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New onset atrial fibrillation in hospitalized COVID-19 patients : risk factors, mechanisms, management, and prognosis : a narrative review
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A COVID-19 foi identificada pela primeira vez em dezembro de 2019, tendo sido o primeiro caso reportado na cidade de Wuhan, na China. Desde então, o vírus tem-se alastrado pelo mundo. A infeção pode ter uma apresentação desde assintomática até casos críticos com necessidade de internamento hospitalar. Conhecem-se vários fatores de risco, nomeadamente cardiovasculares. Fibrilhação Auricular (FA) é a arritmia com maior prevalência em todo o mundo e a sua associação com casos clínicos agudos já era conhecida anteriormente. A FA é também a arritmia mais prevalente neste grupo de doentes, sendo que a FA de novo apresenta prevalências heterogéneas entre populações estudadas. O seu desenvolvimento pode resultar, não só da ação direta do vírus no tecido cardíaco, mas também da inflamação sistémica e “tempestade de citocinas”, resposta imune exacerbada, hipoxia, hiperativação do sistema nervoso simpático, desequilíbrio hidroeletrolítico, interações medicamentosas e efeitos adversos de fármacos utilizados no tratamento da infeção por SARS-CoV- 2.
Estes doentes apresentam maior mortalidade intra-hospitalar, maior tempo de internamento, maior necessidade de ventilação invasiva e maior risco de eventos tromboembólicos. Sendo mais frequente em doentes mais velhos, do sexo masculino e com várias comorbilidades, tais como hipertensão arterial, diabetes, doença renal e doença arterial periférica.
Estes doentes têm, em geral, pior prognóstico e, portanto, compreendendo os prováveis mecanismos subjacentes, as características mais frequentes dos doentes, os resultados laboratoriais e clínicos, podemos alcançar um diagnóstico mais rápido, um tratamento mais adequado e um melhor prognóstico.
COVID-19 was first described in December 2019 with the first case being reported in Wuhan, China. Since then, the virus has spread around the world. This infection can go from asymptomatic to critical presentations and need of hospital admission. Many risk factors have been known, especially cardiovascular. Atrial Fibrillation is the most prevalent arrythmia worldwide and its association with acute clinical cases has already been studied before. Atrial Fibrillation is also the most prevalent arrhythmia in this group of patients, and new atrial fibrillation presents heterogeneous prevalence among the populations studied. Its development may result not only from the direct action of the virus on cardiac tissue, but also from systemic inflammation and "cytokine storm", exacerbated immune response, hypoxia, hyperactivation of the sympathetic nervous system, hydro electrolytic imbalance, drug interactions and adverse effects of drugs used in the treatment of SARS-CoV-2 infection. These patients have higher in-hospital mortality, longer hospital stay, increased need for invasive ventilation and increased risk of thromboembolic events. Being more frequent in older and male patients with various comorbities, such as hypertension, diabetes, renal disease, and peripheral arterial disease. These patients have, overall, worse clinical outcomes. Thus, understanding the potential underlying mechanisms, most frequent patient features, laboratory findings and clinical outcomes leads to a faster diagnose, a more adequate treatment and a better prognosis.
COVID-19 was first described in December 2019 with the first case being reported in Wuhan, China. Since then, the virus has spread around the world. This infection can go from asymptomatic to critical presentations and need of hospital admission. Many risk factors have been known, especially cardiovascular. Atrial Fibrillation is the most prevalent arrythmia worldwide and its association with acute clinical cases has already been studied before. Atrial Fibrillation is also the most prevalent arrhythmia in this group of patients, and new atrial fibrillation presents heterogeneous prevalence among the populations studied. Its development may result not only from the direct action of the virus on cardiac tissue, but also from systemic inflammation and "cytokine storm", exacerbated immune response, hypoxia, hyperactivation of the sympathetic nervous system, hydro electrolytic imbalance, drug interactions and adverse effects of drugs used in the treatment of SARS-CoV-2 infection. These patients have higher in-hospital mortality, longer hospital stay, increased need for invasive ventilation and increased risk of thromboembolic events. Being more frequent in older and male patients with various comorbities, such as hypertension, diabetes, renal disease, and peripheral arterial disease. These patients have, overall, worse clinical outcomes. Thus, understanding the potential underlying mechanisms, most frequent patient features, laboratory findings and clinical outcomes leads to a faster diagnose, a more adequate treatment and a better prognosis.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
COVID-19 SARS-CoV-2 Fibrilhação auricular Arritmia Cardiologia