Yoğun Bakımda COVID-19 ve Kalp Yetersizliği
Özet
COVID-19 pandemisinde, virüsün akciğerler dışındaki organları da etkileyerek sistemik komplikasyonlara yol açtığı ve özellikle kalp yetersizliği (KY) olan bireylerde mortaliteyi ikiye katladığı görülmüştür. SARS-CoV-2, hücre içine girmek için ADE2 reseptörlerini kullanmakta; bu durum miyokardit, sitokin fırtınası, iskemik hasar, stres kardiyomiyopatisi ve mikrovasküler disfonksiyon gibi mekanizmalarla doğrudan veya dolaylı miyokard hasarını tetiklemektedir. Yoğun bakım hastalarında yeni başlangıçlı KY ve dirençli kardiyojenik şok vakaları sıklıkla mortalite artışıyla ilişkilendirilmekte; hastaların tanı ve takibinde troponin, NT-proBNP biyobelirteçleri, EKG ve ekokardiyografi kritik rol oynamaktadır. Tedavide kılavuzlara uygun ADEİ, ARB veya beta bloker gibi kronik KY ilaçlarının sürdürülmesi önerilirken, akut dekompansasyonda diüretik dozajı titizlikle ayarlanmalı ve gerekli durumlarda hemofiltrasyon ile mekanik dolaşım desteği (ECMO) tercih edilmelidir.
In the COVID-19 pandemic, it has been observed that the virus affects organs beyond the lungs, causing systemic complications and doubling mortality, particularly in individuals with pre-existing heart failure (HF). SARS-CoV-2 utilizes ACE2 receptors for cellular entry, triggering direct or indirect myocardial injury through mechanisms such as myocarditis, cytokine storm, ischemic damage, stress cardiomyopathy, and microvascular dysfunction. In intensive care patients, cases of new-onset HF and refractory cardiogenic shock are frequently associated with increased mortality, with troponin, NT-proBNP biomarkers, ECG, and echocardiography playing a critical role in diagnosis and monitoring. In terms of treatment, continuing guideline-directed chronic HF medications such as ACE inhibitors, ARBs, or beta-blockers is recommended, while diuretic dosages must be adjusted cautiously during acute decompensation, and hemofiltration along with mechanical circulatory support (ECMO) should be preferred when necessary.
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