Вальсальва

Cardiovascular disease and COVID-19: a consensus paper from the ESC Working Group on Coronary Pathophysiology & Microcirculation, ESC Working Group on Thrombosis and the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Heart Rhythm Association (EHRA)

https://academic.oup.com/cardiovascres/ ... 98/6370961

Ниже на слайде: Post-acute sequelae of SARS-CoV-2 infection. У нас это состояние называют "постковидный синдром".

Цитата:

Тo date, a few cases-series of ‘COVID-19-related myocarditis’ with diverse clinical presentations, have been published.133–136 Patients with an exuberant immune response can manifest acute myocarditis with profound myocardial injury or cardiogenic shock.128,134 However, it is worth remembering that the available findings are more consistent with ‘clinically suspected myocarditis’ or possible Tako-Tsubo syndrome.133,137 A molecular analysis showed the absence of the SARS-CoV-2 genome in the myocardium of a patient diagnosed with COVID-19 and endomyocardial biopsy proven lymphocytic myocarditis, indicating that the identification of SARS-CoV-2 in the respiratory tract is insufficient to prove that clinically suspected myocarditis is caused by SARS-CoV-2.

MR data suggest that cardiac involvement is present inapproximately 80% of patients and ongoing myocardial inflammation in 60% of patients, at a median time interval of 71 days since COVID-19 diagnosis, even in asymptomatic patients.258 Of note, when compared with healthy controls, patients who have recovered from COVID-19 have lower left ventricular ejection fraction, higher left ventricular volumes, late gadolinium enhancement (LGE) irreversible previous myocardial injury (necroptosis, fibrosis), and pericardialenhancement indicating pericardial inflammation.

Вот еще одна интересная цитата:

Recently, rare and self-limiting cases of myocarditis with temporal association to immunization with an mRNA-based COVID-19 vaccinehave been reported, especially in young men (mean age 25 years old).Data from the Israeli Ministry of Health suggest a crude incidence rate of approximately 24 cases per million following a second dose. Still, the true incidence of this adverse event is unknown at this time. Although the specific mechanisms are unclear an immune-mediated mechanism is likely.

In summary, to date, there is scarce evidence supporting direct myocardial injury through COVID 19 infection. Given the risks of COVID-19, including the risk of myocardial injury from COVID-19 infection, concerns about rare or even extremely rare adverse events following immunization should not undermine confidence in the value of vaccination.