Covid-19-associated cardiac damage in patients on maintenance hemodialysis. Case reports and review of the literature

A brief review of current publications about incidence, outcomes and mechanisms of cardiovascular complications in patients with the new coronaviral disease (COVID-19) is given. The possibility of direct deleterious viral effect on the myocardium, negative consequences of cytokine storm, the role of hypoxemia complicating acute respiratory distress syndrome (ARDS), myocardial infarction 1,2 type (MI 1, 2), hypercoagulation, systolic disfunction of right ventricle due to ARDS, recurrent pulmonary embolism (PE) and cardiotoxic effects of drug therapy is discussed. Three case reports of cardiac injury in patients on maintenance hemodialysis (MHD) with COVID-19 are presented. The first case demonstrated MI 2 type due to ischemic imbalance in a patient with severe ARDS in the absence of obstructive coronary arteries lesion. The second case represented coexistent affection of heart as a result of viral myocarditis and cardiotoxic effect of Azithromycin and Plaquenil co-administration. The viral myocarditis was proven by postmortem histological and immunohistochemical tests. The third case demonstrated the diagnostic quest in a patient with recurrent dyspnea due to sequential severe ARDS, viral hemorrhagic exudative pericarditis with cardiac tamponade and PE progression. Currently three basic phenotypes of cardiac injury are distinguished: permanent elevation of myocardial damage markers, MI 1, 2 Type and viral myo/pericarditis. Of note, the course of COVID-19 in patients on MHD is more complicated in comparison with the general population. The initial vulnerability of these patients is determined not only by severe co-morbidity. Some interconfounding pathophysiological processes same to COVID-19 are critically important for the understanding of the current state of the art. The crucial role of persistent chronic inflammation, coagulopathy, pulmonary hypertension, permanent hemodynamic stress and fluctuation of volemic status should also be taken into consideration. MHD by itself is a powerful risk factor which overburdens the course of COVID-19.

COVID-19, программный гемодиализ, острое повреждение сердца, инфаркт миокарда, миокардит, геморрагический перикардит, тампонада сердца, тромбоэмболия легочной артерии, COVID-19, maintenance hemodialysis, acute cardiac injury, acute myocardial infarction, myocarditis, hemorrhagic pericarditis, сardiac tamponade, pulmonary embolism

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