Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Oct;97(1152):655-666.
doi: 10.1136/postgradmedj-2020-138284. Epub 2020 Sep 17.

COVID-19 and the heart: what we have learnt so far

Kunal Bikram Shaha  1 , Dhiraj Narayan Manandhar  2 , Jung Rae Cho  3 , Ashok Adhikari  4 , Man Bahadur K C  5
Affiliations
Review

COVID-19 and the heart: what we have learnt so far

Kunal Bikram Shaha et al. Postgrad Med J. 2021 Oct.

Abstract

Since the outbreak of COVID-19 or coronavirus disease caused by severe acute respiratory syndrome coronavirus 2 from Wuhan, China, the cardiology fraternity's interest has been drawn towards the pandemic with a high case fatality rate of 10.5% and 6% in patients with heart disease and hypertension, respectively. One of the postulated mechanisms for this high fatality rate is the possible abundance of ACE type 2 receptor in the cardiovascular system that strongly binds with the spike protein of COVID-19 and helps internalise into the cell resulting in acute cardiac injury (ACI). More than 7% of cases with COVID-19 are reported to have this type of ACI. A tenfold rise in mortality has been observed in patients with COVID-19 who experience a rise in high-sensitivity (hs)-troponin. All most half of the patients who died of COVID-19 had a rise in hs-troponin. More than 15% of cases with COVID-19 experienced different types of arrhythmias. All these statistics denote how important cardiovascular pathology is in patients with COVID-19. Controversies of renin-angiotensin-aldosterone system inhibitors usage in patients with COVID-19 and meticulous handling of case with acute coronary syndrome categorically stresses cardiologists to bust the myths hovering around and set a standard guideline to counterfeit the fatality with timely diagnosis and treatment of COVID-19-induced ACI. In this review, we sought to summarise the current evidence of COVID-19-associated cardiac injury and suggest the implications for its proper diagnosis and treatment.

Keywords: Angiotensin receptor blocker; Arrhythmias; COVID-19; Carditis; SARS-Cov-2.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Three-step SARS-CoV-2 virus internalisation in host cell. SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TMPRSS2, type 2 transmembrane protease receptor.
Figure 2
Figure 2
Proposed multipronged attack by COVID-19 resulting in acute cardiac injury. DIC, disseminated intravascular coagulation.
Figure 3
Figure 3
(A) Putative mechanism of type 1 MI in COVID-19. (B) Putative mechanism of type 2 MI in COVID-19. MI, myocardial infarction.
Figure 4
Figure 4
SARS-CoV-2–induced ACE-mediated damage and role of ACEI/ARB in COVID-19. ACEI, ACE inhibitor; Ang I, angiotensin I; ARB, angiotensin receptor blocker; ATIR, angiotensin II type 1 receptor.
Figure 5
Figure 5
SARS-CoV-2 virology and possible therapeutic intervention. (A) Fusion. (B) Entocytosis. (C) Translation. (D) Proteolysis. (E) Translation and RNA replication. (F) Virion release. SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
See this image and copyright information in PMC

References

    1. Zou X, Chen K, Zou J, et al. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med 2020;14:185–92. - PMC - PubMed
    1. Wrapp D, Wang N, Corbett KS, et al. Cryo-EM structure of the 2019-nCoV spike in the perfusion conformation. Science 2020;367:1260–3. - PMC - PubMed
    1. Tikellis C, Thomas MC. Angiotensin-converting enzyme 2 (ACE2) is a key modulator of the renin angiotensin system in health and disease. Int J Pept 2012;2012:256294. 10.1155/2012/256294fpage - DOI - PMC - PubMed
    1. Zhang H, Penninger JM, Li Y, et al. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med 2020;46:586–90. - PMC - PubMed
    1. Clerkin KJ, Fried JA, Raikhelkar J, et al. COVID-19 and cardiovascular disease. Circulation 2020;141:1648–55. - PubMed