En nuestra consulta recibimos muchos pacientes que nos indican que están cansados, fatigados, debilitados desde hace un tiempo… y siempre coincide lo mismo: “¡esto me pasa desde que tuve el covid!”.
Pasan las semanas y no se recuperan, y estos síntomas les ocasiona una merma de salud física y psicológica. Acuden al cardiólogo buscando respuestas, soluciones, los dirigen otros especialistas para que nosotros podamos sacarles de este problema porque, habitualmente, son personas jóvenes, activas, deportistas, sin enfermedades previas, que de repente se ven mermados de sus capacidades físicas, refieren molestias en el pecho, se habla mucho de la miocarditis…
La mejoría es lenta, en ocasiones con pasos hacia atrás, y en algunas personas hay miradas de desesperación, antes no habían tenido ningún problema, y no saben como superarlo. Y preguntan ¿Por qué me pasa esto? ¿Hay solución? ¿Remitirá la sensación de falta de aire, el dolor de cabeza y de articulaciones, poder correr y hacer ejercicio como antes? ¿Tener una vida normal?
Se indica que 1 de cada 40 personas tienen síntomas tras 3 meses pasada la infección por coronavirus. ¿Dónde reside el problema? Los últimos estudios indican que pueden residir en 3 sitios:
- Problemas de coagulación: Presencia de pequeños coágulos que afectan a la microcirculación, la más distal, la localizada a nivel de los capilares, que se encargan de irrigar nuestros órganos, nuestros músculos. Es típica la sensación de muchos pacientes que refieren “dolor muscular”, “aturdimiento”, “dificultad de concentración”, “falta de memoria”, están desmemoriados, no se concentran, han disminuido notablemente su actividad laboral.
- Problemas del sistema inmunitario: Se trata de un virus nuevo para nuestro organismo, se generan nuevas defensas frente al coronavirus, anticuerpos que tienen que defendernos del “agresor”, con presencia de una hiperactividad importante, un incremento inflamatorio impresionante, algo totalmente nuevo para nosotros y, en ocasiones, sin poder de desactivarlo del todo, con probable persistencia del virus en nuestro organismo, algo que se está evidenciando en los últimos estudios.
- Daño en mitocondrias: Las mitocondrias forman parte de nuestras células, y tienen una función esencial, ya que son muy abundantes en los órganos y tejidos del organismo con mayores requerimientos energéticos, son las responsables de nuestra energía, son un órgano vital en nuestra energia, además de tener un papel importante en otros menesteres. Se piensa que el coronavirus provoca que las mitocondrias se inactiven, con la consiguiente disminución de nuestra energía, afectando sensiblemente a nuestro metabolismo.
¿Hay alguna medicina o terapia para solucionar estos síntomas del “long-covid?
De momento no hay nada específico para mejorar estos síntomas. Tenemos que insistir en mejorar nuestro estilo de vida, ya que muchos casos se dan en personas obesas, fumadoras, inactivas, sedentarias, en los que estos síntomas permanecen más tiempo.
Contamos con una prueba diagnóstica, que es muy útil para diagnosticar a estos pacientes que siguen experimentando dificultad para respirar después de la COVID-19, a pesar de que tienen radiografías, TAC pulmonares, pruebas de función pulmonar normales. Se trata de la prueba de esfuerzo cardiopulmonar (CPET) o ergoespirometría, donde diferentes parámetros están alterados (VO2 pico por debajo del previsto; el VE/VCO2 slope > 30; la Presión end-tidal de CO2 en reposo o PetC02 <35 mmHg,…).
Y por ello es importante mejorar la función muscular a través de programas de rehabilitación, con ejercicio mixto, aeróbico y de fuerza o muscular, con incrementos progresivos y programados que consigan fortalecer la musculatura dañada, para ir recuperando tono y fuerza.
Con el tiempo estamos aprendiendo y a pesar de que el virus está atenuándose (muy lentamente) y disminuye la gravedad, seguimos viendo secuelas que nos complican mucho nuestra vida.
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