Physical and rehabilitation medicine, medical rehabilitationPhysical and rehabilitation medicine, medical rehabilitationФизическая и реабилитационная медицина, медицинская реабилитация2658-68432949-1436Eco-Vector3408010.36425/rehab34080REVIEWSНАУЧНЫЙ ОБЗОРResearch ArticlePotential effects of COVID-19 on the cardiovascular systemПотенциальное влияние COVID-19 на сердечно-сосудистую системуhttps://orcid.org/0000-0002-4329-098X7209-0144MikhaylovskayaTatyana V.МихайловскаяТатьяна Валентиновна
Russian Federation

MD, PhD

к.м.н., доцент кафедры госпитальной терапии

tanyadoc8484@mail.ruhttps://orcid.org/0000-0003-4734-9237YakovlevaNataliya D.ЯковлеваНаталия Дмитриевна
Russian Federation
n.d.karpova@inbox.ruhttps://orcid.org/0000-0002-9630-42307922-4184SafronovMaksim A.СафроновМаксим Алексеевич
Russian Federation
pack90@bk.ruhttps://orcid.org/0000-0001-9459-59626070-1100KharlamovaYana I.ХарламоваЯна Игоревна
Russian Federation
kafedra-ht@rambler.ruFederal State Budgetary Educational Institution of Higher Education “Ivanovo State Medical Academy” of the Ministry of Healthcare of the Russian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Ивановская государственная медицинская академия» Минздрава РоссииMedis ClinicООО «Медис»Аrkadiya PlusOOO «Аркадия Плюс»07072020221331391405202020052020Copyright ©; 2020, Mikhaylovskaya T.V., Yakovleva N.D., Safronov M.A., Kharlamova Y.I.Copyright ©; 2020, Михайловская Т.В., Яковлева Н.Д., Сафронов М.А., Харламова Я.И.2020Mikhaylovskaya T.V., Yakovleva N.D., Safronov M.A., Kharlamova Y.I.Михайловская Т.В., Яковлева Н.Д., Сафронов М.А., Харламова Я.И.https://creativecommons.org/licenses/by/4.0https://journals.eco-vector.com/2658-6843/article/view/34080

It is known that coronaviruses can cause acute coronary syndrome, arrhythmias, and aggravation of heart failure, mainly due to a combination of a significant systemic inflammatory response and a local vascular inflammation at the level of arterial plaque. In the context of massive SARS-CoV-2infections and the announced pandemic, there is a need to update management of cardiovascular patients in order to reduce COVID-19-related complications. COVID-19 can cause viral pneumonia, as well as extrapulmonary symptoms and complications. A larger proportion of severe COVID-19 patients had a cardiovascular disease or a high cardiovascular risk. The presence of arterial hypertension and other cardiovascular and cerebrovascular diseases is considered as a factor aggravating the course of the disease and increasing the lethality. Severe cases of COVID-19 were accompanied by acute, often lethal, cardiovascular disorders, with an increase in the level of highly sensitive troponins. There is no reliable evidence that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can increase the risk of infection or severe course of COVID-19, so there is no reason to cancel them. The role of inhibition of the renin-angiotensin system in the treatment of COVID-19 remains controversial. COVID-19 treatment boils down to supportive care and treatment for complications. Based on the results of the studies, a large number of cardiovascular complications of COVID-19 can be expected. Their therapy should be carried out strictly according to modern guidelines. Recommendations include antiplatelet agents, β-blockers, ACE inhibitors and statins.

Известно, что коронавирусы наряду со многими осложнениями могут вызывать острый коронарный синдром, аритмии и усиление симптомов сердечной недостаточности в основном вследствие значительного системного воспалительного ответа в сочетании с локализованным сосудистым воспалением на уровне артериальной бляшки. В связи с массовым заражением новым коронавирусом SARS-CoV-2 и объявлением пандемии особенно актуальны вопросы ведения пациентов с сердечно-сосудистыми заболеваниями в условиях риска заражения и при развитии COVID-19, а также предотвращения сердечно-сосудистых осложнений этого заболевания. COVID-19 может вызывать вирусную пневмонию, а также внелегочные симптомы и осложнения. Согласно наблюдениям, большая доля пациентов в тяжелом состоянии имела кардиоваскулярные заболевания или риск их развития. Наличие артериальной гипертензии и других сердечно-сосудистых и цереброваскулярных патологий рассматривается как фактор, не только отягощающий течение заболевания, но и приводящий к летальному исходу. В тяжелых случаях COVID-19 наблюдались острые сердечно-сосудистые нарушения, сопровождаемые повышением уровня высокочувствительных тропонинов, что зачастую приводило к летальному исходу. Достоверные сведения о риске заражения или тяжелого течения COVID-19 вследствие приема ингибиторов ангиотензинпревращающего фермента и блокаторов ангиотензиновых рецепторов отсутствуют, поэтому оснований для их отмены нет. Вопрос о роли ингибирования ренин-ангиотензиновой системы в лечении COVID-19 остается спорным. Лечение COVID-19 сводится к поддерживающей терапии и лечению осложнений. Основываясь на результатах проведенных исследований, можно ожидать большое число сердечно-сосудистых осложнений COVID-19, терапия которых должна проводиться строго по современным руководствам. Рекомендуется использовать антиагреганты, β-блокаторы, ингибиторы ангиотензинпревращающего фермента и статины.

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