Cardiac Involvement of COVID-19: A Comprehensive Review

Abstract

Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus. SARS-CoV-2 caused COVID-19 has reached a pandemic level. COVID-19 can significantly affect patients' cardiovascular systems. First, those with COVID-19 and preexisting cardiovascular disease have an increased risk of severe disease and death. Mortality from COVID-19 is strongly associated with cardiovascular disease, diabetes, and hypertension. Second, therapies under investigation for COVID-19 may have cardiovascular side effects of arrhythmia. Third, COVID-19 is associated with multiple direct and indirect cardiovascular complications. Associated with a high inflammatory burden related to cytokine release, COVID-19 can induce vascular inflammation, acute myocardial injury, myocarditis, arrhythmias, venous thromboembolism, metabolic syndrome and Kawasaki disease. Understanding the effects of COVID-19 on the cardiovascular system is essential for providing comprehensive medical care for cardiac and/or COVID-19 patients. We hereby review the literature on COVID-19 regarding cardiovascular virus involvement.

Keywords: Coronavirus; Covid-19; Myocardial injury; Sars-cov-2; myocarditis.

Graphical abstract

Fig. 1

Cardiovascular involvements by SRAS-CoV2 infection include direct damage (such as myocarditis, heart failure, and arrhythmia) and indirect damage (such as thromboembolism and metabolic disorder). Direct damage may be mediated through downregulation of ACE2, vascular endothelial cell dysfunction, microvascular dysfunction, pericyte injury, and hypoxemia. Indirect damage may be mediated through the release of cytokines (interleukin 6…), coagulopathy, and insulin resistance.