Peculiarities of the Course of Acute Coronary Syndrome in Patients with New Coronavirus Infection

INTRODUCTION: Coronary heart disease (CHD) is an important medical and social problem. It occupies one of the leading positions in the structure of morbidity, temporary and permanent disability and mortality. The peculiarities of the course of acute coronary syndrome (ACS) in patients with new coronavirus infection COVID-19 are of great clinical interest. Studies have shown that the effect of COVID-19 on the cardiovascular system consists not only the in direct cardiotoxic effect of the virus, but also in myocardial damage due to hemodynamic disorders, systemic hypoxia, destabilization of atherosclerotic plaques due to endothelial dysfunction, increased myocardial oxygen demand as a response to systemic inflammation, coagulopathy and others. An important role is played by the involvement of the vascular endothelium in the pathological process. There is extensive evidence of SARS-CoV-2 directly infecting endothelial cells because of the high level of expression of angiotensin-converting enzyme 2. The combination of ACS and new coronavirus infection is a frequent event in both infectious disease units and specialized coronary centers. However, many questions of pathogenesis, clinical presentation, diagnosis and management tactics of such patients are not clear enough. There are data on the manifestation of cardiovascular diseases against the background COVID-19. The difficulty is that clinical presentation of acute coronary syndrome in COVID-19 patients can be masked by peculiarities of the course of infectious disease itself. CONCLUSION: Differential diagnosis of COVID-19 and ACS has also become a problem for clinicians due to the fact that symptoms of chest pain or chest tightness are common in patients with new coronavirus infection. Myocardial damage in coronavirus infection can impair interpretation of the results of some clinical diagnostic tools. A complex disputable problem is assessment of prognosis in ACS combined with COVID-19. Most patients with COVID-19 have disorders of the clotting system, the severity of which determines the probability of adverse outcomes, above all, the risk of death.