lvrachЛечащий ВрачLechaschi Vrach1560-51752687-1181ООО «Издательство "Открытые системы"»10.51793/OS.2021.24.7.002lvrach-776Research ArticleКАРДИОЛОГИЯ. АНГИОЛОГИЯCARDIOLOGY. ANGIOLOGYСердечно-сосудистые последствия перенесенного COVID-19: патогенез, диагностика и лечениеCardiovascular consequences of COVID-19: pathogenesis, diagnosis and treatmentМельниковаЛ. В.MelnikovaL. V.

доктор медицинских наук, профессор

Москва

Moscow

lumel2408@yandex.ruЛохинаТ. В.LokhinaT. V.

доктор медицинских наук

Пенза

Penza

БеренштейнН. В.BerenshteinN. V.

кандидат медицинских наук

Пенза

Penza

ИванчуковаМ. Г.IvanchukovaM. G.

Пенза

Penza

ФГБОУ ДПО РМАНПО Минздрава РоссииРоссияFederal State Budgetary Educational Institution of Further Professional Education «Russian Medical Academy of Continuous Professional Education» of the Ministry of Healthcare of the Russian FederationRussian FederationПИУВ – филиал ФГБОУ ДПО РМАНПО Минздрава РоссииРоссияPenza Institute for Further Training of Physicians – Branch of the Further Professional Education «Russian Medical Academy of Continuous Professional Education» of the Ministry of Healthcare of the Russian FederationRussian Federation20210309202107813Copyright © Мельникова Л.В., Лохина Т.В., Беренштейн Н.В., Иванчукова М.Г., 20212021Мельникова Л.В., Лохина Т.В., Беренштейн Н.В., Иванчукова М.Г.Melnikova L.V., Lokhina T.V., Berenshtein N.V., Ivanchukova M.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.lvrach.ru/jour/article/view/776

В статье представлен обзор научной литературы, содержащий данные о патогенезе, диагностике и лечении сердечно-сосудистых последствий перенесенной новой коронавирусной инфекции. Поражение сердца наблюдается у 7-28% госпитализированных пациентов с COVID-19. Поражение миокарда при воздействии коронавирусной инфекции может быть реализовано посредством двух патологических механизмов: прямое повреждение миокарда вследствие взаимодействия SARS-CoV-2 с миокардиальными рецепторами ангиотензинпревращающего фермента 2, а также косвенное повреждение миокарда, которое может быть вызвано цитокинами и другими провоспалительными факторами, нарушением микроциркуляции, гипоксическими изменениями кардиомиоцитов. Частыми аритмическими осложнениями COVID-19 бывают фибрилляция предсердий и желудочковая экстрасистолия. Несмотря на многочисленные публикации о поражении сердца в острой фазе этого заболевания, данные о сохраняющихся после выздоровления нарушениях недостаточны, клинические рекомендации по ведению таких пациентов отсутствуют. На основе приведенного клинического случая описаны механизмы комбинированной терапии бисопрололом и амлодипином частой желудочковой экстрасистолии, возникшей после перенесенного СОVID-19.

The paper presents an overview of the scientific literature containing data on the pathogenesis, diagnosis and treatment of cardiovascular consequences of a new coronavirus infection. Heart damage is observed in 7-28% of hospitalized patients with COVID-19. Myocardial damage when exposed to coronavirus infection can be realized through two pathological mechanisms: direct myocardial damage due to the interaction of SARS-CoV-2 with myocardial ACE2 receptors, as well as indirect myocardial damage, which can be caused by cytokines and other pro-inflammatory factors, microcirculation disorders, hypoxic changes cardiomyocytes. Frequent arrhythmic complications of COVID-19 are atrial fibrillation and ventricular premature beats. Despite numerous publications on heart damage in the acute phase of this disease, data on disorders remaining after recovery are insufficient, there are no clinical recommendations for the management of such patients. Based on the given clinical case, mechanisms of combination therapy of bisoprolol and amlodipine of frequent ventricular extrasystolia, which arose after COVID-19, are described.

СОVID-19постковидный синдромсердечно-сосудистые осложнениябисопрололамлодипинжелудочковая экстрасистолияартериальная гипертензияCOVID-19long-COVIDcardiovascular complicationsbisoprololamlodipineventricular extrasystoliaarterial hypertensionReferencesAkhmerov A., Marbán E. COVID-19 and the heart // Circ. Res. 2020; 126: 1443-1455.Akhmerov A., Marbán E. COVID-19 and the heart // Circ. Res. 2020; 126: 1443-1455.Liu P. P., Blet A., Smyth D. et all. The science underlying COVID-19: implications for the cardiovascular system // Circulation. 2020; 142: 68-78.Liu P. P., Blet A., Smyth D. et all. The science underlying COVID-19: implications for the cardiovascular system // Circulation. 2020; 142: 68-78.Wang D., Hu B., Hu C. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China // JAMA. 2020; 323 (11): 1061-1069.Wang D., Hu B., Hu C. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China // JAMA. 2020; 323 (11): 1061-1069.Guo T., Fan Y., Chen M. et all. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19) // JAMA Cardiol. 2020; 5 (7): 811-818.Guo T., Fan Y., Chen M. et all. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19) // JAMA Cardiol. 2020; 5 (7): 811-818.Shi S., Qin M., Shen B. et all. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China // JAMA Cardiol. 2020; 5 (7): 802-810.Shi S., Qin M., Shen B. et all. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China // JAMA Cardiol. 2020; 5 (7): 802-810.Richter D., Guasti L., Koehler F. et all. Late phase of COVID-19 pandemic in General Cardiology. A position paper of the ESC Council for Cardiology Practice // ESC Heart Fail. 2021 Jun 25.Richter D., Guasti L., Koehler F. et all. Late phase of COVID-19 pandemic in General Cardiology. A position paper of the ESC Council for Cardiology Practice // ESC Heart Fail. 2021 Jun 25.Goërtz Y. M. J., Van Herck M., Delbressine J. M. et all. Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome? // ERJ Open Res. 2020 Oct 26; 6 (4): 00542-2020.Goërtz Y. M. J., Van Herck M., Delbressine J. M. et all. Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome? // ERJ Open Res. 2020 Oct 26; 6 (4): 00542-2020.Mitrani R. D., Dabas N., Goldberger J. J. COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors // Heart Rhythm. 2020; 17 (11): 1984-1990.Mitrani R. D., Dabas N., Goldberger J. J. COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors // Heart Rhythm. 2020; 17 (11): 1984-1990.COVID-19 rapid guideline: managing the long-term effects of COVID-19. London: National Institute for Health and Care Excellence (UK); 2020 Dec 18.COVID-19 rapid guideline: managing the long-term effects of COVID-19. London: National Institute for Health and Care Excellence (UK); 2020 Dec 18.Zheng Y., Ma Y., Zhang J. et all. COVID-19 and the cardiovascular system // Nat Rev Cardiol. 2020; 17: 259-260.Zheng Y., Ma Y., Zhang J. et all. COVID-19 and the cardiovascular system // Nat Rev Cardiol. 2020; 17: 259-260.Huang C., Wang Y., Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China // Lancet. 2020; 6736: 1-10.Huang C., Wang Y., Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China // Lancet. 2020; 6736: 1-10.Kochi A. N., Tagliari A. P., Forleo G. B. et all. Cardiac and arrhythmic complications in patients with COVID-19 // J Cardiovasc Electrophysiol. 2020; 31 (5): 1003-1008.Kochi A. N., Tagliari A. P., Forleo G. B. et all. Cardiac and arrhythmic complications in patients with COVID-19 // J Cardiovasc Electrophysiol. 2020; 31 (5): 1003-1008.Chorin E., Wadhwani L., Magnani S. et all. QT interval prolongation and torsade de pointes in patients with COVID-19 treated with hydroxychloroquine/ azithromycin // Heart Rhythm. 2020; 17 (9): 1425-1433.Chorin E., Wadhwani L., Magnani S. et all. QT interval prolongation and torsade de pointes in patients with COVID-19 treated with hydroxychloroquine/ azithromycin // Heart Rhythm. 2020; 17 (9): 1425-1433.Danta C.C. Calcium Channel Blockers: A Possible Potential Therapeutic Strategy for the Treatment of Alzheimer's Dementia Patients with SARS-CoV-2 Infection. // ACS Chem Neurosci. 2020 Aug 5; 11(15): 2145-2148.Danta C.C. Calcium Channel Blockers: A Possible Potential Therapeutic Strategy for the Treatment of Alzheimer's Dementia Patients with SARS-CoV-2 Infection. // ACS Chem Neurosci. 2020 Aug 5; 11(15): 2145-2148.Porzionato A., Emmi A., Barbon S. et all. Sympathetic activation: a potential link between comorbidities and COVID-19 // FEBS J. 2020; 287(17): 3681-3688.Porzionato A., Emmi A., Barbon S. et all. Sympathetic activation: a potential link between comorbidities and COVID-19 // FEBS J. 2020; 287(17): 3681-3688.Talasaz A. H., Kakavand H., Van Tassell B. et all. Cardiovascular Complications of COVID-19: Pharmacotherapy Perspective // Cardiovasc Drugs Ther. 2021; 35 (2): 249-259.Talasaz A. H., Kakavand H., Van Tassell B. et all. Cardiovascular Complications of COVID-19: Pharmacotherapy Perspective // Cardiovasc Drugs Ther. 2021; 35 (2): 249-259.Suthahar N., Meijers W.C., Sillje H.H.W. et all. From inflammation to fibrosis-molecular and cellular mechanisms of myocardial tissue remodelling and perspectives on differential treatment opportunities // Curr Heart Fail Rep. 2017; 14: 235-250.Suthahar N., Meijers W.C., Sillje H.H.W. et all. From inflammation to fibrosis-molecular and cellular mechanisms of myocardial tissue remodelling and perspectives on differential treatment opportunities // Curr Heart Fail Rep. 2017; 14: 235-250.Huang L., Zhao P., Tang D. et all. Cardiac Involvement in Patients Recovered From COVID-2019 Identified Using Magnetic Resonance Imaging // JACC Cardiovasc Imaging. 2020; 13 (11): 2330-2339.Huang L., Zhao P., Tang D. et all. Cardiac Involvement in Patients Recovered From COVID-2019 Identified Using Magnetic Resonance Imaging // JACC Cardiovasc Imaging. 2020; 13 (11): 2330-2339.Puntmann V. O., Carerj M. L., Wieters I. et all. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19) // JAMA Cardiol. 2020; 5 (11): 1265-1273.Puntmann V. O., Carerj M. L., Wieters I. et all. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19) // JAMA Cardiol. 2020; 5 (11): 1265-1273.Kociol R. D., Cooper L. T., Fang J. C. Recognition and initial management of fulminant myocarditis: a scientific statement from the American Heart Association // Circulation. 2020; 141: e69-e92.Kociol R. D., Cooper L. T., Fang J. C. Recognition and initial management of fulminant myocarditis: a scientific statement from the American Heart Association // Circulation. 2020; 141: e69-e92.Siripanthong B., Nazarian S., Muser D., et al. Recognizing COVID-19-related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management // Heart Rhythm. 2020; 17 (9): 1463-1471.Siripanthong B., Nazarian S., Muser D., et al. Recognizing COVID-19-related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management // Heart Rhythm. 2020; 17 (9): 1463-1471.Lakkireddy D. R., Chung M. K., Gopinathannair R. et all. Guidance for cardiac electrophysiology during the COVID-19 pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association // Heart Rhythm. 2020; 17 (9): e233-e241.Lakkireddy D. R., Chung M. K., Gopinathannair R. et all. Guidance for cardiac electrophysiology during the COVID-19 pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association // Heart Rhythm. 2020; 17 (9): e233-e241.Kang J., Wang L., Chen X-L. et al. Interactions of a series of fluoroquinolone antibacterial drugs with the human cardiac K + channel HERG // Mol. Pharmacol. 2001; 59: 122-126.Kang J., Wang L., Chen X-L. et al. Interactions of a series of fluoroquinolone antibacterial drugs with the human cardiac K + channel HERG // Mol. Pharmacol. 2001; 59: 122-126.Ray W. A., Murray K. T., Hall K. et al. Azithromycin and the risk of cardiovascular death // N. Engl. J. Med. 2012; 366 (20): 1881-1890.Ray W. A., Murray K. T., Hall K. et al. Azithromycin and the risk of cardiovascular death // N. Engl. J. Med. 2012; 366 (20): 1881-1890.Остроумова О. Д. Удлинение интервала QT // Русский медицинский журнал. Кардиология. 2001; 18: 750.Ostroumova O. D. Udlineniye intervala QT [Prolongation of the QT interval] // RMJ. Kardiologiya. 2001; 18: 750.Lau S. T., Yu W. C., Mok N. S. et all. Tachycardia amongst subjects recovering from severe acute respiratory syndrome (SARS) // Int J Cardiol. 2005; 100: 167-169.Lau S. T., Yu W. C., Mok N. S. et all. Tachycardia amongst subjects recovering from severe acute respiratory syndrome (SARS) // Int J Cardiol. 2005; 100: 167-169.Недогода С. В. Фиксированная комбинация бисопролола и амлодипина: новые возможности антигипертензивной терапии // Фарматека. 2013; 6 (259): 90-97.Nedogoda S. V. Fiksirovannaya kombinatsiya bisoprolola i amlodipina: novyye vozmozhnosti antigipertenzivnoy terapii [Fixed combination of bisoprolol and amlodipine: new possibilities of antihypertensive therapy] // Farmateka. 2013; 6 (259): 90-97.Gao P., Wu W., Tian R. et al. Association between tachyarrhythmia and mortality in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19) // Ann Transl Med. 2021; 9(10): 883.Gao P., Wu W., Tian R. et al. Association between tachyarrhythmia and mortality in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19) // Ann Transl Med. 2021; 9(10): 883.Golgsmith S. R. Effect of amlodipine and felodipine on sympathetic activity and baroreflex function in normal humans // Am J Hypertens 1995; 8 (9): 902-908.Golgsmith S. R. Effect of amlodipine and felodipine on sympathetic activity and baroreflex function in normal humans // Am J Hypertens 1995; 8 (9): 902-908.Peng C., Wang H., Guo Y.F. et al. Calcium channel blockers improve prognosis of patients with coronavirus disease 2019 and hypertension // Chin Med J (Engl). 2021; Jun 16; 134(13): 1602-1609.Peng C., Wang H., Guo Y.F. et al. Calcium channel blockers improve prognosis of patients with coronavirus disease 2019 and hypertension // Chin Med J (Engl). 2021; Jun 16; 134(13): 1602-1609.Новикова Л. Б., Акопян А. П., Шарапова К. М. и соавт. Неврологические и психические расстройства, ассоциированные с COVID-19 // Артериальная гипертензия. 2020; 26 (3): 317-326.Novikova L. B., Akopyan A. P., Sharapova K. M. i soavt. Nevrologicheskiye i psikhicheskiye rasstroystva, assotsiirovannyye s COVID-19 [Neurological and mental disorders associated with COVID-19] // Arterial'naya gipertenziya. 2020; 26 (3): 317-326.Запесочная И. Л., Автандилов А. Г. Динамика показателей церебрального кровотока при комбинированной терапии амлодипином и бисопрололом // Клиническая медицина. 2016; 94 (9): 908-914.Zapesochnaya I. L., Avtandilov A. G. Dinamika pokazateley tserebral'nogo krovotoka pri kombinirovannoy terapii amlodipinom i bisoprololom [Dynamics of cerebral blood flow indicators in combination therapy with amlodipine and bisoprolol] // Klinicheskaya meditsina. 2016; 94 (9): 908-914.

The authors declare that there are no conflicts of interest present.