Acute myocardial damage with coronovirus disease 2019 (covid-19) (case study)

Abstract

In 20% of cases, COronaVIrus Disease 2019 is characterized by a severe and very severe course, which is accompanied by pneumonia, acute respiratory distress syndrome, multiple organ dysfunctions. Complications related to the cardiovascular system occur in 20-25% and alone or together with respiratory failure are the cause of deaths in 40% patients with an unfavorable course of the disease. Acute myocardial damage (5-38%), caused in majority of cases by combination of causes: Type 2 heart attack on the background of acute viral myocarditis and a cytokine storm; coronary thrombosis due to COVID-associated coagulopathy; vasoconstriction due to blockage of SARS-COV-2 ACE2 receptors and increased concentration of angiotensin II; hypoxia from respiratory failure, manifests itself as heart failure, cardiac arrhythmias (∼20%) and/or sudden death (5-7%). This clinical case demonstrates that in a patient at high risk (hypertension), despite the positive dynamics, after applying therapy with human monoclonal antibodies to the interleukin 6 receptor (sarilumab), sudden death occurred on the 8th day of ICU stay, the cause of which was myocardial damage due to COVID.