Compromiso cardiovascular y trombótico en COVID-19. Implicancias clínicas y terapéuticas
DOI:
https://doi.org/10.22529/me.2021.6(2)07Palabras clave:
COVID 19, SARS Cov2, troponina de alta sensibilidad, dimero D.Resumen
La infección por el coronavirus 2019 (COVID 19) producida por el virus SARS Cov2 se caracteriza por una citocinemia exuberante, inflamación endotelial microvascular y macrovascular que afecta predominantemente el sistema respiratorio, pero hay suficiente evidencia que esta enfermedad, particularmente en sus formas más severas afecta también al sistema cardiovascular entre otros. El objetivo de la presente revisión es la descripción de las manifestaciones cardiovasculares y trombóticas de esta enfermedad y sus implicancias clínicas y terapéuticas. Para ello se han hemos seleccionado artículos publicados en pubmed medline relacionados con las manifestaciones cardiovasculares y de enfermedad tromboembólica que complican a los pacientes con COVID 19. La enfermedad cardiovascular preexistente y los factores de riesgo cardiovasculares presentes aumentan la morbilidad y la mortalidad en esta enfermedad. Las manifestaciones cardiovasculares están dadas por la injuria cardiaca manifestada por el incremento de los niveles de troponina asociadas o no a anormalidades electrocardiográficas y/o ecocardiográficas. La disfunción miocárdica ocurre en alrededor del 60 % de los pacientes hospitalizados por COVID-19 dependiendo de la población que se evalúe. Las potenciales causas de injuria incluyen: desequilibrio entre oferta y demanda de oxígeno por taquicardia hipotensión, hipoxia resultando en un infarto tipo II, síndrome coronario agudo por ruptura de placa en un medio trombótico e inflamatorio resultando en un infarto tipo I, disfunción microvascular debido a microtrombosis difusa, cardiomiopatía por estrés ( síndrome de Takotsubo), injuria miocárdica no isquémica debido a estado hiperinflamatorio por aumento de citosinas, y por toxicidad viral directa produciendo miocarditis. Por otro lado, los mecanismos trombóticos implicados en el COVID-19 son debidos a un estado de hipercoagulabilidad, en donde el virus promueve la formación masiva de fibrina, lo cual explicaría los altos niveles de dímeros D observados. Esta coagulopatía puede causar diversas complicaciones trombóticas y tromboembólicas arteriales y/o venosas, especialmente en pacientes críticamente enfermos, la patogenia se debe a lesión endotelial, inmovilización y aumento de protrombina circulante. Esta patología en sus formas más graves va asociadas a biomarcadores tales como, la troponina de alta sensibilidad, el dimero D y la ferritina entre otros, todos ellos son el resultado del compromiso cardiovascular y trombótico del COVID- 19 constituyéndose también marcadores pronósticos.Descargas
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