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Dtsch Med Wochenschr 2020; 145(16): 1157-1160
DOI: 10.1055/a-1158-5996
Klinischer Fortschritt
Kardiologie

COVID-19 und die Bedeutung der kardiovaskulären Komorbidität

COVID-19 and the impact of cardiovascular comorbidities
Hatim Seoudy
  Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin
,
Norbert Frey
  Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin
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Prognostischer Einfluss kardiovaskulärer Vorerkrankungen Kardiovaskuläre Komorbiditäten sind mit schweren Verlaufsformen und einer erhöhten Letalität mit COVID-19 assoziiert. Eine optimale Behandlung der Begleiterkrankungen könnte den Verlauf von COVID-19 günstig beeinflussen.

Kardiovaskuläre Komplikationen durch COVID-19 COVID-19 induziert bei einem Teil der Patienten ein akutes kardiovaskuläres Syndrom. Die Pathogenese ist noch nicht vollständig geklärt, wesentliche Prozesse sind jedoch eine direkte Schädigung der Kardiomyozyten durch SARS-CoV-2 sowie ein Hyperinflammationssyndrom. Bei schweren COVID-19-Verlaufsformen ist darüber hinaus eine deutlich erhöhte Inzidenz thromboembolischer Komplikationen zu beobachten.

Rolle des Renin-Angiotensin-Aldosteron-Systems Das Renin-Angiotensin-Aldosteron-System spielt in der Pathophysiologie von COVID-19 eine wichtige Rolle. Aktuell wird die Fortsetzung einer indizierten Therapie mit einem ACE-Inhibitor, AT1-Rezeptorantagonisten oder einem Angiotensin-Rezeptor-Neprilysin-Inhibitor empfohlen.

Kardiovaskuläre Nebenwirkungen der medikamentösen Therapie Medikamente zur Behandlung von COVID-19 müssen hinsichtlich ihrer kardiovaskulären Nebenwirkungen bewertet werden. Remdesivir weist nach aktueller Datenlage ein günstiges Sicherheitsprofil auf.

Kardiovaskuläre Erkrankungen und „social distancing“ Das „social distancing“ ist ein wesentliches Instrument zur Ausbreitungskontrolle von SARS-CoV-2. Dennoch muss eine leitliniengerechte Versorgung von Patienten mit kardiovaskulären Erkrankungen sichergestellt werden.

Kardiovaskuläre Langzeitkomplikationen COVID-19 ist potenziell mit kardiovaskulären Langzeitkomplikationen assoziiert. Daher sind Konzepte zur langfristigen Betreuung der Patienten notwendig.

Abstract

Since its outbreak, coronavirus disease 2019 (COVID-19) has rapidly resulted in a global pandemic. Underlying cardiovascular disease (CVD) is associated with severe COVID-19 infection and adverse clinical outcomes. While COVID-19 predominantly causes respiratory symptoms, a substantial number of patients eventually develop an acute cardiovascular syndrome associated with an excessive risk of mortality. While the exact mechanisms remain uncertain, angiotensin-converting enzyme 2 plays a pivotal role as a link between COVID-19 and the cardiovascular system. As there is no evidence that inhibition of the renin-angiotensin-aldosterone-system is harmful in COVID-19, therapy should be continued as indicated in hypertension or heart failure patients. As multiple drugs are being investigated in ongoing clinical trials, potential cardiotoxicity remains an important issue. In times of rigorous public health measures such as social distancing, efforts should be undertaken to ensure timely treatment of acute CVD and continuation of guideline-directed treatment in order to avoid an increase in morbidity and mortality. In addition to its acute complications, COVID-19 is likely to be associated with long-term cardiovascular damage. Consequently, for a subgroup of patients a long-term management strategy is needed.

Schlüsselwörter

COVID-19 - SARS-CoV-2 - kardiovaskuläre Erkrankungen

Key words

COVID-19 - SARS-CoV-2 - cardiovascular disease


Publication History

Article published online:
13 August 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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