-release syndrome caused by SARS-CoV-2, direct viral infection of myocardial and endothelial cells, hypoxia due to respiratory failure, electrolytic imbalances, fluid overload, and side effects of certain COVID-19 medications. The most common complications include arrhythmia atrial fibrillation, ventricular tachyarrhythmia, and ventricular fibrillation , cardiac injury [elevated highly sensitive troponin I hs-cTnI and creatine kinase CK levels], fulminant myocarditis, heart failure and myocardial infarction. Mechanistically, SARS-CoV-2, following proteolytic cleavage of its S protein by a serine protease, binds to the transmembrane angiotensin-converting enzyme 2 ACE2 to enter type 2 pneumocytes, macrophages, perivascular pericytes, and cardiomyocytes. While ACE2 is essential for viral invasion, there is no evidence that ACE inhibitors or angiotensin receptor blockers ARBs worsen prognosis. Hence, patients should not discontinue their use. This review provides a comprehensive overview of COVID-19 and cardiovascular diseases with cardiovascular complications of COVID-19, the use of renin-angiotensin-aldosterone inhibitors and the importance of increased cardiac biomarkers in COVID-19 with the the side effects of drugs used for COVID-19 treatment in cardiovascular diseases.

Keywords

SARS-CoV-2 , COVID-19 , hypertension , reninangiotensin-aldosteron , heart failure , myocarditis , troponin

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