Diagnosis and treatment of painless myocardial ischemia combined with diabetes mellitus in patients who have survived coronavirus infection
Abstract
Introduction. The remote mechanisms of the effect of the SARS-CoV-2 infection on the course of cardiovascular diseases and type 2 diabetes remain a subject of discussion in the scientific community. The aim of the study was to determine the cardiometabolic characteristics and improve the diagnosis of coronary heart disease combined with type 2 diabetes mellitus in patients who survived coronavirus infection. Materials and methods. 120 patients with chronic coronary heart disease and type 2 diabetes were included in the study. The participants were divided into two groups: the main group (with an episode of COVID-19) and the control group (without COVID). Laboratory studies analyzed the levels of highly sensitive C-reactive protein (HCRP), D-dimer, vascular endothelial growth factor (VEGF-A), as well as the profile of lipids in plasma and indicators of antioxidant protection. Instrumental examinations included an electrocardiogram (ECG), a physical stress test (PST), Holter ECG monitoring and ultrasound examination of the brachial artery to assess the elasticity of the vascular wall. Results. Clinical manifestations of coronary heart disease in patients with type 2 diabetes who have had SARS-CoV-2 show an increase in office blood pressure and a worsening of the condition associated with cardiac, psychosomatic and metabolic disorders. In 67.5% of these patients, coronary artery disease manifests itself in the form of pain-free myocardial ischemia (MBIM). Laboratory tests show the presence of dyslipidemia, increased levels of VEGF-A and D-dimer, as well as increased HCRP, while there is a significant decrease in the antioxidant activity of blood plasma. Conclusions. Coronary heart disease in patients with type 2 diabetes who have suffered COVID-19 manifests itself in 67.5% of cases in the form of MBIM, which is accompanied by the development of cardiac and psychosomatic disorders, including asthenoneurotic and asthenovegetative syndromes. In the post-pregnancy period, such patients have lipid metabolism disorders, increased VEGF-A levels, and pronounced endothelial dysfunction, which is associated with increased D-dimer and HCRP against the background of reduced antioxidant activity in blood plasma.
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