Anales de la RANM

162 A N A L E S R A N M R E V I S T A F U N D A D A E N 1 8 7 9 LAS ENFERMEDADES QUE PRODUCE EL CORONAVIRUS José Ramón de Berrazueta Fernández An RANM · Año 2020 · número 137 (02) · páginas 161 a 173 will be severe and in 5% will place the patient in a critical situation. The most common clinical presentation is in the form of progressive bilateral bronchopneumonia, with hypoxemia and severe acute respiratory distress, which compromises the patient's life. These are patients who will need hospital admission for treatment with respiratory assistance, and in critical situations, admission to intensive care units, to connect to assisted breathing, and if it is complicated by cardiac pathology, which can accompany a significant percentage of these severe patients, for circulatory support. These are the patients that reach a high mortality. The virus has a characteristic structure in which the single-stranded chain of RNA is enveloped by a series of proteins, among which the surface spicules that give it the characteristic shape, or S proteins, stand out. They serve as binding to specific receptors cells of the Angiotensin 2 Converting Enzyme, ECA2, with which it interacts. Through them it is introduced into the respiratory epithelial cells or the cardiovascular system and other organs. It uses the genetic structure of invaded cells to replicate and spread throughout the affected organ and throughout the body. The immune response system, both humoral and cellular, tries to stop the replicative stimulus of the virus. The resistance of the virus to limit its replication causes the uncontrolled response of anti-inflammatory mediators to continue, which is summarized in what is called a cytokine storm. This is the most important damage mechanism produced by the body's response. Homeostatic balances are decompensated, both in maintaining blood pressure with critical hypotension and shock situations, and in the balance of pro and anticoagulant systems, with a general production of thrombi that produces the most serious complications, as well as the destruction of own anti-infective barriers. Pulmonary pathology progresses progressively from pneumonia to fibrosis, complicating many of the critically ill patients with pulmonary thromboembolism. Myocardial damage occurs in the circulatory system, with criteria for thrombosis and inflammation in the form of ischemic damage and different forms of cardiomyopathy. One of the most unique occurs specifically in the young population, in the form of a multisystemic hyperinflammatory response. But they can also damage the liver, kidney, central nervous system and other non-vital organs and systems. ACAN: Arterias Coronarias Angiográficamente Normales ACVA: Accidente Cerebro Vascular Agudo. Ang II : Angiotensina II. ARA II: bloqueantes de los receptores de la Angiotensina II CNG: coronariografía. DD: Dímero D DM: Diabetes Mellitus ECA2: Enzima Convertidor de la Angiotensina 2 ECG: electrocardiograma ECMO: oxigeneador extracorpóreo de membrana ECOCG: ECOcardiografía (ECOCG), ECV: Enfermedad Cardio Vascular EPOC: Enfermedad Pulmonar Obstructiva Crónica. FEVI: Fracción de Eyeccion del ventrículo izquierdo HAP: hipertensión arterial pulmonar HTA: hipertensión arterial ICC: insuficiencia cardiaca congestiva IECAS: Inhibidores del Enzima convertidor de la Angiotensina (los IECAS) IFN: interferón IM: infarto de miocardio IR: Insuficiencia renal IRC: Insuficiencia renal crónica MINOCA: Myocardial Infarction Non Obstructive Coronary Ateries NK: células Natural Killer PCR: Reacción en cadena de la polimerasa / polymerase chain reaction RNA: Ácido Ribonucleico RANME.: Real Academia Nacional de Medicina de España. RMN : Resonancia Magnética Nuclear. SARS-COV 2: Síndrome Respiratorio Agudo Severo por Coronaravirus 2. / Severe Acute Respiratory Syndrome. SCA: síndrome coronario agudo SLC: Síndrome de liberación de Citokinas SNC: Sistema Nervioso Central. SRAA: Sistema Renina Angiotensina Aldosterona SU: Servicios de Urgencia TAC: Tomografía Axial Computorizada. TDL: Tasa de letalidad general TEP: tromboembolismo pulmonar TNF : Tumor Necrosis Factor. Tp: Troponina TpI: Troponina I TpT: Tromponina T. UCI: Unidad de Cuidados Intensivos. ÍNDICE DE ABREVIATURAS