Cardiovascular complications

Complications in infectious diseases

Cardiovascular disorders frequently become fatal consequences of severe infections (e.g., COVID-19). Individuals over 65 and patients with comorbid respiratory or cardiovascular pathologies, diabetes, or oncology are at the highest risk.

Major cardiological problems include:

• Development of acute arrhythmias.
• Cardiac decompensation.
• Occurrence of myocardial infarction.

Infectious-toxic shock (ITS) poses a particular danger. Its clinical picture is characterized by a paradoxical combination: against the background of a drop in body temperature and blood pressure, tachycardia rapidly progresses. The patient experiences altered consciousness (up to stupor) and signs of microcirculatory disorders — marked pallor, cyanosis, and petechial skin rash. Without emergency care, ITS leads to a fatal outcome due to acute cardiovascular and multiple organ failure.

During a severe infectious disease, days 5–7 are considered critical. It is precisely during this time that the likelihood of sudden collapse and weakened cardiac function increases sharply, necessitating rigorous medical supervision and strict bed rest until the seventh day of normal temperature.

Valvular heart disease and pregnancy

The state of the cardiovascular system is critically important during pregnancy. The management of such female patients is always carried out jointly by an obstetrician-gynecologist and a cardiologist.

In mitral regurgitation, deformed valve leaflets do not close completely. As a result, during systole, blood is regurgitated back into the left atrium (regurgitation), causing hypertrophy and dilation of the left heart chambers. While a mild degree of the defect usually proceeds without complications, pronounced regurgitation with a sharp enlargement of the left ventricle creates a colossal threat. If heart failure develops, carrying the pregnancy to term is deemed inappropriate.

Combined heart defects (mitral defect, aortic stenosis, and insufficiency) permit pregnancy only in the complete absence of signs of left ventricular hypertrophy and symptoms of circulatory failure.

For women with a surgically treated heart, pregnancy is permitted no earlier than 1 year after successful surgery. The presence of bioprostheses usually ensures a favorable prognosis. However, with installed mechanical valves, there is a high risk of thrombosis, which dictates the need for continuous controlled anticoagulant therapy. The postpartum period requires special attention, as decompensation can occur shortly after delivery.

Cardiovascular risks in surgery

The presence of concomitant cardiological pathology (hypertension, angina pectoris, ischemic heart disease, myocarditis, cardiac rhythm disturbances) significantly complicates surgical operations, including maxillofacial interventions.

Any surgery can trigger life-threatening conditions:

1. Hypertensive crisis.
2. Anginal attack.
3. Acute myocardial infarction.

To prevent such complications, mandatory special preoperative preparation together with a specialized expert — a cardiologist — is required. If the patient additionally has respiratory disorders (bronchial asthma) or has been taking glucocorticoids long-term, it is critically important to take this fact into account when planning anesthesia.

Principles of pathogenetic drug support

The treatment of cardiovascular complications is comprehensive in nature and depends on the leading clinical syndrome. Basic measures include detoxification therapy, as well as the administration of antiplatelet agents, antipyretics, analgesics, and, if necessary, anticoagulants.

Specific pharmacotherapy:

• In acute cardiovascular failure: the administration of sympathomimetics (dopamine, norepinephrine, phenylephrine, ephedrine) is indicated to maintain hemodynamics.
• In infectious-toxic shock: short courses of glucocorticosteroids (dexamethasone, prednisolone) are used.
• In the development of delirium and psychomotor agitation: sedative therapy is prescribed (haloperidol, barbiturates, chlorpromazine, sodium oxybate).
• Mandatory vitamin therapy: the use in sufficient doses of vitamins C, B, and P, which have pronounced vessel-strengthening effects.

Class and exam questions

What else to study on this topic

• Diagnostic criteria and management tactics for pregnant women with newly diagnosed arterial hypertension.
• Features of the development of asthenic states during the convalescence period and limitations of working capacity.
• Specifics of preoperative preparation of patients with renal failure prior to surgical intervention.
• The impact of diffuse connective tissue diseases on the temporomandibular joint and oral mucosa.
• Etiotropic antibacterial therapy of secondary infectious complications (pneumonia, thrombophlebitis).

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.