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. 2020 Jul 14;142(2):101-104.
doi: 10.1161/CIRCULATIONAHA.120.047915. Epub 2020 May 5.

Differentiating COVID-19 Pneumonia From Acute Respiratory Distress Syndrome and High Altitude Pulmonary Edema: Therapeutic Implications

Stephen L Archer  1 , Willard W Sharp  2 , E Kenneth Weir  3
Affiliations

Differentiating COVID-19 Pneumonia From Acute Respiratory Distress Syndrome and High Altitude Pulmonary Edema: Therapeutic Implications

Stephen L Archer et al. Circulation. .
No abstract available

Keywords: acute lung injury; altitude; hypertension, pulmonary; hypoxia; mitochondria; pneumonia; pulmonary edema.

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Figures

Figure:
Figure:. Contrasting pulmonary hemodynamics in ARDS, COVID-19 pneumonia and HAPE
The figure is read from top left to bottom right in clockwise direction. The hallmarks of each syndrome are summarized in the green insert table. Top panel: HPV diverts blood away from an hypoxic alveolar segment, induced by a mucous plug in the bronchus. Blood from this segment is diverted toward a well-ventilated alveolar segment. There is no alveolar injury and segmental HPV does not elevate PA pressure or cause dyspnea. Second panel: In ARDS the primary insult is inflammatory alveolar injury with associated pulmonary hypertension. There is also impaired HPV which increases V/Q mismatch and worsens hypoxemia. The lungs become stiff and fibrotic (green fibrous tissue and fibroblasts in alveolar wall) and hyaline membranes in the alveoli (pink crescent) are a prominent feature. Dyspnea is profound. Third panel: In COVID-19 pneumonia the primary injury is airway inflammation due to SARS-CoV-2 infection. The resulting hypoxemia is exacerbated by an almost complete loss of HPV, resulting in a large V/Q mismatch. Unlike ARDS there is no fibrosis and hyaline membranes are less prominent. Dyspnea is variable and may be absent due to impaired oxygen sensing. Bottom left panel: In HAPE the primary pathology is vascular, namely increased, heterogenous HPV and pulmonary venoconstriction, resulting in capillary damage and leak. Dyspnea is profound.
See this image and copyright information in PMC

References

    1. Dunham-Snary KJ, Wu D, Potus F, Sykes EA, Mewburn JD, Charles RL, Eaton P, Sultanian RA and Archer SL. Ndufs2, a Core Subunit of Mitochondrial Complex I, Is Essential for Acute Oxygen-Sensing and Hypoxic Pulmonary Vasoconstriction. Circ Res. 2019;124:1727–1746. - PMC - PubMed
    1. Lai CC, Jou MJ, Huang SY, Li SW, Wan L, Tsai FJ and Lin CW. Proteomic analysis of upregulated proteins in human promonocyte cells expressing severe acute respiratory syndrome coronavirus 3C-like protease. Proteomics. 2007;7:1446–1460. - PMC - PubMed
    1. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS and China Medical Treatment Expert Group for C. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382:1708–1720. - PMC - PubMed
    1. Gattinoni L, Coppola S, Cressoni M, Busana M and Chiumello D. Covid-19 Does Not Lead to a “Typical” Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. March 30, 2020. doi: 10.1164/rccm.202003-0817LE. [Online ahead of print]. - DOI - PMC - PubMed
    1. Fried JA, Ramasubbu K, Bhatt R, Topkara VK, Clerkin KJ, Horn E, Rabbani L, Brodie D, Jain SS, Kirtane A, Masoumi A, Takeda K, Kumaraiah D, Burkhoff D, Leon M, Schwartz A, Uriel N and Sayer G. The Variety of Cardiovascular Presentations of COVID-19. Circulation. April 3, 2020. doi: 10.1161/CIRCULATIONAHA.120.047164. [Online ahead of print]. - DOI - PMC - PubMed

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