Abstract
The Journal of the Ceylon College of Physicians (JCCP) is a peer-reviewed, open access journal published bi-annually by the Ceylon College of Physicians (CCP) in the last week of June and December.The objective of the Journal is to promote good clinical practice and influence policy making across the medical world through publication of original research and peer reviewed articles on current issues and to foster responsible and balanced debate on issues that affect medicine and health care in Sri Lanka. Contributions to the JCCP reflect its national and multidisciplinary readership and include current thinking across a range of medical specialties.
Highlights
The world is experiencing a pandemic of COVID-19 corona virus infection, which is still evolving and the number of cases continue to rise at an exponential rate
In non-survivors the high-sensitivity troponins and inflammatory biomarkers were significantly elevated and had higher incidence of heart failure (52% vs 12% in survivors) and acute cardiac injury (59% vs 1% in survivors)[8]. These findings suggest high inflammatory burden and possibly, myocarditis contribute to the poor prognosis
severe acute respiratory syndrome (SARS)-CoV spike protein binds to this enzyme receptor Angiotensin-converting enzyme 2 (ACE2) to enter the alveolar cells and once enters it down regulates the receptors resulting in increased levels of angiotensin II, which causes myocardial dysfunction[21]
Summary
The world is experiencing a pandemic of COVID-19 corona virus infection, which is still evolving and the number of cases continue to rise at an exponential rate. In non-survivors the high-sensitivity troponins (hs-cTI) and inflammatory biomarkers (ferritin and Interleukin-6) were significantly elevated and had higher incidence of heart failure (52% vs 12% in survivors) and acute cardiac injury (59% vs 1% in survivors)[8]. Myocardial injury (elevated troponins) is highly prevalent (20%) in hospitalized patients with COVID-19 infection who are more commonly men, older age, have comorbidities (hypertension, coronary heart disease, cardiomyopathy and chronic kidney disease) and among patients who are more likely to develop complications such as acute kidney injury and ARDS12,13. The cytokine storm, or systemic hyperinflammation, is a feature of advanced stage (Figure 2) characterized by multiorgan dysfunction and elevation of typical inflammatory markers This can result in fulminant myocarditis and acute respiratory distress syndrome causing high mortality.
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