In the eye of the storm: the right ventricle in COVID-19

Abstract

The corona virus disease of 2019 pandemic caused by the SARS-CoV-2 virus continues to inflict significant morbidity and mortality around the globe. A variety of cardiovascular presentations of SARS-CoV-2 infection have been described so far. However, the impact of SARS-CoV-2 on the right ventricle is largely unknown. Due to its pathophysiologic relevance, the right ventricle finds itself in the eye of the storm of corona virus disease of 2019, placing it at higher risk of failure. Increased afterload from acute respiratory distress syndrome and pulmonary embolism, negative inotropic effects of cytokines, and direct angiotensin converting enzyme 2-mediated cardiac injury from SARS-CoV-2 are potential mechanisms of right ventricle dysfunction in corona virus disease of 2019. Early detection and treatment of right ventricle dysfunction may lead to decreased mortality and improved patient outcomes in corona virus disease of 2019.

Keywords: COVID-19; acute respiratory distress syndromes (ARDSs) and acute lung injury; pulmonary embolism; pulmonary hypertension; right ventricle function and dysfunction.

Fig. 1.

Plausible mechanisms of development of right ventricular dysfunction in COVID-19. Schematic showing development of right ventricular dysfunction from COVID-19-associated acute respiratory distress syndrome (ARDS), pulmonary embolism, cytokine storm, micro- and macro-vascular dysfunction, and direct angiotensin-converting enzyme 2 (ACE2)-mediated effects of SARS-CoV-2 virus on the right ventricle. Note: Figure created with BioRender.com