File Name: signs and symptoms of cardiovascular disease .zip
In the United States, 1 in every 4 deaths in is the result of a heart disease.
- Acute and Chronic Heart Failure Guidelines
- Types of Cardiovascular Disease
- Everything You Need to Know About Heart Disease
- Warning Signs & Symptoms of Heart Attack and Stroke
Heart attack and stroke are life-or-death emergencies — every second counts. If you have any of these signs, call and get to a hospital right away. Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes or goes away and comes back.
Acute and Chronic Heart Failure Guidelines
Coronavirus disease COVID , caused by a strain of coronavirus known as severe acute respiratory syndrome coronavirus 2 SARS-CoV-2 , has become a global pandemic that has affected the lives of billions of individuals. Extensive studies have revealed that SARS-CoV-2 shares many biological features with SARS-CoV, the zoonotic virus that caused the outbreak of severe acute respiratory syndrome, including the system of cell entry, which is triggered by binding of the viral spike protein to angiotensin-converting enzyme 2.
Pre-existing cardiovascular disease seems to be linked with worse outcomes and increased risk of death in patients with COVID, whereas COVID itself can also induce myocardial injury, arrhythmia, acute coronary syndrome and venous thromboembolism. Potential drug—disease interactions affecting patients with COVID and comorbid cardiovascular diseases are also becoming a serious concern.
By combining our knowledge of the biological features of the virus with clinical findings, we can improve our understanding of the potential mechanisms underlying COVID, paving the way towards the development of preventative and therapeutic solutions. The interaction between the viral spike S protein and angiotensin-converting enzyme 2, which triggers entry of the virus into host cells, is likely to be involved in the cardiovascular manifestations of COVID The presence of underlying cardiovascular comorbidities in patients with COVID is associated with high mortality.
COVID can cause cardiovascular disorders, including myocardial injury, arrhythmias, acute coronary syndrome and venous thromboembolism. The exponential increase in the number of patients with COVID in the past 6 months has overwhelmed health-care systems in numerous countries across the world.
Furthermore, COVID causes coagulation abnormalities in a substantial proportion of patients, which can lead to thromboembolic events 6 , 7.
The genomic sequence 1 , 2 , 3 , 8 and viral protein structure 9 , 10 , 11 of SARS-CoV-2 have been studied intensively since its emergence. Understanding the biological features of the virus will contribute to the development of diagnostic tests, vaccines and pharmacological therapies and can further our knowledge of tissue tropism. Early clinical data indicate that both the susceptibility to and the outcomes of COVID are strongly associated with cardiovascular disease CVD 12 , 13 , 14 , 15 , A high prevalence of pre-existing CVD has been observed among patients with COVID, and these comorbidities are associated with increased mortality 17 , 18 , 19 , 20 , 21 , Furthermore, COVID seems to promote the development of cardiovascular disorders, such as myocardial injury, arrhythmias, acute coronary syndrome ACS and venous thromboembolism 23 , 24 , Children with COVID have also been reported to develop hyperinflammatory shock with features akin to Kawasaki disease , including cardiac dysfunction and coronary vessel abnormalities Together, these data indicate the presence of a bidirectional interaction between COVID and the cardiovascular system, but the mechanisms underlying this interaction remain elusive.
The high burden of systemic inflammation associated with COVID has been proposed to accelerate the development of subclinical disorders or cause de novo cardiovascular damage 5 , 12 , 13 , ACE2, which is a key surface protein for virus entry and part of the renin—angiotensin—aldosterone system RAAS , is also thought to be involved in this interaction on the basis of findings from animal models 12 , 13 , 14 , The fast-moving nature of this research field necessitates the integration of available biological data with clinical findings of COVID to improve our understanding of the pathophysiology of the disease and to contribute to the development of potential therapies.
Furthermore, we provide an overview of the clinical findings related to the effects of COVID on the cardiovascular system. Of note, several limitations of this Review need to be acknowledged. First, given the fast-moving nature of this research field, we will discuss and cite data from preprint reports on bioRxiv or medRxiv in addition to peer-reviewed articles that have cited preprint reports.
These findings need to be interpreted with care and require validation in larger studies. Therefore, potential biases and confounding factors associated with observational data, such as differences in patient background, diagnostic methods and health-care systems, should be taken into account.
Since the emergence of SARS-CoV-2, extensive efforts have been made to characterize the features of this novel coronavirus through genomic sequence studies 1 , 2 , 3 and the evaluation of viral protein structure 9 , 10 , 11 , 27 , Coronaviruses have a crown-like morphology, consisting of four structural proteins known as spike S , envelope E , membrane M and nucleocapsid N proteins 29 , 30 , 32 Fig.
The viral genome surrounded by the N protein is a positive-sense, single-stranded RNA that functions as both a genome and an mRNA 29 , 30 , The S protein consists of two subunits; the S1 subunit contains a receptor-binding domain RBD that binds to angiotensin-converting enzyme 2 ACE2 on the surface of host cells, whereas the S2 subunit mediates fusion between the membranes of the virus and the host cell.
Finally, the genomic RNA and structural proteins are assembled into new viral particles, leading to their release via exocytosis. Among the structural proteins, the S protein has pivotal roles in virus attachment and entry and disease pathogenesis 9 , 10 , 11 , 29 , Second, the S protein of SARS-CoV-2 has an insertion of four amino acid residues 12 nucleotides at the boundary between the S1 and S2 subunits, which introduces a novel furin cleavage site 4 , 8.
This novel cleavage site has not been observed in SARS-CoV or other SARS-related coronaviruses originating from bats and seems to facilitate the processing of S protein at the S1 and S2 subunit boundary by ubiquitously expressed furin-like proteases for preliminary activation 4.
Although the function of this novel cleavage site is unknown, similar cleavage sites have been described in highly pathogenic avian influenza viruses and the Newcastle disease virus 4 , 8. The receptor-binding domain on the surface subunit S1 of the S protein is responsible for attachment of the virus to ACE2.
This endosomal entry pathway, which can be blocked by either lysosomotropic agents such as hydroxychloroquine or cathepsin inhibitors, might be the predominant entry pathway used by coronaviruses in the infection of cells cultured in vitro 40 , but the importance of this pathway for infection in vivo remains unclear. After the release of the viral genomic RNA into the cytoplasm, the first ORF is translated into polyproteins pp1a and pp1ab, which are then cleaved by viral proteases into small non-structural proteins such as RdRP.
Finally, the genomic RNA and structural proteins are assembled into new viral particles, leading to their release through exocytosis 29 , 30 Fig. Each step of the viral life cycle described here is a potential therapeutic target, including S protein priming by TMPRSS2 a target of the serine protease inhibitor camostat mesylate , membrane fusion and endocytosis a target of the antimalarial drug chloroquine and anti-influenza drug umifenovir and RNA replication by RdRP a target of the antiviral agents favipiravir, remdesivir and ribavirin 41 , A series of reports on the clinical characteristics of patients with COVID have also described similar findings 12 , 13 , 14 , The high prevalence of these comorbidities was confirmed in subsequent studies 18 , 19 , 20 , 21 , 22 , 45 , 46 , Importantly, the prevalence of these pre-existing conditions was higher in critically ill patients such as those admitted to the intensive care unit ICU and in those who died.
The individual case fatality rate of patients with CVD was Of note, these early approximations of case fatality rate are likely to be overestimated given that the estimates did not account for the many people who had the virus but were not tested. A similar trend in the prevalence of comorbidities has been reported by researchers in other countries 46 , 47 , 48 , 49 , 50 , Of note, this study from New York highlighted the high prevalence of comorbid obesity among patients with COVID, which had not been reported in the studies on patients in China probably owing to differences in the background prevalence of obesity between the USA and China.
Investigators in this study suggest that obesity might also be a risk factor for respiratory failure and the need for invasive mechanical ventilation Some patients who present without the typical symptoms of fever or cough have cardiac symptoms as the first clinical manifestation of COVID refs 52 , Cardiovascular comorbidities such as hypertension and coronary artery disease are associated with high mortality in patients with coronavirus disease COVID Furthermore, although the main presentation of COVID is viral pneumonia, COVID can also induce cardiovascular manifestations including myocardial injury, myocarditis, arrhythmias, acute coronary syndrome and thromboembolism.
Among these cardiovascular manifestations, myocardial injury has been independently associated with high mortality among patients with COVID ref. Finally, medications that have been proposed as treatments for COVID such as hydroxychloroquine and azithromycin have pro-arrhythmic effects. The presence of myocardial injury was associated with a significantly worse prognosis Of note, cardiac injury was found to be an independent risk factor for in-hospital mortality Another study confirmed this finding and reported that the rate of death in patients with elevated levels of cardiac troponin T was Furthermore, a subsequent study demonstrated that markers of myocardial injury were predictive of the risk of in-hospital mortality in patients with severe COVID ref.
The area under the receiver operating characteristic curve of the initial cardiac troponin I level for predicting in-hospital mortality was as high as 0. Other predictors of myocardial injury include advanced age, presence of comorbidities and high levels of C-reactive protein.
Whether typical clinical features of myocarditis were present in patients who had elevated levels of cardiac troponins during the course of COVID is unclear because most of the early studies did not include echocardiography or MRI data 12 , 13 , 14 , By contrast, several case reports have described typical signs of myocarditis in patients with COVID MRI data also revealed marked biventricular interstitial oedema, diffuse late gadolinium enhancement and circumferential pericardial effusion, features that are consistent with acute myocarditis.
This patient was diagnosed with COVIDinduced fulminant myocarditis and treated with methylprednisolone. By contrast, another case report described a patient with low-grade myocardial inflammation and myocardial localization of coronavirus particles outside of cardiomyocytes , as measured by endomyocardial biopsy, suggesting that SARS-CoV-2 might infect the myocardium directly However, whether these patients had myocarditis or whether the findings were a consequence of systemic inflammation remains unclear.
A marked increase in macrophage infiltration with evidence of myocardial damage was also detected, suggesting that SARS-CoV can infect the heart directly Taken together, these findings suggest that myocardial injury is not only a common manifestation of COVID, but also a risk factor for poor prognosis.
However, on the basis of the available clinical evidence, myocardial injury seems to be largely attributable to advanced systemic inflammation. In early studies from China, a small proportion of patients with COVID presented with chest pain on admission to hospital, but the characteristics of the chest pain were not described 17 , In a case series from New York involving 18 patients with COVID and ST segment elevation, which is indicative of potential acute myocardial infarction, five of the six patients with myocardial infarction required percutaneous coronary intervention In a case series from Italy involving 28 patients with COVID and ST segment elevation myocardial infarction, assessment by coronary angiography showed that 17 patients had evidence of a culprit lesion that required revascularization Considering the overwhelmed health-care facilities of many cities during the COVID outbreak, the number of cases of acute myocardial infarction among patients with COVID might be underestimated in early studies.
The mechanisms underlying COVIDinduced ACS might involve plaque rupture, coronary spasm or microthrombi owing to systemic inflammation or cytokine storm 67 , For example, activated macrophages secrete collagenases that degrade collagen, a major constituent of the fibrous cap on atherosclerotic plaques, which can lead to plaque rupture Activated macrophages are also known to secrete tissue factor, a potent procoagulant that triggers thrombus formation when the plaque ruptures Given that patients with COVID are likely to be older and to have pre-existing comorbidities such as coronary artery disease, hypertension and diabetes, heart failure might be the result of an exacerbation of these pre-existing conditions, whether already diagnosed or unknown, or the uncovering of subclinical cardiac dysfunction.
In particular, elderly patients with reduced diastolic function might develop heart failure with preserved EF during the course of COVID, which can be triggered by high fever, tachycardia, excessive hydration and impaired renal function In the advanced stages of COVID, the response of the immune system to infection might trigger the development of stress-induced cardiomyopathy or cytokine-related myocardial dysfunction, as with sepsis-associated cardiac dysfunction 80 , Given that COVID primarily causes respiratory symptoms and viral pneumonia with bilateral, peripheral and lower lung distribution, the pulmonary oedema that is observed in these patients, which is usually accompanied by ARDS, is mainly regarded as non-cardiogenic.
Additional haemodynamic data from patients with COVIDrelated respiratory failure are needed to validate this involvement. Heart palpitations have been reported to be the main presenting symptom of COVID in patients without a fever or cough In-hospital and out-of-hospital sudden cardiac arrests have also been reported in patients with COVID refs 57 , 66 , However, the exact contribution of COVID to cardiac arrhythmias remains uncertain given that arrhythmias, such as atrial and ventricular tachycardia and fibrillation, can be triggered by myocardial injury or other systemic causes such as fever, sepsis, hypoxia and electrolyte abnormalities 24 , COVID is associated with coagulation abnormalities, which can result in thromboembolic events Patients with COVID often have elevated levels of d -dimer, modestly reduced platelet counts and slightly prolonged prothrombin time.
By contrast, the changes in platelet counts and prothrombin time were modest. These findings show that a substantial proportion of patients with COVID have coagulation abnormalities that typically do not meet the criteria of disseminated intravascular coagulation established by the International Society on Thrombosis and Haemostasis 86 , but nevertheless might contribute to the development of the diverse cardiovascular manifestations of COVID Clinical observations of increased thromboembolic events in patients with COVID suggest the presence of a hypercoagulable state.
Venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, is a common complication in critically ill patients with COVID An autopsy study revealed that deep vein thrombosis was present in 7 of 12 patients who died with COVID in whom venous thromboembolism was not suspected before death, whereas pulmonary embolism was identified in 4 of the 12 patients Arterial thrombotic events have also been reported.
All 20 patients were diagnosed with COVIDrelated pneumonia before acute limb ischaemia was detected. The mechanisms underlying these coagulation abnormalities, particularly hypercoagulation, in the setting of COVID are unclear. One hypothesis is that the severe inflammatory response and endothelial damage induced by COVID in combination with underlying comorbidities might predispose patients to a hypercoagulable state 6.
Of note, certain antiviral medications and investigational therapies given to these patients might promote thrombosis or bleeding events through drug—drug interactions with antiplatelet agents and anticoagulants A retrospective study in New York showed that systemic anticoagulation was associated with prolonged survival in patients hospitalized with COVID ref.
Types of Cardiovascular Disease
It occurs when the arteries supplying blood to the heart narrow or harden from the build-up of plaque. Plaque is made up of fat, cholesterol and other substances found in the blood. This plaque build-up is also known as atherosclerosis. The site of the plaque determines the type of heart disease:. The decrease in blood flow due to plaque build-up can lead to chest pain, also called angina, or progress to a heart attack. The five most common symptoms of a heart attack are:.
Request PDF | Symptoms and signs of cardiac disease | Despite the widespread availability of investigational tests and imaging techniques for the diagnosis.
Everything You Need to Know About Heart Disease
Heart disease kills more Americans each year than any other disease or illness. It is important to understand what makes heart disease so common and how you can reduce your chances of having heart disease. Heart disease can be silent no symptoms in some persons. They may not be aware of heart disease until they have a heart attack also known as a myocardial infarction.
This document provides practical, evidence-based guidelines for the diagnosis and treatment of heart failure. Essential initial investigations: natriuretic peptides, electrocardiogram, echocardiography. Stress echocardiography. Single-photon emission computed tomography and radionuclide ventriculography. Objectives in the management of heart failure.
Are you a patient, family member, or caregiver? Heart disease differs significantly from other illnesses in its course and treatment. Hospice care for advanced cardiac disease addresses a wide range of symptoms, including shortness of breath, chest pain, weakness, functional decline and the management of fluid status.
Get the Facts About Cardiovascular Disease Cardiovascular disease is the leading cause of death for both men and women in the United States. It encompasses a broad range of conditions and diseases, some of which are genetic, and many of which are the result of lifestyle choices.
Warning Signs & Symptoms of Heart Attack and Stroke
The cardiovascular, or circulatory, system supplies the body with blood. It consists of the heart, arteries, veins, and capillaries. To discover more evidence-based information and resources for healthy aging, visit our dedicated hub.
Коммандер… сэр, я… извините за беспокойство, но монитор… я запустил антивирус и… - Фил, Фил, - нехарактерным для него ласковым тоном сказал Стратмор. - Потише и помедленнее. Что случилось. По голосу Стратмора, мягкому и спокойному, никто никогда не догадался бы, что мир, в котором он жил, рушится у него на глазах. Он отступил от двери и отошел чуть в сторону, пропуская Чатрукьяна в святая святых Третьего узла. Тот в нерешительности застыл в дверях, как хорошо обученная служебная собака, знающая, что ей запрещено переступать порог. По изумлению на лице Чатрукьяна было видно, что он никогда прежде не бывал в этой комнате.
Еще. На пальцах ничего. Резким движением Халохот развернул безжизненное тело и вскрикнул от ужаса. Перед ним был не Дэвид Беккер. Рафаэль де ла Маза, банкир из пригорода Севильи, скончался почти мгновенно.
Signs and Symptoms of Heart Attack
Вы уничтожите этот алгоритм сразу же после того, как мы с ним познакомимся. - Конечно. Так, чтобы не осталось и следа. Сьюзан нахмурилась. Она понимала, что найти принадлежащую Хейлу копию ключа будет очень трудно.
Камера вдруг повернулась к укрытию Халохота. Убийцы там уже не. Подъехал полицейский на мотоцикле. Женщина, наклонившаяся над умирающим, очевидно, услышала полицейскую сирену: она нервно оглянулась и потянула тучного господина за рукав, как бы торопя. Оба поспешили уйти. Камера снова показала Танкадо, его руку, упавшую на бездыханную грудь.
ME TOO, что означало: Я. Беккер расхохотался. Он дожил до тридцати пяти лет, а сердце у него прыгало, как у влюбленного мальчишки.
Его костюм выглядел так, будто он в нем спал. Стратмор сидел за современным письменным столом с двумя клавиатурами и монитором в расположенной сбоку нише. Стол был завален компьютерными распечатками и выглядел каким-то чужеродным в этом задернутом шторами помещении.
Давайте же, ребята… уже миллион раз вы меня проверяли. Когда она приблизилась к последнему контрольно-пропускному пункту, коренастый часовой с двумя сторожевыми псами на поводке и автоматом посмотрел на номерной знак ее машины и кивком разрешил следовать. Она проехала по Кэнин-роуд еще сотню метров и въехала на стоянку С, предназначенную для сотрудников.
Почему Стратмор отмел такую возможность. Хейл извивался на полу, стараясь увидеть, чем занята Сьюзан. - Что .
- Я тоже толстый и одинокий. Я тоже хотел бы с ней покувыркаться. Заплачу кучу денег.
И не пытайтесь, коммандер, - прошипел. - Вы рискуете попасть в Сьюзан. Хейл выжидал. Стояла полная тишина, и он внимательно прислушался. Ничего.
Джабба, дело очень серьезное. У меня чутье. У нее чутье.
Стояла полная тишина, и он внимательно прислушался. Ничего. Вроде бы на нижней ступеньке никого. Может, ему просто показалось.
Сьюзан протянула карточку и приготовилась ждать обычные полминуты. Офицер пропустил удостоверение через подключенный к компьютеру сканер, потом наконец взглянул на. - Спасибо, мисс Флетчер. - Он подал едва заметный знак, и ворота распахнулись.
Ну и чертовщина. Перед глазами возник текст: PRIMEDIFFERENCEBETWEEN ELEMENTSRESPONSIBLE FORHIROSHIMAANDNAGASAKI - Введите пробелы, - приказала Сьюзан. - Нам предстоит решить одну задачку.
И снова Беккер изложил свою проблему: - Si, si, senor. Меня зовут сеньор Ролдан. Буду рад вам помочь.
Он стал лучшим программистом корпуса, и перед ним замаячила перспектива отличной военной карьеры.