“Acute Myocardial Infarction in the Time of COVID-19”: A Review of Biological, Environmental, and Psychosocial Contributors
Abstract
:1. Introduction
2. Possible Causal Links between COVID-19 Infection and AMI
2.1. Inflammation
2.2. Immune Status
2.3. Comorbidities
2.3.1. Diabetes
2.3.2. Obesity
2.3.3. Hypertension
2.3.4. Gender-related Effects
2.4. Drug Effects in the Relationship between the Cardiovascular System and the COVID-19 Infection
2.5. COVID-19, Acute Myocardial Infarction, and Air Pollution
3. COVID-related Fear and Distress
4. AMI during COVID pandemic: Fall in Admission and Delayed Access to Hospital Care
5. Discussion
- Attention to vulnerable subjects (e.g., elderly, frail people, patients at high CV risk);
- Correct information to patients on the delayed hospital access risks;
- Epidemiological monitoring;
- Strategies aimed to reduce distress;
- Workload for healthcare professionals based on health specialty;
- Multidisciplinary team including intensive care specialists, laboratorists, psychologists, and cardiologists;
- Teleconsultations and telemonitoring to monitor high-risk patients;
- Electronic devices/apps to help patients in their personal disease management;
- Warning receipt in case of alarming data;
- Regular, clear, and reliable information on pandemic to patients.
6. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Air Pollution | SARS-CoV-2 |
---|---|
Inflammatory response: increased levels of C-reactive [80], fibrinogen [81], and cytokines [82]. | Severe systemic inflammation, cytokine storm [83]. |
Autonomic nervous system disruption [84]: heart rate variability decrease [80], heart rate increase [85]. | Myocardial injury (elevated troponins); binding of SARS-CoV-2 to ACE2 antiviral drugs, corticosteroids, and other therapies [86]. |
Enhanced thrombosis/coagulation [87], fibrinolytic capacity inhibition [88]. | Hypercoagulability, prothrombotic risk [89]. |
Oxidative stress, telomere erosion [90]. | Myocardial oxygen demand supply mismatch: increased cardiometabolic demand required with the systemic infection and hypoxia caused by acute respiratory failure [13]. |
Vasoconstrictor increase (e.g., endothelin) [91,92]. | Left ventricular dysfunction, heart failure, arrhythmias [93,94]. |
Atherosclerosis progression of and increased plaque rupture vulnerability [95]. | Increased susceptibility to plaque rupture [13]. |
Oxygen saturation reduction [96]. | Endothelial dysfunction, oxidative stress [97]. |
General Population (n = 294) [106] | CV Outpatients (n = 45) | |
---|---|---|
FACTOR 1—Emotional Fear Reactions | ||
1. I am most afraid of the coronavirus. | 3.4 | 3.5 |
2. It makes me uncomfortable to think about the coronavirus | 2.9 | 3.2 |
4. I am afraid of losing my life because of the coronavirus | 2.4 | 2.9 |
5. When watching news and stories about the coronavirus on social media, I become nervous or anxious | 2.9 | 3.0 |
FACTOR 2—Symptomatic Expression of Fear | ||
3. My hands become clammy when I think about the coronavirus | 1.5 | 2.1 |
6. I cannot sleep because I’m worrying about getting the coronavirus | 1.6 | 2.2 |
7. My heart races or palpitates when I think about getting the coronavirus | 2.1 | 2.4 |
1 January– 21 February | 22 February– 3 June | 4 June– 10 June | |
---|---|---|---|
Symptom Onset to First Medical Contact | 110 (15–570) | 133 (15–600) | 208 (15–1280) |
Door to Hospital Arrival Time | 95 (25–405) | 94 (20–390) | 83 (20–390) |
Hospital Arrival to Insufflation Time | 46 (15–120) | 38 (15–90) | 48 (15–120) |
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Gorini, F.; Chatzianagnostou, K.; Mazzone, A.; Bustaffa, E.; Esposito, A.; Berti, S.; Bianchi, F.; Vassalle, C. “Acute Myocardial Infarction in the Time of COVID-19”: A Review of Biological, Environmental, and Psychosocial Contributors. Int. J. Environ. Res. Public Health 2020, 17, 7371. https://doi.org/10.3390/ijerph17207371
Gorini F, Chatzianagnostou K, Mazzone A, Bustaffa E, Esposito A, Berti S, Bianchi F, Vassalle C. “Acute Myocardial Infarction in the Time of COVID-19”: A Review of Biological, Environmental, and Psychosocial Contributors. International Journal of Environmental Research and Public Health. 2020; 17(20):7371. https://doi.org/10.3390/ijerph17207371
Chicago/Turabian StyleGorini, Francesca, Kyriazoula Chatzianagnostou, Annamaria Mazzone, Elisa Bustaffa, Augusto Esposito, Sergio Berti, Fabrizio Bianchi, and Cristina Vassalle. 2020. "“Acute Myocardial Infarction in the Time of COVID-19”: A Review of Biological, Environmental, and Psychosocial Contributors" International Journal of Environmental Research and Public Health 17, no. 20: 7371. https://doi.org/10.3390/ijerph17207371