it is an extremely rare side effect to covid and it has doctors stumped patients developing
massively in large tongues what is going on here welcome i'm dr mike hansen and i'm going to break
down what's going on here so in texas a lady by the name of karen washington a preschool teacher
unfortunately has a stroke the stroke was severe enough to cause her to be in a coma for two weeks
when people are comatose they're unable to protect their airway meaning saliva can end up going down
the wrong pipe meaning going down into the lungs and this is called aspiration and aspiration
can also occur when people vomit and they're not able to protect your airway and it goes down the
wrong pipe so to preemptively protect against this we put a breathing tube down so she was
on a ventilator she had that breathing tube and the good news is that she woke up from her coma
the bad news is that she woke up to having a huge tongue and this is known as macroglossia when
she woke up her tongue was incredibly swollen i couldn't eat i couldn't talk i couldn't do nothing
it was just hanging all the way down to my chin macroglossia is relatively rare
but it's not unheard of there are certain chronic conditions that can cause it like amyloidosis
but it can also be caused by different types of angioedema
angioedema is an area of swelling meaning edema of the lower layer of skin and tissue just
under that skin or in the mucous membranes so there's something called hereditary angioedema
that occurs at a younger age and then there's something called acquired c1 inhibitor deficiency
and that usually occurs at an older age and then there's also the well-known ace inhibitor-induced
angioedema so ace inhibitors are most commonly given for patients with high blood pressure
now over the last year or so there have been a cluster of these macroglossia cases in texas dr
james melville has seen nine of these cases in that time frame because he gets these patients
referred to him so he can surgically reduce the size of their tongue i think i know all the cases
in the united states currently because they have reached out to me i don't know all the details
in these cases but based on the media report this is what we know so in all nine cases they
were intubated meaning they're on a ventilator in two of the cases they suffered from strokes
and in the other seven they were hospitalized with covid it has to do a lot with just kind of
where the virus is kind of attaching itself and the body is just kind of you mean a response to
it there are several explanations as to what is going on here and it could be a combination
of these and if you like these types of videos don't forget to click on that subscribe button
and the bell notification because that way you won't miss out when my next one comes out
and you can help my channel grow now in order to understand what's going on here it helps to
better understand a known medical condition called ace inhibitor induced angioedema so angiotensin
converting enzyme inhibitors are the leading cause of drug induced angioedema in the united states
because they're so widely prescribed examples of these medications include lacinopril captopril
ramipril enalapril and the like basically anything that ends in pril is an ace inhibitor when
angioedema occurs as a result of these medications it most commonly causes swelling of the lips
tongue or face hives meaning urticaria is notably absent ace inhibitor-induced angioedema occurs in
0.1 to 0.7 of those who receive these medications and is five times more likely to occur in those
of african descent swelling usually develops over minutes to hours and then peaks and then resolves
around 24 to 72 hours although complete resolution may take days in some cases swelling occurs as
a result of elevated levels of bradykinin a substance called des arge 9pk and a substance
called substance p these substances cause the blood vessels to dilate which leads to swelling
when the body doesn't break down these substances quick enough that's where you get that swelling
so when someone is taking an ace inhibitor the risk of this happening is slightly higher
is it possible that these patients were given an ace inhibitor yes it's possible especially
the ones who had strokes because usually stroke patients have elevated blood pressures but it's
also possible that this was covid related for the two people who were not covid cases maybe
they had covid and they didn't know it maybe they had a false negative test because they
were tested outside the window for the pcr test we just don't know but we know that seven out of the
nine cases they did have covid that's why they're hospitalized and covid binds to ace2 receptors
and the tongue is lined with h2 receptors and when the virus binds to that receptor we know that it
alters this pathway which affects bradykinin levels this is something i talked a lot about
in my previous video these two molecules by way of the ace ii enzyme are converted to indotensite 1-9
and geotension 1-7 this is very important because this pathway here is going to lead to vasodilation
meaning the blood vessels the pulmonary arteries get dilated why are some people more prone to this
it comes down to genetics there are various genetic polymorphisms in certain enzymes
called aminopeptidase p and neutral endopeptidase which occur at a greater rate in african americans
these polymorphisms lead to lower circulating levels of these enzymes which are responsible
for degrading bradykinin and its active metabolite which is this arch9bk and it makes sense that the
sars cov2 virus triggers this same mechanism so covid tongue looks like one more thing to add to
the list of strange things that comes with this disease and one more reason to get the vaccine
so that's all for this one thanks for watching and i'll see you soon