Neurological implications of cardiac compromise in COVID-19

Abstract

Objectives: There is increasing evidence that particularly in patients with severe SARS-CoV-2 infection (COVID-19) the heart can be primarily or secondarily compromised. Neurological disease as a complication of SARS-CoV-2 associated cardiac disease is conceivable. This review aims at summarising and discussing previous and recent advances in the clinical presentation, pathophysiology, diagnosis, treatment, and outcome of cardiac complications and its implications on the brain of SARS-CoV-2 infected patients.

Method: Literature review using appropriate search terms and applying inclusion and exclusion criteria.

Results: Cardiac complications in SARS-CoV-2 infected patients not only include myocardial injury, myocarditis, Takotsubo cardiomyopathy (TTS), coagulation abnormalities, heart failure, cardiac arrest, arrhythmias, acute myocardial infarction, or cardiogenic shock, but a number of other more rarely occurring cardiac abnormalities. Additionally considered should be endocarditis due to superinfection, viral or bacterial pericarditis, aortic dissection, pulmonary embolism from the right atrium, ventricle or outflow tract, and cardiac autonomic denervation. Cardiac damage due to side effects from the anti-COVID medication should not be neglected. Several of these conditions may be complicated by ischemic stroke, intracerebral bleeding, or dissection of cerebral arteries.

Conclusion: The heart can be definitively affected in severe SARS-CoV-2 infection. Heart disease in COVID-19 may be complicated by stroke, intracerebral bleeding, or dissection of cerebral arteries. Treatment of SARS-CoV-2 associated cardiac disease is not at variance from that of cardiac disease without this infection.

Keywords: COVID-19; SARS-CoV-2; cardiac; endocarditis; myocarditis; myocardium.

Figure 1

Flow-chart of literature retrieval.