The heart and SARS-CoV-2

Abstract

SARS-Cov2 is currently causing a persistent Covid-19 pandemic, which poses a risk of causing long-term cardiovascular sequels in the population. The viral mechanism of cell infection through the angiotensin 2 converter enzyme receptor and the limited antiviral innate immune response are the suspected causes for a more frequent cardiovascular damage in SARS-Cov2 infection. Knowledge of: the appearance during acute infection of other cardiac conditions beyond the classical myocarditis and pericarditis), the long-term cardiac manifestations (persistent Covid-19), and the increased incidence of myocarditis and pericarditis after vaccination; it is of special interest in order to offer our patients best practices based on current scientific evidence.

Keywords: COVID-19; COVID-19 vaccine; Cardiovascular manifestations; Persistent COVID; SARS-CoV-2.

Figure 1

Pathogenic mechanisms involved in cardiac involvement after SARS-CoV-2 infection. 1) Direct cytotoxic effect of SARS-CoV-2 on alveoli, myocytes, and endothelial cells. 2) Dysregulation of the renin-angiotensin system with less inactivation of angiotensin 2 and less generation of angiotensin (1-7). 3) Immunothrombosis.

Figure 2

Example of cardiac magnetic resonance in a patient with COVID-19 myocarditis. Pericardial effusion (A, arrow) is observed in CINE SSFP sequences, subepicardial delayed enhancement in the mid inferolateral segment (B, arrow) and increased T1 values in native mapping (C) and T2 values in mapping (D).

Figure 3

Action protocol for patients with long COVID with cardiovascular symptoms. High-quality face-to-face consultation, where a detailed history taking, physical examination, electrocardiogram and echocardiography play a key role. More specific tests, such as cardiac MRI, 24 h monitoring or ergospirometry, will be indicated in a minority of patients after evaluation.