Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC143310.15690/vramn1433INFECTIOUS DISEASES: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ ИНФЕКЦИОННЫХ БОЛЕЗНЕЙResearch ArticleClinical and Morphological Features of Myocardial Damage and the Course of Fulminant Myocarditis on the Background of СOVID-19, Diagnosis and Treatment TacticsКлинические и морфологические особенности повреждения миокарда и течения фульминантного миокардита на фоне СOVID-19, диагностика и тактика леченияhttps://orcid.org/0000-0002-9856-8643331566777783-6965OynotkinovaOlga S.ОйноткиноваОльга Шонкоровна
Russian Federation

MD, PhD, Professor

д.м.н., профессор

olga-oynotkinova@yandex.ruhttps://orcid.org/0000-0002-5231-711X5618-1533NikonovEvgenii L.НиконовЕвгений Леонидович
Russian Federation

MD, PhD, Professor

д.м.н., профессор

drnikonov@mail.ruhttps://orcid.org/0000-0003-3606-38234817-1084ZayratyantsOleg V.ЗайратьянцОлег Вадимович
Russian Federation

MD, PhD, Professor

д.м.н., профессор

ovzair@mail.ruhttps://orcid.org/0000-0001-7194-82193216-2315RzhevskayaElena V.РжевскаяЕлена Васильевна
Russian Federation

MD, PhD

к.м.н.

nolamz@mail.ruhttps://orcid.org/0000-0002-8396-1936KrukovEvgenii V.КрюковЕвгений Владимирович
Russian Federation

MD, PhD, Professor, Corresponding Member of the RAS

д.м.н., профессор, член-корреспондент РАН

Evgeniy.md@mail.ruhttps://orcid.org/0000-0001-9425-413X6133-1780VoevodaMichail I.ВоеводаМихаил Иванович
Russian Federation

MD, Professor, Academician of the RAS

д.м.н., профессор, академик РАН

director@centercem.ruhttps://orcid.org/0000-0001-9599-73815516-9979MaslennikovaOlga M.МасленниковаОльга Михайловна
Russian Federation

MD, PhD, Associate Professor

д.м.н., доцент

o.m.maslennikova@gmail.comhttps://orcid.org/0000-0001-7825-55973674-9620LarinaVera N.ЛаринаВера Николаевна
Russian Federation

MD, PhD, Associate Professor

д.м.н., доцент

larinav@mail.ruhttps://orcid.org/0000-0001-6385-540X70037716239600-9796DemidovaTatiana Y.ДемидоваТатьяна Юльевна
Russian Federation

MD, PhD, Professor

д.м.н., профессор

t.y.demidova@gmail.comhttps://orcid.org/0000-0002-9118-37088724-4940DedovEvgenii I.ДедовЕвгений Иванович
Russian Federation

MD, PhD

д.м.н.

dedov-e-i@yandex.ruResearch Institute of Healthcare Organization and Medical ManagementНаучно-исследовательский институт организации здравоохранения и медицинского менеджментаPirogov Russian National Research Medical UniversityРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаA.I. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian FederationМосковский государственный медико-стоматологический университет имени А.И. Евдокимова Министерства здравоохранения Российской ФедерацииPolyclinic No. 1 of the Office of the President of the Russian FederationПоликлиника № 1 Управления делами Президента Российской ФедерацииMain Military Clinical Hospital Named after N.N. BurdenkoГлавный военный клинический госпиталь имени академика Н.Н. БурденкоFederal Research Center for Fundamental and Translational MedicineФедеральный исследовательский центр фундаментальной и трансляционной медициныCentral State Medical AcademyЦентральная государственная медицинская академия Управления делами Президента Российской Федерации04122020755S4144250908202018102020Copyright ©; 2020, "Paediatrician" Publishers LLCCopyright ©; 2020, Издательство "Педиатръ"2020"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/article/view/1433

In a review article based on my own clinical experience of managing patients with acute myocardial injury and fulminant myocarditis, taking into account expert recommendations on the clinical treatment of myocardial damage associated with novel coronavirus infection a National clinical geriatric medical research center, division of cardiovascular diseases, the Chinese geriatrics society, Department of cardiology, Beijing Medical Association and European clinics discusses the pathogenesis, diagnosis and treatment of myocardial damage and FM patients, infected with SARS-CoV-2 in the context of the COVID-19 pandemic. Clinical features and diagnostic criteria are presented, including screening tests of markers of myocardial damage in the form of a highly sensitive troponin test, a natriuretic peptide. The article discusses in detail the pathogenesis and mechanisms of myocardial damage, including immune mechanisms, cytokine storm, systemic inflammation with macro- and microvascular dysfunction and the development of myocardial dysfunction with acute heart failure, hypotension, cardiogenic shock and/or life-threatening heart rhythm disorders caused by hypoxia and metabolic disorders at the cellular level. Features of the clinical course of fulminant myocarditis in infected patients (SARS-CoV-2) in the conditions of the COVID-19 pandemic are presented. For the first time, a detailed histo-morphological analysis of pathological myocardial injuries and complications is presented on the basis of unique autopsy material on post-mortem diagnostics of various pathoanatomic autopsies of those who died from COVID-19 in Moscow. Based on the clinical, functional and morphological material, the Protocol of etiopathogenetic treatment is presented. The basis of standard therapy is considered antiviral drugs, immunoglobulin G, the use of monoclonal antibodies to interleukin-6, anticoagulants, glucocorticoids, depending on the clinical situation, cardioprotectors and symptomatic treatment are recommended to maintain the heart, which in combination can achieve a certain clinical effectiveness. As adjuvant cardioprotective targeted therapy, the sodium salt of phosphocreatine is considered in order to preserve the myocardium, maintain its contractility and vital activity.

В обзорной статье обсуждаются вопросы патогенеза, диагностики и лечения повреждения миокарда и фульминантного миокардита у больных, инфицированных SARS-CoV-2, в условиях пандемии COVID-19. Представлены клинические особенности и диагностические критерии, включающие скрининговые тесты маркеров повреждения миокарда в виде высокочувствительного тропонинового теста, натрийуретического пептида. Детально обсуждаются вопросы патогенеза и механизмы повреждения миокарда, включающие иммунные механизмы, цитокиновый шторм, системное воспаление с макро- и микроваскулярной дисфункцией и развитием дисфункции миокарда с острой сердечной недостаточностью, гипотензией, кардиогенным шоком и/или жизнеугрожающими нарушениями ритма сердца, обусловленные гипоксией и метаболическими нарушениями на клеточном уровне. Представлены особенности клинического течения фульминантного миокардита у больных, инфицированных SARS-CoV-2, в условиях пандемии COVID-19. Впервые представлен детальный гистоморфологический анализ патологических повреждений миокарда и осложнений на основе уникального аутопсийного материала по посмертной диагностике многообразных патологоанатомических вскрытий умерших от COVID-19 в Москве. На основании клинико-функционального и морфологического материала представлен протокол этиопатогенетического лечения. В зависимости от клинической ситуации для поддержания работы сердца в качестве метаболической адъювантной кардиопротективной таргетной терапии рассматривается натриевая соль фосфокреатина с целью поддержания сократительной способности и жизнедеятельности миокарда. Для улучшения прогноза у больных с COVID-19, перенесших острое повреждение миокарда, фульминантный миокардит, в протокол лечения рекомендовано введение кардиопротективной терапии, которая в комбинации со стандартной терапией позволяет достичь клинической эффективности.

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