Yoğun Bakımda COVID-19 ve Akut Koroner Sendrom
Özet
COVID-19 pandemisi, kardiyovasküler hastalığı olan bireylerde daha yüksek mortalite riski taşırken, enfeksiyon süreci doğrudan sitotoksik etkiler veya enflamasyon, sitokin fırtınası ve artmış pıhtılaşma eğilimi gibi dolaylı mekanizmalarla akut koroner sendrom (AKS), miyokard hasarı ve aritmi gibi ölümcül patolojileri tetiklemektedir. Akut miyokard hasarı, kardiyak troponinlerin yükselmesi ve EKG anormallikleri ile tanımlanmakta; özellikle yoğun bakım hastalarında troponin, D-dimer ve natriüretik peptit düzeylerinin yüksekliği kötü prognoz ve artmış solunum desteği ihtiyacı ile güçlü bir şekilde ilişkilendirilmektedir. AKS tanısında klinik değerlendirme, seri EKG takipleri ve bilgisayarlı tomografi anjiyografi önemli bir rol oynarken, tedavi süreçlerinde ST yükselmeli miyokard enfarktüsü (STEMI) vakaları için 120 dakikalık hedef sürede primer perkütan koroner girişim veya alternatif olarak fibrinolitik tedavi planlanmakta ve tüm hastalar test sonucu çıkana kadar potansiyel enfekte kabul edilmektedir. ST segment elevasyonsuz akut koroner sendromlar (NSTEMI) ise hastaların risk düzeylerine göre konservatif veya zamanlaması test sonuçlarına göre ayarlanan invaziv stratejilerle yönetilmektedir. Yoğun bakım ortamında AKS olgularının güncel kılavuzlar ışığında erken teşhisi ve doğru yönetimi, COVID-19'a bağlı morbidite ve mortalitenin azaltılmasında kritik bir öneme sahiptir.
The COVID-19 pandemic carries a higher mortality risk in individuals with cardiovascular disease, and the infection process triggers fatal pathologies such as acute coronary syndrome (ACS), myocardial injury, and arrhythmia through direct cytotoxic effects or indirect mechanisms including inflammation, cytokine storm, and increased coagulation tendency. Acute myocardial injury is defined by elevated cardiac troponins and ECG abnormalities; particularly in intensive care patients, high levels of troponin, D-dimer, and natriuretic peptides are strongly associated with poor prognosis and increased need for respiratory support. While clinical evaluation, serial ECG monitoring, and computed tomography angiography play an important role in ACS diagnosis, primary percutaneous coronary intervention within a target time of 120 minutes or alternatively fibrinolytic therapy is planned for ST-elevation myocardial infarction (STEMI) cases, and all patients are considered potentially infected until test results are available. Non-ST-segment elevation acute coronary syndromes (NSTEMI) are managed with conservative or invasive strategies, the timing of which is adjusted according to test results based on patients' risk levels. Early diagnosis and proper management of ACS cases in the intensive care setting in light of current guidelines are of critical importance in reducing COVID-19-related morbidity and mortality.
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