Impact of COVID-19 on the course of chronic ischemic heart disease

December 9, 2022

Patients with cardiovascular disease are at particular risk during the COVID-19 pandemic. The spread of coronavirus infection poses a particular danger in terms of decompensation of existing chronic diseases, specific damage to the cardiovascular system, especially in the case of a severe course of the disease and a high risk of adverse consequences in patients with chronic coronary heart disease (CHD). CHD is the leading cause of death and the most common cardiovascular disease worldwide. The number of cases of COVID-19 in patients with a history of CHD is increasing. CHD is a risk factor for a severe course of COVID-19, as SARS-CoV-2 induces endothelial inflammation, contributing to the progression of vascular dysfunction. The article discusses the main aspects of the impact of the coronavirus disease on the cardiovascular system, including the mechanism, pathogenesis, and important ways of impact of COVID-19 on the course of chronic CHD. The cause of exacerbation of CHD is the ulceration of the atherosclerotic plaque with the exposure of collagen fibers and the subsequent adhesion and aggregation of platelets on them. This leads to the formation of blood clots in the arteries of the heart and the release of thromboxane A2 from the platelets into the bloodstream, which causes spasm of the coronary arteries and the reduction or cessation of blood flow in them. When endothelium is damaged, plasma hemostasis is activated at the same time as platelet hemostasis. In patients with CHD, significant disturbances in the system of plasma hemostasis are noted, which increase as the disease progresses. Signs of blood hypercoagulation are noted: shortening of the activated partial thromboplastin time, increase in the content of fibrinogen, factors VII, VIII, XIII, the appearance in the bloodstream of fibrin-monomer complexes and fibrinogen/fibrin degradation products, a decrease in anticoagulant activity, inhibition of fibrinolysis.


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