 Home > Active Ingredient News > Infection > The heart muscle damage of BA.5 is the same as Delta! Strenuous exercise is deadly? NEJM: Myocarditis in new crown hospitalized patients increased by 16 times! BMJ tells you how to exercise after Yangkang

The heart muscle damage of BA.5 is the same as Delta! Strenuous exercise is deadly? NEJM: Myocarditis in new crown hospitalized patients increased by 16 times! BMJ tells you how to exercise after Yangkang

 Last Update: 2023-02-03
 Source: Internet
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Is there a high chance of myocarditis after the new crown? Are the consequences serious? The problem of myocarditis after Yangkang is far from simple.
.
.
.
Recently, there have been many reports of sudden death of myocarditis caused by strenuous exercise after Yangkang
.
First, a 14-year-old boy in Guangdong who was treated for acute myocarditis in the pediatric emergency department of Guangdong Provincial People's Hospital was rescued for many days, which was worrying; Then there was a 40-year-old young and middle-aged lawyer Yang Kang after fitness, and he died suddenly of fulminant myocarditis
.
It is understood that this period is a concentrated outbreak of myocarditis, the director of the emergency department of a third-class hospital in Hebei Province said that he has received 3 cases of viral myocarditis, patients aged 28~35 years, none of them have underlying diseases, 2~4 days after infection with the new crown, rapid progression, respiratory cardiac arrest
.
Wang Dezhao, director of the Cardiovascular Center and chief physician of the Department of Cardiology at Beijing United Family Hospital, also said that on December 27 alone, 18 "Yangkang" patients came to make an appointment, they had varying degrees of fatigue, and they had symptoms such as palpitation, chest tightness, and chest compression, and they were afraid that fulminant myocarditis would appear as reported in the news, so they all came to check their hearts
.
In order to conduct cardiac consultations for patients infected with the new crown, Wang Dezhao rushes to the fever clinic, emergency department and ward every day, all of whom are infected with elevated cardiac enzymes and troponin
.
These indicators are related to myocardial damage, and the greater the increase in value, the greater
the area of myocardial damage.
Many people will ask, is the new crown related to myocarditis? The answer is yes, there are about 20 viruses that can cause fulminant myocarditis, mainly coxsackievirus
.
In addition, new coronavirus, adenovirus, influenza A H1N1, EV-71 can cause fulminant myocarditis
.
In the presence of myocarditis, myocardial tissue will present localized or diffuse acute or chronic inflammatory lesions, with inflammatory cell infiltration, myocardial cell damage necrosis, fibrosis and other pathological changes
.
The vast majority of myocarditis resolves spontaneously or after treatment, and only a very few may develop acute heart failure, which
is life-threatening.
There are many causes of myocarditis, the most common is viral infection, and fulminant, acute myocarditis caused by viral infection is the most dangerous
.
The weak body after repeated attacks by the virus, once fulminant myocarditis, often cause acute heart failure, severe arrhythmia and cardiogenic shock, with the characteristics of acute onset, severe disease, rapid progression, poor prognosis, in a short period of time suddenly appear vital signs unstable, such as blood pressure drop, unconsciousness, and even cardiac arrest, sudden cardiac death, can be accompanied by respiratory failure and liver and kidney failure, mortality of up to 80%.

In view of the harm of fulminant myocarditis, if emergency or hospitalization is required in Europe and the United States when receiving new crown infected patients, the three examinations of electrocardiogram, myocardial enzymes, and echocardiography will definitely be done to check for myocarditis and other heart complications
.
So, how much is the correlation between the new crown and myocarditis? In March 2022, the American College of Cardiology (ACC) released the Expert Consensus Decision Path for Cardiovascular Sequelae of Adult New Crown Infection, which clarifies that new crown infection can cause myocardial damage, including myocarditis, type 1 and type 2 myocardial infarction, multisystem inflammatory syndrome (MIS) in children and adults, and Takotsubo (stressed) cardiomyopathy
.
In addition, data from the US Centers for Disease Control (CDC) indicate that men, adults over 50 years of age, and children under 16 years of age are risk factors
for Covid-19-related myocarditis.
According to a recent review in NEJM, the true incidence of myocarditis in patients with Covid-19 is difficult to determine because early reporting lacks a clear diagnosis of myocarditis, and biomarkers reflecting myocardial injury may also be associated
with non-primary myocardial injury (multiple organ failure, hypoxia, hypoperfusion, and coagulopathy).
Studies have reported that according to the increase of serum myocardial enzymes, 15%~27.
8% of patients with severe Covid-19 pneumonia will have myocardial injury
.
In addition, patients with Covid-19 who do not develop pneumonia can also develop myocarditis, suggesting that advanced cardiovascular complications
are possible even in patients with mild symptoms.
In fact, the more inflammatory factors are released after the new crown infection, the heavier the systemic symptoms, and the more serious the damage to the heart muscle
.
In the first half of 2021, data from more than 900 hospitals in the United States found that the incidence of myocarditis in patients hospitalized with new crown infection was 16 times
that of non-new crown infection hospitalization.
Recently, a study published in Circulation analyzed
more than 56,000 patients hospitalized with COVID-19 in 23 hospitals in Europe and the United States.
Studies have shown that the prevalence of patients with definitively diagnosed or most likely myocarditis is 2.
4 per 1000 patients, and if cases that may be myocarditis are included, the prevalence is 4.
1 per 1000 patients
.
The median age of patients was 38 years and 61.
1% were male
.
38.
9% of patients with acute myocarditis with COVID-19 had fulminant manifestations requiring muscular strength support or temporary mechanical circulatory support, and 70.
4% were admitted to the intensive care unit
.
A study in South Korea included 181656 hospitalized patients
.
During follow-up, the incidence of myocarditis/pericarditis was 0.
08% (0.
78 per 1000 hospitalized patients).

For the general population, data from the UK suggest that there are 40 additional myocarditis events per million people after SARS-CoV-2 infection, of which the incidence ratio (IRR) of myocarditis 1~7 days after a positive SARS-CoV-2 test is 21.
08, the IRR of 8~14 days is 11.
29, the IRR of 15~21 days is 5.
36, and the IRR of 21~28 days is 3.
08
。 Autopsy results for COVID-19 patients also vary
.
Among the 22 cardiac autopsies with a total of 277 cases, typical myocarditis accounted for 7.
2%, non-myocarditic inflammatory infiltrates accounted for 12.
6%, single-cell ischemia (formerly known as single cardiomyocyte necrosis, cardiomyocyte damage, local necrosis) accounted for 13.
7%, acute myocardial infarction accounted for 4.
7%, and 47.
8% of patients had at least one cardiovascular histopathological abnormality , including large or microvascular thrombosis, inflammation, or intraluminal megakaryocytes
.
Overall, these data suggest that although fulminant myocarditis is rare as a cause of death, non-specific cardiac inflammation and/or injury is not uncommon in
deaths.
STTT: Omicron BA.
5 is more damaging to the heart muscle than BA.
1, similar to Delta.
No, the latest research shows that the facts are very unusual
.
On December 25, 2022, researchers from the University of Ulm in Germany published a paper titled Signal Transduction and Targeted Therapy Strong attenuation of SARS-CoV-2 Omicron BA.
1 and increased replication of the BA.
5 subvariant in human cardiomyocytes
.
Because cardiomyocytes highly express the new coronavirus receptor ACE2, it is a key receptor for coronavirus-infected cardiomyocytes, which the researchers cultured through in vitro The original strain, Delta, Omicron BA.
1, BA.
2 and BA.
5 were tested for replication and damage
to cells.
Measurements of cardiomyocytes showed that the rate of beating of uninfected cardiomyocytes steadily decreased from 30 to 10 beats every 30 seconds over 10 days, while cardiomyocytes infected with the original strain or Delta usually stopped beating
completely on days 3-5.
In contrast, cardiomyocytes infected with BA.
1 had a delay
in stopping beats.
For toxicity, Delta has a stronger cytopathic effect
than the original strain and BA.
1.
By microscopic observation, on the third day of infection, cardiomyocytes infected with the original strain and Delta lost the troponin T-positive sarcomere structure, while the cardiomyocytes infected with BA.
1 also maintained a well-organized sarcomere structure
.
From the perspective of virus replication, different new crown variants can infect cardiomyocytes, virus production usually reaches a maximum about 5 days after infection, compared with BA.
1, the original strain and Delta have a stronger replication ability, and the infectious virions produced are about 2-3 orders of magnitude
higher.
The study also found that compared to BA.
1, the BA.
5 variant is more replicable, produces a more contagious virus, can cause stronger cytopathic effects, and stops heart muscle cells beating faster, or similar
to Delta.
The Anta variant has much stronger replication and destructive power in cardiomyocytes than the BA.
1 variant, which is still expected by the researchers; surprisingly, for BA.
2, especially the BA.
5 variant, the replication ability and damage ability in cardiomyocytes are also much stronger than BA.
1, similar to the Delta variant, which is too pessimistic
.
However, it should be noted that this is an in vitro study, and whether this is the case in humans has yet to be verified
.
Yangkang people should protect their little hearts! Nature & BMJ: How do you exercise after turning yin? The Expert Consensus Decision Path for Cardiovascular Sequelae of Adult New Crown Infection has clearly pointed out that people with advanced age, men, underlying cardiovascular diseases, obesity, diabetes, hypertension, immunosuppression and severe systemic diseases are more likely to develop myocarditis
after infection with the new crown.
In May 2022, Chris Goodnow, head of the immunogenomics laboratory at the Canadian Institute of Medicine in Australia and director of the Institute for the Future of Cell Genomics at the University of New South Wales, unfortunately contracted the new crown.

Two months later, Professor Chris Goodnow wrote "Reflections of an Australian Immunologist: Starting from Myocarditis Infected with the New Crown"
based on his own painful experience.
Chris Goodnow has 40 years of experience in antibody research and has an in-depth understanding
of the coronavirus.
He said in the article that although he had completed a sufficient amount of vaccination, he was still accompanied by myocarditis
after infection with Omicron.
He still has heart symptoms after recovery, which he describes as a terrible experience, "The new crown is not a common cold, and recovery from infection does not mean that you can sit back and relax
.
" "The author thought that some people really don't care about anything, and it's really unwise to go to the gym to pick up the iron immediately after Yangkang! Nature Medicine recently published a paper on Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or A research paper on SARS-CoV-2 infection that provides scientific advice
for exercise recovery in yang healthy people.
The study noted that the new coronavirus is prone to myocarditis, with the highest relative risk rate (IRR) of 16 in the first week, 7.
0 in the second week, 3.
0 in the third week, and 1.
5
in the fourth week.
Therefore, it is important to rest well one to two weeks after the new crown virus infection, there must be no fluke mentality, after two weeks is generally safer, but do not engage in intense exercise within a month
.
The article emphasizes that any exercise in the first two weeks after Yangkang is harmful, and after two weeks, we can first try low-intensity exercise such as walking, jogging, etc.
, and control the heart rate below 70% of the maximum heart rate (220–age), and the time should not exceed 15 minutes; Then gradually increase the amount of exercise to the pre-Covid level
.
For patients diagnosed with myocarditis during the new crown infection, strenuous exercise should be stopped for 3~6 months, and even more intense sexual life is not allowed
.
After 3~6 months, it is necessary to undergo evaluation of myocardial enzymes, electrocardiogram, Holter and/or cardiac MRI, and then further develop a plan
for resuming exercise.
After Yangkang, how to do some specific sports? An article published in BMJ, Returning to physical activity after COVID-19 It is noted that there may be some risks of restarting physical activity after being hospitalized with COVID-19, but for those who are asymptomatic after infection or who have only mild or moderate symptoms and do not need to be hospitalized, physical activity
can be resumed two weeks after turning negative.
But still start with a lower intensity workout
.
The text gives four main stages of movement
.
Stages 1-2: Two weeks after rehabilitation, very low-intensity exercise training
is recommended.
When performing very low intensity exercise, the RPE should not exceed 11
.
Activities include simple walks, chores, breathing exercises to restore lung function, stretching exercises to improve flexibility, and low-intensity exercises
such as balance and yoga exercises to improve stability.
Stage 3-4: After one month, intermittent moderate-intensity exercise
is recommended.
For example, intermittent brisk walking, jogging, going up and down stairs, swimming, etc.
, each set of exercise time does not exceed 5 minutes
.
Exercise should not be felt difficult during each set of exercise, RPE is in the middle of 12-14, that is, the heart rate is between
120-140.
Of course, you also need to pay attention to the heart rate can not exceed your maximum heart rate
.
The formula for calculating the maximum heart rate can be quickly derived
by "(220-age) = maximum heart rate".
Both studies have shown that you should not do strenuous exercise within two weeks after turning yin, protect your heart, prevent myocarditis, and do not show your ability and act indiscriminately
.
References:[1].
Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2 infection

[2].
Ammirati, E.
et al.
Prevalence, Characteristics, and Outcomes of COVID-19-Associated Acute Myocarditis.
Circulation 145, 1123–1139 (2022).

[3].
Nchioua, R.
et al.
Strong attenuation of SARS-CoV-2 Omicron BA.
1 and increased replication of the BA.
5 subvariant in human cardiomyocytes.
Signal Transduct.
Target.
Ther.
7, 395 (2022).

[4].
Patone, M.
et al.
Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2 infection.
Nat.
Med.
28, 410–422 (2022).

[5].
Salman, D.
et al.
Returning to physical activity after covid-19.
BMJ 372, m4721 (2021).

Written by | Alaska Treasure Editor | Alaska Treasure

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