{"id":4552,"date":"2020-10-28T17:16:35","date_gmt":"2020-10-28T14:16:35","guid":{"rendered":"https:\/\/www.elitenicosia.com\/?p=4552"},"modified":"2020-10-28T21:32:22","modified_gmt":"2020-10-28T18:32:22","slug":"ani-kalp-krizi-olumleri-ve-covid-19","status":"publish","type":"post","link":"https:\/\/www.elitenicosia.com\/en\/ani-kalp-krizi-olumleri-ve-covid-19\/","title":{"rendered":"Sudden Heart Attack Deaths and Covid-19"},"content":{"rendered":"

Sudden Heart Attack Deaths and Covid-19<\/strong><\/p>\n

The coronavirus disease, known as COVID-19 and caused by the SARS-CoV-2 virus, affected the world starting in Wuhan, China, in December 2019 and infected more than 36 million people in almost a year and caused the death of approximately one million people. has given1<\/sup>. In addition to measures such as social distance, hand washing and wearing a mask, we have access to some new and meaningful information about how we can protect ourselves, accompanied by many study findings.<\/p>\n

Since its emergence, it has been known that the disease affects the elderly and people with chronic diseases more and is more lethal in these people. It is also known that men are more likely to get the disease than women. The role of the ACE2 receptor in the progression of infection has been a topic that has been discussed since the early times. Recent studies show that the serine protease called TMPRSS2 facilitates the entry of the SARS-CoV-2 virus through the ACE2 receptor.2<\/sup>. Since the TMPRSS2 gene is a gene related to androgen levels and the expression of this gene is higher in men, it is thought that men have a higher risk of contracting COVID-19.<\/p>\n

\u015eu an, asl\u0131nda belirti g\u00f6steren hastalar\u0131n neredeyse 3-4 kat\u0131 kadar\u0131n\u0131n enfekte olmas\u0131na ra\u011fmen ciddi bir semptom g\u00f6stermedi\u011fi ve hastal\u0131\u011f\u0131 farketmeden atlatabildi\u011fi raporlanm\u0131\u015ft\u0131r. Her ne kadar da t\u00fcm n\u00fcfusa test yaparak net rakamlar\u0131n bilinmesi m\u00fcmk\u00fcn olmasa da, k\u00fc\u00e7\u00fck pop\u00fclasyonlarda yap\u0131lan \u00e7al\u0131\u015fmalar bize yol g\u00f6sterici olabilmektedir. \u00d6rne\u011fin Arjantin\u2019in cruise gemisinde ya\u015fanan salg\u0131nda, pozitif vakalar\u0131n %81\u2019inin herhangi bir belirti g\u00f6stermeden enfeksiyonu atlatt\u0131klar\u0131 g\u00f6sterilmi\u015ftir. Di\u011fer \u00e7al\u0131\u015fmalarda bu rakam %18 ve %81 aras\u0131nda de\u011fi\u015fiklik g\u00f6stermektedir. Fakat t\u00fcm n\u00fcfusun teste tabi tutulamayaca\u011f\u0131n\u0131 g\u00f6z \u00f6n\u00fcnde bulundurdu\u011fumzuda, COVID-19 ile enfekte olmu\u015f fakat herhangi bir belirti g\u00f6stermeyen ki\u015filerin belirti g\u00f6steren ki\u015filere oranla \u00e7o\u011funlukta oldu\u011funu d\u00fc\u015f\u00fcnmek m\u00fcmk\u00fcnd\u00fcr3<\/sup>.<\/p>\n

The World Health Organization (WHO) categorizes asymptomatic patients as patients who do not show obvious symptoms despite having a positive PCR test. However, it is also important to differentiate asymptomatic patients from pre-symptomatic patients. Since pre-symptomatic patients are in the first stage of the disease, their PCR tests may have just become positive and physical symptoms may not have started yet. Some symptoms may occur later in these people. It has been reported that the LDH level in the blood can be used as a marker to differentiate asymptomatic and pre-symptomatic patients. Observing an increase in LDH level may mean that symptoms may follow.4<\/sup>. \u00d6te yandan, g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemleri akci\u011ferde hasar olup olmad\u0131\u011f\u0131na bakarak hastal\u0131k seyri i\u00e7in bir fikir vermektedir. Fakat, son \u00e7\u0131kan \u00e7al\u0131\u015fmalarda, hastal\u0131\u011f\u0131 semptomsuz ge\u00e7iren ki\u015filerin %30\u2019unda buzlu cam opasitesi (ground glass opacity) ve %27\u2019sinde konsolidasyon g\u00f6r\u00fcld\u00fc\u011f\u00fc raporlanm\u0131\u015ft\u0131r5<\/sup>. In other words, it is not clear whether patients will develop symptoms just by looking at a lung x-ray or tomography.<\/p>\n

Semptomlu veya semptomsuz vakalar\u0131n bir \u015fekilde COVID-19 enfeksiyonunu atlatt\u0131ktan sonra kal\u0131c\u0131 bir rahats\u0131zl\u0131klar\u0131 olup olmayaca\u011f\u0131n\u0131 halen net olarak bilmiyoruz. Beyin hasar\u0131, akci\u011fer hasar\u0131, kalp hasar\u0131 ve vask\u00fcler rahats\u0131zl\u0131klar\u0131 raporlayan bir\u00e7ok vaka serisi mevcuttur. Son zamanlarda, ani kalp krizi \u00f6l\u00fcmleri de COVID-19 ile alakaland\u0131r\u0131lm\u0131\u015ft\u0131r. \u00d6rne\u011fin \u0130talya\u2019da hastane d\u0131\u015f\u0131 kalp krizi ge\u00e7irme oranlar\u0131n\u0131n ge\u00e7mi\u015f senelere oranla %58 daha y\u00fcksek oldu\u011fu raporlanm\u0131\u015ft\u0131r6<\/sup>. Bu hastalar\u0131n bir b\u00f6l\u00fcm\u00fc \u00fczerinde yap\u0131lan \u00e7al\u0131\u015fmalarda, hastalar\u0131n %77\u2019sinin COVID-19 ge\u00e7irdi\u011fi veya COVID-19 \u015f\u00fcphesi oldu\u011fu g\u00f6sterilmi\u015ftir. Paris\u2019teki hastane d\u0131\u015f\u0131 kalp krizi vakalar\u0131n\u0131 konu alan May\u0131s 2020 tarihli \u00e7al\u0131\u015fmada da bu t\u00fcr hastalar\u0131n say\u0131s\u0131nda \u00f6nceki y\u0131llara g\u00f6re iki kata yak\u0131n bir art\u0131\u015f oldu\u011fu g\u00f6zlemlenmi\u015ftir7<\/sup>.<\/p>\n

Yo\u011fun bak\u0131mda yatma ihtiyac\u0131 olan COVID-19 hastalar\u0131n\u0131n 3\u2019te 1\u2019inde miyokardit ve stres kardiyomiyopati g\u00f6r\u00fcld\u00fc\u011f\u00fc bilinmektedir. Bu da bu hastal\u0131\u011f\u0131n kalp \u00fczerinde belli ba\u015fl\u0131 hasar yaratabilece\u011fini g\u00f6stermektedir. Frankfurt\u2019ta COVID-19 enfeksiyonu ge\u00e7irmi\u015f 100 ki\u015fi \u00fczerinde ortalama olarak hastal\u0131\u011f\u0131n bitmesinden 71 g\u00fcn sonra yap\u0131lan bir \u00e7al\u0131\u015fmada, ki\u015filerin %78\u2019inde kalp hasar\u0131 tespit edilmi\u015ftir. Yine ayn\u0131 \u00e7al\u0131\u015fmada, kalp hasar\u0131n\u0131n ge\u00e7irilen hastal\u0131\u011f\u0131n \u015fiddeti veya \u00f6nceden mevcut kornik hastal\u0131klarla bir ili\u015fkisi olmad\u0131\u011f\u0131 anla\u015f\u0131lm\u0131\u015ft\u0131r8<\/sup>. Yani, kronik bir hastal\u0131\u011f\u0131 olmayan ve COVID-19\u2019u hafif \u015fekilde atlatan ki\u015filerde de kalp hasar\u0131 g\u00f6r\u00fcnme oran\u0131 yo\u011fun bak\u0131m ihtiyac\u0131 olu\u015fan hastalarla ayn\u0131d\u0131r. New York\u2019ta yap\u0131lan ba\u015fka bir \u00e7al\u0131\u015fmada, Hidroksiklorokin (HCQ) adl\u0131 ila\u00e7 ve Hidroksiklorokin + Azitromisin (HCQ+AZ) kombinasyonu alan ki\u015filer aras\u0131nda yap\u0131lan bir ara\u015ft\u0131rmada, sadece HCQ alan ki\u015filerde kalp hasar\u0131na ait bulgular\u0131n %16, fakat HCQ+AZ kombinasyonunu kullanan hastalarda bu rakam\u0131n %27 oldu\u011fu ve istatistiksel anlaml\u0131 bir fark bulundu\u011fu tespit edilmi\u015ftir. Bu ila\u00e7lar\u0131n etkisinin yan\u0131 s\u0131ra, COVID-19 hastal\u0131\u011f\u0131n\u0131n da kalp \u00fczerinde ciddi bir olumsuz etkisi oldu\u011fu bilinmektedir. Genel olarak t\u00fcm vir\u00fctik enfeksiyonlar mevcut kalp rahats\u0131zl\u0131\u011f\u0131 bulunan ki\u015filerde kalbin metabolik ihtiya\u00e7lar\u0131n\u0131n artmas\u0131na ve enflamasyon olu\u015fmas\u0131na sebebiyet verir ve mevcut kalp rahats\u0131zl\u0131\u011f\u0131n\u0131n \u015fiddetini b\u00fcy\u00fct\u00fcr 9<\/sup>. Another fact that makes the situation even more serious is that people who have cardiovascular problems but have no symptoms yet are also at risk.<\/p>\n

It has been shown in certain case studies that COVID-19 infection affects endothelial damage and functions of endothelial cells, thus causing both arterial and venous thrombosis.10<\/sup>. Although there are not enough studies and it is not known how many people are at risk of thrombosis due to COVID-19, cases of pulmonary embolism and coronary thrombosis and heart attacks as a result of these have been reported recently. For example, it was recently determined that a 41-year-old diabetic patient was actually an asymptomatic COVID-19 patient after he suddenly had a heart attack and died while exercising.11<\/sup>. Likewise, people with limited clinical findings have also been reported to have pulmonary embolism and heart attack.<\/p>\n

It is necessary to investigate whether COVID-19 is behind the sudden heart attack-related deaths, which have been increasing in numbers recently in our country. It is also difficult to detect heart diseases, which can manifest themselves both shortly after the disease, in people who are infected but do not show symptoms, or after a long time after the disease, because it is known that the antibody levels of people who have the disease drop significantly after a period of 3-4 months. In other words, it is almost impossible to make an exact diagnosis in people who have the disease without symptoms, whose antibody response decreases, and who still succumb to heart disease months later. However, since not all patients will be like this, investigating sudden deaths in terms of both COVID-19 PCR, antibodies and autopsy will shed light on us to develop possible prevention methods.<\/p>\n

Son olarak, yap\u0131lan en son klinik \u00e7al\u0131\u015fmalarda D vitamini eksikli\u011finin hastal\u0131k ge\u00e7iren ki\u015filerin ortak bir \u00f6zelli\u011fi oldu\u011fu g\u00f6sterilmi\u015ftir. \u0130spanya\u2019da 216 COVID-19 hastas\u0131 \u00fczerinde yap\u0131lan \u00e7al\u0131\u015fmada, hastalar\u0131n %80 oran\u0131nda D vitamini eksikli\u011fi oldu\u011fu tespit edilmi\u015ftir12<\/sup>. Previous studies have previously reported that COVID-19 creates a cytokine storm and uncontrolled inflammation. The role of T cells called Treg in such extreme bodily reactions is known. It is also known that vitamin D strengthens Treg defense.13<\/sup>. In addition, it is a known fact that the risk of thrombosis increases with vitamin D deficiency and vitamin D deficiency is also observed in certain chronic diseases.14<\/sup>. In this case, it seems possible to say that vitamin D deficiency makes it easier to both contract the disease and increase the severity of the disease in many ways.<\/p>\n

In short, it is observed that vitamin D has both a protective and a reducing effect on the severity of the disease. Of course, it should be known that since vitamin D is not a water-soluble vitamin, it is stored in the body and toxic effects can be observed when taken in excess. Therefore, before using vitamin D supplements, the vitamin D level should be measured and the supplement should be used under the supervision of a physician.<\/p>\n

I wish you healthy days,<\/p>\n

Dr. Ahmet Ozyigit<\/p>\n

References:<\/strong><\/p>\n

1. who.int. 2020. Coronavirus Disease (COVID-19) Situation Reports. [online] Available at: [Accessed 27 October 2020].<\/p>\n

2. Djomkam, A., Olwal, C., Sala, T. and Paemka, L., 2020. Commentary: SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Frontiers in Oncology, 10.<\/p>\n

3. Nikolai, L., Meyer, C., Kremsner, P. and Velavan, T., 2020. Asymptomatic SARS Coronavirus 2 infection: Invisible yet invincible. International Journal of Infectious Diseases, 100, pp.112-116.<\/p>\n

4. Ooi, E. and Low, J., 2020. Asymptomatic SARS-CoV-2 infection. The Lancet Infectious Diseases, 20(9), pp.996-998.<\/p>\n

5. Long, Q., Tang, X., Shi, Q., Li, Q., Deng, H., Yuan, J., Hu, J., Xu, W., Zhang, Y., Lv, F ., Su, K., Zhang, F., Gong, J., Wu, B., Liu, X., Li, J., Qiu, J., Chen, J. and Huang, A., 2020. Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections. Nature Medicine, 26(8), pp.1200-1204.<\/p>\n

6. Baldi, E., Sechi, G., Mare, C., Canevari, F., Brancaglione, A., Primi, R., Klersy, C., Palo, A., Contri, E., Ronchi, V ., Beretta, G., Reali, F., Parogni, P., Facchin, F., Bua, D., Rizzi, U., Bussi, D., Ruggeri, S., Oltrona Visconti, L. and Savastano, S., 2020. Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy. New England Journal of Medicine, 383(5), pp.496-498.<\/p>\n

7. Marijon, E., Karam, N., Jost, D., Perrot, D., Frattini, B., Derkenne, C., Sharifzadehgan, A., Waldmann, V., Beganton, F., Narayanan, K. ., Lafont, A., Bougouin, W. and Jouven, X., 2020. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. The Lancet Public Health, 5(8), pp.e437-e443.<\/p>\n

8. Puntmann, V., Carerj, M., Wieters, I., Fahim, M., Arendt, C., Hoffmann, J., Shchendrygina, A., Escher, F., Vasa-Nicotera, M., Zeiher , A., Vehreschild, M. and Nagel, E., 2020. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiology.<\/p>\n

9. Shi, S., Qin, M., Shen, B., Cai, Y., Liu, T., Yang, F., Gong, W., Liu, X., Liang, J., Zhao, Q ., Huang, H., Yang, B. and Huang, C., 2020. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiology, 5(7), p.802.<\/p>\n

10. Huertas, A., Montani, D., Savale, L., Pichon, J., Tu, L., Parent, F., Guignabert, C. and Humbert, M., 2020. Endothelial cell dysfunction: a major player in SARS-CoV-2 infection (COVID-19)?. European Respiratory Journal, 56(1), p.2001634.<\/p>\n

11. Polat, V. and Bostanc\u0131, G., 2020. Sudden death due to acute pulmonary embolism in a young woman with COVID-19. Journal of Thrombosis and Thrombolysis, 50(1), pp.239-241.<\/p>\n

12. Jos\u00e9 L Hern\u00e1ndez, Daniel Nan, Marta Fernandez-Ayala, Mayte Garc\u00eda-Unzueta, Miguel A Hern\u00e1ndez-Hern\u00e1ndez, Marcos L\u00f3pez-Hoyos, Pedro Mu\u00f1oz Cacho, Jos\u00e9 M Olmos, Manuel Guti\u00e9rrez-Cuadra, Juan J Ruiz-Cubill\u00e1n, Javier Crespo, V\u00edctor M Mart\u00ednez-Taboada, 2020. Vitamin D Status in Hospitalized Patients With SARS-CoV-2 Infection, The Journal of Clinical Endocrinology & Metabolism.<\/p>\n

13. Fisher, S., Rahimzadeh, M., Brierley, C., Gration, B., Doree, C., Kimber, C., Plaza Cajide, A., Lamikanra, A. and Roberts, D., 2019. The role of vitamin D in increasing circulating T regulatory cell numbers and modulating T regulatory cell phenotypes in patients with inflammatory disease or in healthy volunteers: A systematic review. PLOS ONE, 14(9), p.e0222313.<\/p>\n

14. Mohammad, S., Mishra, A. and Ashraf, M., 2019. Emerging Role of Vitamin D and its Associated Molecules in Pathways Related to Pathogenesis of Thrombosis. Biomolecules, 9(11), p.649.<\/p>","protected":false},"excerpt":{"rendered":"

Ani Kalp Krizi \u00d6l\u00fcmleri ve Covid-19 COVID-19 olarak bilinen ve SARS-CoV-2 vir\u00fcs\u00fcn\u00fcn sebep oldu\u011fu koronavir\u00fcs hastal\u0131\u011f\u0131, Aral\u0131k 2019 y\u0131l\u0131nda \u00c7in\u2019in Wuhan kentinde ba\u015flayarak d\u00fcnyay\u0131 etkisi alt\u0131na alm\u0131\u015f ve neredeyse bir y\u0131la yak\u0131n bir s\u00fcrede 36 milyondan fazla ki\u015fiyi enfekte etmi\u015f ve yakla\u015f\u0131k bir milyon ki\u015finin \u00f6l\u00fcm\u00fcne sebebiyet vermi\u015ftir1. Sosyal mesafe, el y\u0131kama ve maske takma gibi \u00f6nlemlerin yan\u0131 s\u0131ra bir\u00e7ok \u00e7al\u0131\u015fma bulgular\u0131n\u0131n da e\u015fli\u011finde kendimizi nas\u0131l koruyabilece\u011fimize dair baz\u0131 yeni ve anlaml\u0131 bilgilere eri\u015fmekteyiz. Hastal\u0131\u011f\u0131n \u00e7ikt\u0131\u011f\u0131 zamandan beri ya\u015fl\u0131 ve kronik hastal\u0131\u011f\u0131 bulunan n\u00fcfusu daha fazla etkiledi\u011fi ve bu ki\u015filerde daha \u00f6l\u00fcmc\u00fcl oldu\u011fu bilinmektedir. Ayn\u0131 zamanda erkeklerin kad\u0131nlara oranla hastal\u0131\u011fa […]<\/p>","protected":false},"author":8,"featured_media":4553,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[30],"tags":[],"class_list":["post-4552","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-aile-hekimligi"],"yoast_head":"\nAni Kalp Krizi \u00d6l\u00fcmleri ve Covid-19 - Elite Hospital<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.elitenicosia.com\/en\/ani-kalp-krizi-olumleri-ve-covid-19\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ani Kalp Krizi \u00d6l\u00fcmleri ve Covid-19 - Elite Hospital\" \/>\n<meta property=\"og:description\" content=\"Ani Kalp Krizi \u00d6l\u00fcmleri ve Covid-19 COVID-19 olarak bilinen ve SARS-CoV-2 vir\u00fcs\u00fcn\u00fcn sebep oldu\u011fu koronavir\u00fcs hastal\u0131\u011f\u0131, Aral\u0131k 2019 y\u0131l\u0131nda \u00c7in\u2019in Wuhan kentinde ba\u015flayarak d\u00fcnyay\u0131 etkisi alt\u0131na alm\u0131\u015f ve neredeyse bir y\u0131la yak\u0131n bir s\u00fcrede 36 milyondan fazla ki\u015fiyi enfekte etmi\u015f ve yakla\u015f\u0131k bir milyon ki\u015finin \u00f6l\u00fcm\u00fcne sebebiyet vermi\u015ftir1. 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