PDF(Pubmed)
Abstract：
Background/Objectives: The newly emergent COVID-19 pandemic involved primarily the respiratory system and had also major cardiovascular system (CVS) implications, revealed by acute myocardial infarction (AMI), arrhythmias, myocardial injury, and thromboembolism. CVS involvement is done through main mechanisms-direct and indirect heart muscle injury, with high mortality rates, worse short-term outcomes, and severe complications. AMI is the echo of myocardial injury (revealed by increases in CK, CK-MB, and troponin serum markers-which are taken into consideration as possible COVID-19 risk stratification markers). When studying myocardial injury, physicians can make use of imaging studies, such as cardiac MRI, transthoracic (or transesophageal) echocardiography, coronary angiography, cardiac computed tomography, and nuclear imaging (which have been used in cases where angiography was not possible), or even endomyocardial biopsy (which is not always available or feasible). Two-case-series presentations: We present the cases of two COVID-19 positive male patients who were admitted into the Clinical Department of Cardiology in \"Sfântul Apostol Andrei\" Emergency Clinical Hospital of Galați (Romania), who presented with acute cardiac distress symptoms and have been diagnosed with ST elevation AMI. The patients were 82 and 57 years old, respectively, with moderate and severe forms of COVID-19, and were diagnosed with anteroseptal left ventricular AMI and extensive anterior transmural left ventricular AMI (with ventricular fibrillation at presentation), respectively. The first patient was a non-smoker and non-drinker with no associated comorbidities, and was later discharged, while the second one died due to AMI complications. Conclusions: From this two-case series, we extract the following: old age alone is not a significant risk factor for adverse outcomes in COVID-19-related CVS events, and that the cumulative effects of several patient-associated risk factors (be it either for severe forms of COVID-19 and/or acute cardiac injury) will most probably lead to poor patient prognosis (death). At the same time, serum cardiac enzymes, dynamic ECG changes, along with newly developed echocardiographic modifications are indicators for poor prognosis in acute cardiac injury in COVID-19 patients with acute myocardial injury, regardless of the presence of right ventricular dysfunction (due to pulmonary hypertension).
摘要：
背景/目标：新出现的COVID-19大流行主要涉及呼吸系统，也有主要的心血管系统（CVS）影响，由急性心肌梗死（AMI）显示，心律失常,心肌损伤，和血栓栓塞。CVS参与是通过主要机制-直接和间接心肌损伤，死亡率很高，更糟糕的短期结果，和严重的并发症。AMI是心肌损伤的回声（通过CK的增加显示，CK-MB,和肌钙蛋白血清标志物-被认为是可能的COVID-19风险分层标志物)。在研究心肌损伤时，医生可以利用成像研究，比如心脏核磁共振,经胸（或食道）超声心动图，冠状动脉造影,心脏计算机断层扫描,和核成像（已在无法进行血管造影的情况下使用），甚至心内膜活检（并不总是可用或可行）。两个病例系列介绍：我们介绍了两名COVID-19阳性男性患者的病例，这些患者在“SfántulApostolAndrei”加尔西（罗马尼亚）急诊临床医院的心脏病学临床科住院，出现急性心脏窘迫症状并被诊断为ST段抬高AMI。患者分别为82岁和57岁，分别,患有中度和重度形式的COVID-19，并被诊断为前间隔左心室AMI和广泛的前透壁左心室AMI（出现室颤），分别。第一位患者是非吸烟者和饮酒者，没有相关的合并症，后来出院了,第二个人死于AMI并发症。结论：从这两个案例系列中，我们提取了以下内容：在COVID-19相关的CVS事件中，仅老年并不是不良结局的重要危险因素，以及几种与患者相关的危险因素(无论是严重形式的COVID-19和/或急性心脏损伤)的累积效应最有可能导致患者预后不良(死亡)。同时,血清心肌酶，动态心电图变化,以及新开发的超声心动图修改是COVID-19急性心肌损伤患者急性心脏损伤预后不良的指标，无论是否存在右心室功能障碍（由于肺动脉高压）。
