Correlation between Coronavirus Disease 2019 and Heart Failure: A Review

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in devastating conditions worldwide. In addition to affecting the respiratory system, COVID-19 affects other systemic organs, and in particular, cardiovascular failure is related to the worsening of symptoms and death. Among these, cardiac insufficiency seems to be an important prognostic factor. Methods and Findings: We reviewed the association between COVID-19 and heart failure by searching Google Scholar and PubMed for reports related to COVID-19 and heart failure and selected those qualitatively and quantitatively established. The presence of heart failure may cause increased susceptibility to SARS-CoV-2 due to an abnormal immune response, which may aggravate COVID-19. In addition, myocardial injury, cytokine storm, endothelial dysfunction, blood coagulation abnormality, and hypoxemia due to respiratory injury may lead to worsening heart failure. Conclusions: Heart failure and COVID-19 are closely related, and their mechanisms are diverse. Multidisciplinary treatment is required to control the progression of cardiac insufficiency, which complicates COVID-19. Further elucidation of the pathology and establishment of efficacious therapy is desirable.

Acute myocardial infarction,arterial thrombosis and thrombophilia in young patients

Acute coronary syndrome (ACS) represent emergency state in an intensive cardiovascular care unit, which implies immediate and specific treatment. Of peculiar interest for cardiologists are young patients with acute myocardial infarction (AMI). The family history taking for premature coronary artery disease (CAD) and establishment of genetic factors, responsible for coagulation, both are on target for this group of patients. Gold standard for AMI diagnosis is coronary angiography (CA), which usually implies endovascular treatment (EVT). When coronary thrombus formation is found in young patients, different diagnostic opportunities are possible. Thrombophilia (TF) represents blood coagulation abnormality resulting in an increased risk of thrombosis. It could affect different sections of the cardiovascular system, most commonly venous, but also arterial. This clinical condition could be confirmed by performing laboratory genetic tests. We studied a group of forty-one young patients with first appearance of ACS ≤ 55 years old included for a five-year period. All of them were evaluated with CA and received EVT. According to the thrombotic risk, we defined a high-risk group, treated with anticoagulant (AC) on top of dual antiplatelet therapy (DAPT). The patients were followed-up for recurrent ischemic and bleeding events. We performed laboratory tests for the most frequent TF gene mutations in Bulgarian population. There is a conflicting data about this issue in different ethnic origins. The aim of our study is to estimate the possible relationship between the TF and the arterial thrombosis in young ACS patients, to defi ne specific treatment strategies, improving the prognosis of the patients.

Prominent coagulation disorder is closely related to inflammatory response and could be as a prognostic indicator for ICU patients with COVID-19

The new outbreak of Coronavirus Disease 2019 (COVID-19) has emerged as a serious global public health concern. A more in-depth study of blood coagulation abnormality is needed. We retrospectively analyzed 147 consecutive patients with COVID-19 who were admitted to three ICUs in Wuhan from February 9th, 2020 to March 20th, 2020. The baseline coagulation and other characteristics were studied. Our results showed that the prolonged PT, FDP, DD were positively correlated with the levels of neutrophils, ferritin, LDH, total bilirubin, multi-inflammation cytokines, and negatively correlated with the lymphocytes level (p < 0.01). The level of ATIII was significantly negatively correlated with the levels of neutrophils, ferritin, LDH, total bilirubin, IL2R, IL6 and IL8 (p < 0.05). The patients in the ARDS group had a more prominent abnormality in PT, FDP, DD and ATIII, while the patients in the AKI group had more prolonged PT, more severe FDP and DD level, more inferior ATIII and Fib level than those in the non-AKI group (p < 0.01). The value of PT, DD and FDP were positively correlated with the classical APACHE II, SOFA and qSOFA scores, while the ATIII was negatively correlated with them (p < 0.001). The high levels of PT, FDP and DD were correlated with in-hospital mortality (p < 0.001). In conclusion, blood coagulation disorder was prominent in ICU patients with COVID-19 and was correlated with multi-inflammation factors. The abnormality of blood coagulation parameters could be an adverse prognostic indicator for ICU patients with COVID-19.

A Patient With Organic Hypermenorrhea Who Developed Massive Genital Hemorrhage During Treatment Of Acute-Phase Cerebral Infarction And Responded To Microwave Endometrial Ablation

Microwave endometrial ablation (MEA) has been attracting attention as a low-invasive treatment alternative to conventional total hysterectomy for systemic disease-induced hypermenorrhea, such as functional hypermenorrhea and blood coagulation abnormality, and organic disease-induced hypermenorrhea such as myoma of the uterus and adenomyosis. We report a patient with hypermenorrhea causing massive genital hemorrhage during anticoagulant therapy who demonstrated a complete response to MEA. The patient was 41 years old, gravida 3 para 1. Aphasia and articulation disorder developed during work and she visited the emergency department. Cerebral infarction was noted on head MRI and anticoagulant therapy was initiated. Hypermenorrhea had been observed from approximately 4 years prior, but she had not visited a gynecology department. As massive genital hemorrhage and progression of anemia (Hb: 4.6 g/dL) were observed during the menstrual period, she was referred to our department. Multiple myomas of the uterus were observed on ultrasonography and pelvic MRI, and the patient was diagnosed with organic hypermenorrhea. As there was acute-phase cerebral infarction, MEA was performed as treatment for hypermenorrhea. The postoperative course was smooth and menstruation resumed on postoperative day 21. On subjective evaluation using the visual analogue scale (VAS), both hypermenorrhea and dysmenorrhea markedly improved from 10 to 1. The course was smooth without complications and the postoperative course was also favorable. MEA is a low-invasive treatment method safely applicable within a short time, and it may be an effective hypermenorrhea treatment method during oral anticoagulant administration or for those with perioperative risk due to complications.

A BLOOD COAGULATION ABNORMALITY IN RABBITS DEFICIENT IN THE SIXTH COMPONENT OF COMPLEMENT (C6) AND ITS CORRECTION BY PURIFIED C6

Evidence for the involvement of the sixth component of complement (C6) in normal blood coagulation is provided by the description of a coagulation abnormality in rabbits with a genetic C6 deficiency and by its correction with highly purified preparations of C6. Whole blood clotting time in glass or plastic was prolonged and prothrombin consumption was decreased in blood from the deficient animals. Other parameters of blood coagulation were normal, including prothrombin time, partial thromboplastin time, specific clotting factor activities, platelet factor III function, platelet count, and bleeding time. Clotting time and prothrombin consumption became normal when physiologic amounts of highly purified C6 were added to the deficient blood. Partial consumption of C6 hemolytic activity, with a time course similar to the consumption of prothrombin, was demonstrated during the clotting of normal human blood.