Острые респираторные вирусные инфекции (ОРВИ) – самая распространенная группа заболеваний, объединяющая грипп, коронавирусную, аденовирусную и другие инфекции. Существует прямая зависимость между подъемом заболеваемости ОРВИ и увеличением частоты сердечно-сосудистых заболеваний: инфаркт миокарда, миокардит, аритмии, сердечная недостаточность, тромбоэмболия легочной артерии и диссеминированное внутрисосудистое свертывание крови. Наиболее подвержены отрицательному воздействию на сердечно-сосудистую систему при ОРВИ больные с ишемической болезнью сердца, нарушениями мозгового кровообращения, гипертонической болезнью, сахарным диабетом. Изменения со стороны сердечно-сосудистой системы, вызываемые ОРВИ, не всегда имеют выраженную клиническую симптоматику. Их проявление (клинические симптомы, расширение полостей сердца, гемодинамические расстройства) может быть отсроченным, нарастать в течение недель или нескольких месяцев. Своевременное выявление кардиальной патологии, развившейся в непосредственной связи с перенесенным ОРВИ, зависит от работы участковых терапевтов, врачей общей практики. Во всех случаях вновь возникших диспноэ, кардиалгии, аритмии необходимо назначение дополнительных методов обследования (электрокардиография, маркеры повреждения миокарда, натрийуретические пептиды), позволяющих подтвердить или исключить вовлеченность миокарда и определить тактику дальнейшего ведения. Патология миокарда и ее генез во многих случаях становятся очевидными только при динамическом наблюдении.
Acute respiratory viral infections (ARI) is the most widespread group of infections that includes flu, coronavirus, adenovirus, and other infections. There is a direct correlation between increase in ARI incidence and increase of incidence of cardiovascular disorders such as acute myocardial infarction, myocarditis, arrythmia, cardiac insufficiency, pulmonary artery thromboembolia, and disseminated intravascular clotting. Patients with ischemic heart disease, cerebrovascular disease, arterial hypertension, and diabetes mellitus are most vulnerable to ARI negative impact on cardiovascular system. Changes of cardiovascular system caused by ARI are not always clinically evident. Their manifestation (clinical symptoms, cardiac cavity dilatation, hemodynamics disorders) may be postponed, may increase for several weeks or months. Timely diagnosis of cardiac pathology that developed in association with previous ARI depends on general practitioners and family doctors. All cases of development of dyspnoea, cardialgia, or arrythmia are indications for additional examination tests performance (electrocardiography, cardiac injury markers, natriuretic peptides) that will allow to confirm or exclude myocardium involvement and define management strategy. In many cases presence of myocardium pathology and its genesis become evident only in follow-up.
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[Ostrye respiratornye virusnye infektsii u vzroslykh. Klinicheskie rekomendatsii Minzdrava Rossii po spetsial'nosti "Infektsionnye bolezni'. 2014 (in Russian).]
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[Bogomolov B.P., Malkova T.N., Devyatkin A.V. Acute respiratory infections and heart. Moscow, 2003 (in Russian).]
4. Spencer FA, Goldberg RJ, Becker RC, Gore JM. Seasonal distribution of acute myocardial infarction in the second national registry of myocardial infarction. J Am Coll Cardiol 1998; 31: 1226–33.
5. Warren-Gash C, Bhaskaran K, Hayward A et al. Circulating influenza virus, climatic factors, and acute myocardial infarction: a time series study in England and Wales and Hong Kong. J Infect Dis 2011; 203: 1710–8.
6. Pettinen J, Valonen P. The risk of myocardial infarction among Finnish farmers seeking medical care for an infection. Am J Pub Health 1996; 86: 1440–2.
7. Бокарев И.Н. Воспаление и тромбообразование. Тромбозы, кровоточивость и болезни сосудов. 2016; 14: 7–11.
[Bokarev I.N. Vospalenie i tromboobrazovanie. Trombozy, krovotochivost' i bolezni sosudov. 2016; 14: 7–11 (in Russian).]
8. Siscovick DS, Raghunathan TE, Lin D et al. Influenza vaccination and the risk of primary cardiac arrest. Am J Epidemiol 2000; 152: 674–7.
9. Naghavi M, Barlas Z, Siadaty S et al. Association of influenza vaccination and reduced risk of recurrent myocardial infarction. Circulation 2000; 102: 3039–45.
10. Lavallee P, Perchaud V, Gautier-Bertrand M et al. Association between influenza vaccination and reduced risk of brain infarction. Stroke 2002; 33: 513–8.
11. Gurfinkel EP, Leon de la Fuente R, Mendiz O, Mautner B. Flu vaccination in acute coronary syndromes and planned percutaneous coronary interventions (FLUVACS). Study Eur Heart J 2004; 25: 25–31.
12. Gwini SM, Coupland CA, Siriwardena AN. The effect of influenza vaccination on risk of acute myocardial infarction: self-controlled case-series study. Vaccine 2011; 29: 1145–9.
13. Casscells SW, Granger E, Kress AM et al. Use of oseltamivir after infuenza infection is associated with reduced incidence of recurrent adverse cardiovascular outcomes among military health system beneficiaries with prior cardiovascular diseases. Circ Cardiovasc Qual Outcomes 2009; 2: 108–15.
14. Guzik TJ, Mohiddin SA, Dimarco A et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res 2020; Apr 30: cvaa106.
15. Wang D, Hu B, Hu C et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China [J]. JAMA 2020; e1–e9.
16. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020; 109: 102433.
17. McCarthy RE 3rd, Boehmer JP, Hruban RH et al. Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med 2000; 342: 690–5.
18. Kyto V, Sipila J, Rautava P. The effects of gender and age on occurrence of clinically suspected myocarditis in adulthood. Heart 2013; 99 (22): 1681–4.
19. Mason JW, O’Connell JB, Herskowitz A et al. A clinical trial of immunosuppressive therapy for myocarditis. The Myocarditis Treatment Trial investigators. N Engl J Med 1995; 333: 269–75.
20. Hufnagel G, Pankuweit S, Richter A et al. The European Study of Epidemiology and Treatment of Cardiac Inflammatory Diseases (ESETCID). First epidemiological results. Herz 2000; 25: 279–85.
21. Максимов В.А. Миокардиты. Л.: Медицина, 1979.
[Maximov V.A. Myocarditis. Leningrad: Meditsina, 1979 (in Russian).]
22. Caforio AL, Calabrese F, Angelini A et al. A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. Eur Heart J 2007; 28: 1326–33.
23. Caforio ALP, Pankuweit S, Arbustini E et al. Current state of knowledge on aetiology, diagnosis, management and therapy of myocarditis. A Position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013; 34: 2636–48.
24. Cooper LT, Baughman KL, Feldman AM et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. Eur Heart J 2007; 28: 3076–93.
25. Bock CT, Klingel K, Kandolf R. Human parvovirus B19-associated myocarditis. N Engl J Med 2010; 362: 1248–9.
26. Bowles NE, Ni J, Kearney DL et al. Detection of viruses in myocardial tissues by polymerase chain reaction: evidence of adenovirus as a common cause of myocarditis in children and adults. J Am Coll Cardiol 2003; 42: 466–72.
27. Schultheiss HP, Kühl U, Cooper LT. The management of myocarditis. Eur Heart J 2011; 32: 2616–25.
28. Francone M, Chimenti C, Galea N et al. CMR sensitivity varies with clinical presentation and extent of cell necrosis in biopsy-proven acute myocarditis. JACC Cardiovasc Imaging 2014; 7: 254–63.
29. Röttgen R, Christiani R, Freyhardt P et al. Magnetic resonance imaging findings in acute myocarditis and correlation with immunohistological parameters. Eur Radiol 2011; 21: 1259–66.
30. Caforio ALP, Marcolongo R, Jahns R et al. Immune-mediated and autoimmune myocarditis: clinical presentation, diagnosis and treatment. Heart Fail Rev 2013; 18: 715–32.
31. Fabre A, Sheppard MN. Sudden adult death syndrome and other nonischaemic causes of sudden cardiac death. Heart 2006; 92 (3): 316–20.
32. Schultz JC, Hilliard AA, Cooper LT Jr, Rihal CS. Diagnosis and Treatment of Viral Myocarditis. Mayo Clin Proc 2009; 84 (11): 1001–9.
33. Caforio ALP, Marcolongo R, Cristina Basso, Sabino Iliceto. Clinical presentation and diagnosis of myocarditis. Heart 2015; 101 (16): 1332–44.
34. Punja M, Mark DG, McCoy JV et al. Electrocardiographic manifestations of cardiac infectious-inflammatory disorders. Am J Emerg Med 2010; 28: 364–77.
35. Angelini A, Calzolari V, Calabrese F et al. Myocarditis mimicking acute myocardial infarction: role of endomyocardial biopsy in the differential diagnosis. Heart 2000; 84: 245–50.
36. Cooper LT Jr. Myocarditis. N Engl J Med 2009; 360: 1526–38.
37. Lauer B, Niederau C, Kühl U et al. Cardiac troponin T in patients with clinically suspected myocarditis. J Am Coll Cardiol 1997; 30 (5): 1354–9.
38. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [J]. Lancet 2020; 1–10.
39. Medical expert group of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. Diagnosis and treatment of pneumonia caused by new coronavirus is fast Guide (Third Edition) [J]. Medical Herald 2020; 1–9.
40. Шляхто Е.В., Конради А.О., Арутюнов Г.П. и др. Руководство по диагностике и лечению болезней системы кровообращения в контексте пандемии COVID-19. Рос. кардиол. журн. 2020; 3: 1–20.
[Shliakhto E.V., Konradi A.O., Arutiunov G.P. et al. Rukovodstvo po diagnostike i lecheniiu boleznei sistemy krovoobrashcheniia v kontekste pandemii COVID-19. Ros. kardiol. zhurn. 2020; 3: 1–20 (in Russian).]
41. Диагностика и лечение миокардитов. Клинические рекомендации. М., 2019.
[Diagnosis and treatment of myocarditis. Clinical recommendations. Moscow, 2019 (in Russian).]
42. Chinese Medical Association Cardiovascular Branch Precision Medicine Group, Adult Fulminant Myocarditis Working Group. Adult Fulminant Myocarditis Diagnosis Expert Consensus on Interruption and Treatment [J]. J Intern Med Crit Care Med 2017; 45 (9): 742–52.
43. Abdel-Aty H, Boye P, Zagrosek A et al. Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. J Am Coll Cardiol 2005; 45: 1815–22.
44. Стукалова О.В., Гупало Е.М., Миронова Н.А. и др. Роль МРТ сердца с контрастированием в диагностике миокардита с различным клиническим течением. Сердце. 2016; 15 (2): 133–40.
[Stukalova O.V., Gupalo E.M., Mironova N.A. et al. Rol' MRT serdtsa s kontrastirovaniem v diagnostike miokardita s razlichnym klinicheskim techeniem. Serdtse. 2016; 15 (2): 133–40 (in Russian).]
45. Lakdawala NK, Givertz MM. Dilated cardiomyopathy with conduction disease and arrhythmia. Circulation 2010; 122 (5): 527–34.
46. Thomson LE, Kim RJ, Judd RM. Magnetic resonance imaging for the assessment of myocardial viability. J Magn Reson Imaging 2004; 19 (6): 771–88.
47. Friedrich MG, Sechtem U, Schulz-Menger J et al. Cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol 2009; 53 (17): 1475–87.
48. Mahrholdt H, Goedecke C, Wagner A et al. Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation 2004; 109: 1250–8.
49. Aretz HT. Myocarditis: the Dallas criteria. Hum Pathol 1987; 18: 619–24.
50. Baughman KL. Diagnosis of myocarditis: death of Dallas criteria. Circulation 2006; 113: 593–5.
51. Kindermann I, Kindermann M, Kandolf R et al. Predictors of outcome in patients with suspected myocarditis. Circulation 2008; 118: 639–48.
________________________________________________
1. Ostrye respiratornye virusnye infektsii u vzroslykh. Klinicheskie rekomendatsii Minzdrava Rossii po spetsial'nosti "Infektsionnye bolezni'. 2014 (in Russian).
2. Bilichenko T.N., Chuchalin A.G. Morbidity and mortality of the Russian population from acute respiratory viral infections, pneumonia and vaccination. Therapeutic Archive. 2018; 90 (1): 22–9 (in Russian).
3. Bogomolov B.P., Malkova T.N., Devyatkin A.V. Acute respiratory infections and heart. Moscow, 2003 (in Russian).
4. Spencer FA, Goldberg RJ, Becker RC, Gore JM. Seasonal distribution of acute myocardial infarction in the second national registry of myocardial infarction. J Am Coll Cardiol 1998; 31: 1226–33.
5. Warren-Gash C, Bhaskaran K, Hayward A et al. Circulating influenza virus, climatic factors, and acute myocardial infarction: a time series study in England and Wales and Hong Kong. J Infect Dis 2011; 203: 1710–8.
6. Pettinen J, Valonen P. The risk of myocardial infarction among Finnish farmers seeking medical care for an infection. Am J Pub Health 1996; 86: 1440–2.
7. Bokarev I.N. Vospalenie i tromboobrazovanie. Trombozy, krovotochivost' i bolezni sosudov. 2016; 14: 7–11 (in Russian).
8. Siscovick DS, Raghunathan TE, Lin D et al. Influenza vaccination and the risk of primary cardiac arrest. Am J Epidemiol 2000; 152: 674–7.
9. Naghavi M, Barlas Z, Siadaty S et al. Association of influenza vaccination and reduced risk of recurrent myocardial infarction. Circulation 2000; 102: 3039–45.
10. Lavallee P, Perchaud V, Gautier-Bertrand M et al. Association between influenza vaccination and reduced risk of brain infarction. Stroke 2002; 33: 513–8.
11. Gurfinkel EP, Leon de la Fuente R, Mendiz O, Mautner B. Flu vaccination in acute coronary syndromes and planned percutaneous coronary interventions (FLUVACS). Study Eur Heart J 2004; 25: 25–31.
12. Gwini SM, Coupland CA, Siriwardena AN. The effect of influenza vaccination on risk of acute myocardial infarction: self-controlled case-series study. Vaccine 2011; 29: 1145–9.
13. Casscells SW, Granger E, Kress AM et al. Use of oseltamivir after infuenza infection is associated with reduced incidence of recurrent adverse cardiovascular outcomes among military health system beneficiaries with prior cardiovascular diseases. Circ Cardiovasc Qual Outcomes 2009; 2: 108–15.
14. Guzik TJ, Mohiddin SA, Dimarco A et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res 2020; Apr 30: cvaa106.
15. Wang D, Hu B, Hu C et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China [J]. JAMA 2020; e1–e9.
16. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020; 109: 102433.
17. McCarthy RE 3rd, Boehmer JP, Hruban RH et al. Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med 2000; 342: 690–5.
18. Kyto V, Sipila J, Rautava P. The effects of gender and age on occurrence of clinically suspected myocarditis in adulthood. Heart 2013; 99 (22): 1681–4.
19. Mason JW, O’Connell JB, Herskowitz A et al. A clinical trial of immunosuppressive therapy for myocarditis. The Myocarditis Treatment Trial investigators. N Engl J Med 1995; 333: 269–75.
20. Hufnagel G, Pankuweit S, Richter A et al. The European Study of Epidemiology and Treatment of Cardiac Inflammatory Diseases (ESETCID). First epidemiological results. Herz 2000; 25: 279–85.
21. Максимов В.А. Миокардиты. Л.: Медицина, 1979.
[Maximov V.A. Myocarditis. Leningrad: Meditsina, 1979 (in Russian).]
22. Caforio AL, Calabrese F, Angelini A et al. A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. Eur Heart J 2007; 28: 1326–33.
23. Caforio ALP, Pankuweit S, Arbustini E et al. Current state of knowledge on aetiology, diagnosis, management and therapy of myocarditis. A Position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013; 34: 2636–48.
24. Cooper LT, Baughman KL, Feldman AM et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. Eur Heart J 2007; 28: 3076–93.
25. Bock CT, Klingel K, Kandolf R. Human parvovirus B19-associated myocarditis. N Engl J Med 2010; 362: 1248–9.
26. Bowles NE, Ni J, Kearney DL et al. Detection of viruses in myocardial tissues by polymerase chain reaction: evidence of adenovirus as a common cause of myocarditis in children and adults. J Am Coll Cardiol 2003; 42: 466–72.
27. Schultheiss HP, Kühl U, Cooper LT. The management of myocarditis. Eur Heart J 2011; 32: 2616–25.
28. Francone M, Chimenti C, Galea N et al. CMR sensitivity varies with clinical presentation and extent of cell necrosis in biopsy-proven acute myocarditis. JACC Cardiovasc Imaging 2014; 7: 254–63.
29. Röttgen R, Christiani R, Freyhardt P et al. Magnetic resonance imaging findings in acute myocarditis and correlation with immunohistological parameters. Eur Radiol 2011; 21: 1259–66.
30. Caforio ALP, Marcolongo R, Jahns R et al. Immune-mediated and autoimmune myocarditis: clinical presentation, diagnosis and treatment. Heart Fail Rev 2013; 18: 715–32.
31. Fabre A, Sheppard MN. Sudden adult death syndrome and other nonischaemic causes of sudden cardiac death. Heart 2006; 92 (3): 316–20.
32. Schultz JC, Hilliard AA, Cooper LT Jr, Rihal CS. Diagnosis and Treatment of Viral Myocarditis. Mayo Clin Proc 2009; 84 (11): 1001–9.
33. Caforio ALP, Marcolongo R, Cristina Basso, Sabino Iliceto. Clinical presentation and diagnosis of myocarditis. Heart 2015; 101 (16): 1332–44.
34. Punja M, Mark DG, McCoy JV et al. Electrocardiographic manifestations of cardiac infectious-inflammatory disorders. Am J Emerg Med 2010; 28: 364–77.
35. Angelini A, Calzolari V, Calabrese F et al. Myocarditis mimicking acute myocardial infarction: role of endomyocardial biopsy in the differential diagnosis. Heart 2000; 84: 245–50.
36. Cooper LT Jr. Myocarditis. N Engl J Med 2009; 360: 1526–38.
37. Lauer B, Niederau C, Kühl U et al. Cardiac troponin T in patients with clinically suspected myocarditis. J Am Coll Cardiol 1997; 30 (5): 1354–9.
38. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [J]. Lancet 2020; 1–10.
39. Medical expert group of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. Diagnosis and treatment of pneumonia caused by new coronavirus is fast Guide (Third Edition) [J]. Medical Herald 2020; 1–9.
40. Shliakhto E.V., Konradi A.O., Arutiunov G.P. et al. Rukovodstvo po diagnostike i lecheniiu boleznei sistemy krovoobrashcheniia v kontekste pandemii COVID-19. Ros. kardiol. zhurn. 2020; 3: 1–20 (in Russian).
41. Diagnosis and treatment of myocarditis. Clinical recommendations. Moscow, 2019 (in Russian).
42. Chinese Medical Association Cardiovascular Branch Precision Medicine Group, Adult Fulminant Myocarditis Working Group. Adult Fulminant Myocarditis Diagnosis Expert Consensus on Interruption and Treatment [J]. J Intern Med Crit Care Med 2017; 45 (9): 742–52.
43. Abdel-Aty H, Boye P, Zagrosek A et al. Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. J Am Coll Cardiol 2005; 45: 1815–22.
44. Stukalova O.V., Gupalo E.M., Mironova N.A. et al. Rol' MRT serdtsa s kontrastirovaniem v diagnostike miokardita s razlichnym klinicheskim techeniem. Serdtse. 2016; 15 (2): 133–40 (in Russian).
45. Lakdawala NK, Givertz MM. Dilated cardiomyopathy with conduction disease and arrhythmia. Circulation 2010; 122 (5): 527–34.
46. Thomson LE, Kim RJ, Judd RM. Magnetic resonance imaging for the assessment of myocardial viability. J Magn Reson Imaging 2004; 19 (6): 771–88.
47. Friedrich MG, Sechtem U, Schulz-Menger J et al. Cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol 2009; 53 (17): 1475–87.
48. Mahrholdt H, Goedecke C, Wagner A et al. Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation 2004; 109: 1250–8.
49. Aretz HT. Myocarditis: the Dallas criteria. Hum Pathol 1987; 18: 619–24.
50. Baughman KL. Diagnosis of myocarditis: death of Dallas criteria. Circulation 2006; 113: 593–5.
51. Kindermann I, Kindermann M, Kandolf R et al. Predictors of outcome in patients with suspected myocarditis. Circulation 2008; 118: 639–48.
Авторы
А.А. Кириченко*
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*andrey.apollonovich@yandex.ru