The viral myocarditis with cardiac аrrhythmia as complication of COVID-19 in the practice of family doctor of the tuberculosis dispensary

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Abstract

BACKGROUND: About 70% of TB dispensary patients have chronic somatic diseases which not only prevent effective treatment of TB but also take progressive course themselves.

AIMS: To timely detect and treat acute and chronic somatic disease combined with TB.

MATERIALS AND METHODS: since 2020 the algorithm of patient complex investigation by specialists of therapeutic profile was developed in the Tuberculosis Dispensary No. 5, among them the general practitioner was the coordinator of the patient’s medical route. This became especially relevant during the COVID-19 pandemic.

RESULTS: In accordance with the developed algorithms of diagnostic search the patient was comprehensively examined. There were no signs of tuberculosis were in him, however the general practitioner involving to specialists team could diagnose signs of complex cardiac arrhythmia the probable cause which was a new coronavirus infection that he had had six weeks before.

CONCLUSIONS: The organization of a new form of medical service for phthisiatric patients allowed general practitioner to reveal serious cardiac pathology directly at the TB dispensary, to refer the patient for consultation to the cardiologist-arrhythmologist, to follow the patient and perform recommended cardiologic treatment simultaneously with measures or medical supervision over persons contacting with tuberculosis.

About the authors

Irina V. Yubrina

North-Western State Medical University named after I.I. Mechnikov; Tuberculosis Dispensary No. 5

Author for correspondence.
Email: zav-monitoring@ptd5spb.ru
SPIN-code: 3387-5719

MD, Cand. Sci. (Med.)

Russian Federation, 41 Kirochnaya str., Saint Petersburg, 191015; Saint Petersburg

Ludmila N. Degtyareva

North-Western State Medical University named after I.I. Mechnikov

Email: ludmila.degtyareva@szgmu.ru
ORCID iD: 0000-0001-8375-3363
SPIN-code: 5942-8540
ResearcherId: O-4144-2014

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, 41, Kirochnaya street, Saint-Petersburg, 191015

Igor A. Bozhkov

North-Western State Medical University named after I.I. Mechnikov; Tuberculosis Dispensary No. 5

Email: glvr@ptd5spb.ru
ORCID iD: 0000-0001-5586-9633

MD, Dr. Sci. (Med.)

Russian Federation, 41 Kirochnaya str., Saint Petersburg, 191015; Saint Petersburg

References

  1. Antonova TV, Zhevnerova NS. Viral myocarditis: etiology and pathogenesis, problems of diagnostics. Journal Infectology. 2013;5(2):13–21. (In Russ.). doi: 10.22625/2072-6732-2013-5-2-13-21
  2. Blagova OV, Nedostup AV, Kogan EA. Sindrom narushenii ritma i provodimosti serdtsa (“idiopaticheskie” aritmii) In: Bolezni miokarda i perikarda: Ot sindromov k diagnozu i lecheniyu. Moscow; 2019. P. 99–222. (In Russ.)
  3. Kozlov IA, Tyurin IN. Cardiovascular complications of COVID-19. Messenger of Anesthesiology and Resuscitation. 2020;17(4):14–22. (In Russ.). doi: 10.21292/2078-5658-2020-17-4-14-22
  4. Inciardi RM, Lupi L, Zacoone G, et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):819–824. doi: 10.1001/jamacardio.2020.1096
  5. Siripanthong B, Nazarian S, Muser D, et al. Recognizing COVID-19–related myocarditis: the possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm. 2020;17(9):1463–1471. doi: 10.1016/j.hrthm.2020.05.001

Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Electrocardiogram of patient F. Р – 100 ms; Р–Q – 178 ms; QRS – 98 ms; Q–T – 413 ms; Q–Tс – 418 ms; R–R – 974 ms; HR – 61/min; angle α: +6°. Transition point – V2–V3. Cardiac axis is horizontal. Rhithm is sinus, irregular. Frequent ventricular premature bits including early ones of type ‘R-on-T’. No manifestations of heart chambers hypertrophy. 24-hours ESG-monitoring is recommended

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3. Fig. 2. Main indications of the cardiac arrhythmia of patient F. with 24-hour-ECG-monitoring. AV — atrioventricular; HR — heart rate; R–R — R–R interval

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4. Fig. 3

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Copyright (c) 2021 Yubrina I.V., Degtyareva L.N., Bozhkov I.A.

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