ABSTRACT
Severe acute respiratory-syndrome coronavirus-2 (SARS-CoV-2) host cell infection is mediated by binding to angiotensin-converting enzyme 2 (ACE2). Systemic dysregulation observed in SARS-CoV was previously postulated to be due to ACE2/angiotensin 1-7 (Ang1-7)/Mas axis downregulation; increased ACE2 activity was shown to mediate disease protection. Because angiotensin II receptor blockers, ACE inhibitors, and mineralocorticoid receptor antagonists increase ACE2 receptor expression, it has been tacitly believed that the use of these agents may facilitate viral disease; thus, they should not be used in high-risk patients with cardiovascular disease. Based on the anti-inflammatory benefits of the upregulation of the ACE2/Ang1-7/Mas axis and previously demonstrated benefits of lung function improvement in SARS-CoV infections, it has been hypothesized that the benefits of treatment with renin-angiotensin system inhibitors in SARS-CoV-2 may outweigh the risks and at the very least should not be withheld.
Subject(s)
Angiotensin Receptor Antagonists/pharmacology , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Betacoronavirus , Cardiovascular Diseases , Coronavirus Infections , Mineralocorticoid Receptor Antagonists/pharmacology , Pandemics , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral , Angiotensin-Converting Enzyme 2 , Betacoronavirus/drug effects , Betacoronavirus/physiology , COVID-19 , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/metabolism , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Coronavirus Infections/virology , Host Microbial Interactions/drug effects , Humans , Medication Therapy Management , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Renin-Angiotensin System/drug effects , Renin-Angiotensin System/physiology , SARS-CoV-2ABSTRACT
A 59-year-old man had, over a period of 5 years, three different clinical scenarios which led to dynamic left ventricular outflow tract obstruction (LVOTO). Initially, this man who suffered from hypertrophic cardiomyopathy presented with asymmetric septal hypertrophy and systolic anterior motion (SAM) of the anterior mitral leaflet, along with mitral regurgitation. He was treated by septal myectomy and mitral valve repair with insertion of an artificial mitral ring. Several years later, he presented with severe LVOTO, this time related to the anteriorly displaced mitral coaptation site and the prosthetic ring. The ring and the anterior mitral leaflet were resected and a prosthetic mitral valve implanted. Several years later, the patient presented with LVOTO for a third time. It was now SAM of the remaining posterior leaflet that was responsible for the LVOTO.
