The cardiac complications of COVID-19: many publications, multiple uncertainties

Abstract

Since the first description of COVID-19 in December 2019, more than 63,000 publications have described its virology, clinical course, management, treatment and prevention. Most physicians are now encountering, or will soon encounter, patients with COVID-19 and must attempt to simultaneously assimilate this avalanche of information while managing an entirely novel disease with few guiding precedents. It is increasingly clear that, although primarily a respiratory illness, COVID-19 is associated with cardiovascular complications. However, the true incidence of direct cardiac complications remains unclear, as all complications thus far reported can also occur in patients without COVID-19. In this review, we briefly summarise and critically appraise the data on cardiac complications associated with COVID-19 and describe some cases from our own experience. We identify unresolved questions and highlight the many uncertainties in this developing field.

Keywords: COVID-19; infection; inflammation; microvasculature; myocardial injury; thrombosis; vascular disease.

Figure 1

COVID-19 presenting with chest pain and right ventricular thrombosis. (A) Chest X-ray showing typical patchy opacities throughout both lungs and normal cardiac silhouette. (B) Series of echocardiographic images demonstrating RV thrombus. On the annotated images on the bottom row, the thrombus is highlighted in yellow, the right ventricle in blue and the left ventricle in red.

Figure 2

COVID-19 presenting with pulmonary emboli. CT pulmonary angiography showing bilateral acute pulmonary emboli (unfilled arrows) and bilateral patchy airspace consolidation (filled arrow).