Post-Covid Heart Rhythm Disturbances in Patients With High-Risk Arterial Hypertension: From Cerebrovascular Event to Multi-Organ Injury

Objective: To identify arrhythmias and heart blocks in patients who had SARS-CoV-2 pneumonia with PCR+ in the early (after 4, 12 weeks) and late (after 12 months) post-COVID periods Design and method: A total of 177 patients aged 66.6 years (42-88), 85/92 f/m were examined. 39 (22%) were 42-59 years old; 90 (50.8%) – 60-74 years; 48 (27.2%) – 75-88 years. The volume of lung lesions (VLL) was 30.7% (4-82). According to CT data, resolution of inflammatory infiltration was achieved by the 4th week from the onset of the disease. The incidence of arterial hypertension (HTN) was 100%. 49.8% had HTN + ischemic heart disease (CVD); 15.2% had HTN + stroke; 16.4% had HTN+ CVD+ DM2 13% had HNT + CVD + chronic kidney disease (CKD); 5.6% had HTN+ CVD + stroke + DM2+ CKD. Body mass index (BMI) was 28.8 (20.7-38.6) kg/m2. Holter monitoring and echocardiography with calculation of left ventricular ejection fraction (LVEF%), end-diastolic volume (EDVI) index (ml/m2) and end-space volume (ESVI, ml/m2) were performed. CRP, ferritin, D-dimer, fibrinogen, and a clinical blood test were determined. Results: At the 4th week, atrial extrasystoles (AE) 779/day (61-8642) were registered in 37.8% of patients; paroxysms of atrial tachycardia (PAT) in 15.8%; ventricular extrasystoles (VE) of grades IV-V (Lown, Wolf) in 15.2%; pathological pauses (PP) caused by blocks in 19.8%. A positive correlation was found between APL and CRP (r=0.899 p<0.001); ferritin (r=0.943 p<0.001); D-dimer (r=0.862 p<0.001); fibrinogen (r=0.918 p<0.001); neutrophils (r=0.788 p<0.001) and a negative relationship with lymphocytes (r=- 0.702 p<0.001). After 12 weeks, the number of patients with PE (21.5%), PPT (9%), and FE (10.7%) decreased. There was a direct relationship between the duration of pauses and fibrinogen (r=0.741 p<0.001); D-dimer (r=0.786 p<0.001), ferritin (r=0.733 p<0.001) and a negative correlation with platelets (r=-0.721; p<0.001) and lymphocytes (r=-0.718; p<0.001). After 12 months, arrhythmias persisted in 30 (16.9%) patients, and pauses and lymphopenia in 15 (8.5%) Conclusions: Against the background of signs of inflammation and hypercoagulation in the early and late post-COVID periods, detected arrhythmias and heart blocks indicate ongoing myocardial damage with preserved LVEF.