COVID-19 and cardiovascular complications: updates of emergency medicine

Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS-CoV-2 variants, has become a global pandemic resulting in significant morbidity and mortality. Severe cases of COVID-19 are characterized by hypoxemia, hyper-inflammation, cytokine storm in lung. Clinical studies have reported an association between COVID-19 and cardiovascular disease (CVD). Patients with CVD tend to develop severe symptoms and mortality if contracted COVID-19 with further elevations of cardiac injury biomarkers. Furthermore, COVID-19 itself can induce and promoted CVD development, including myocarditis, arrhythmia, acute coronary syndrome, cardiogenic shock, and venous thromboembolism. Although the direct etiology of SARS-CoV-2 induced cardiac injury remains unknown and under-investigated, it is suspected that it is related to myocarditis, cytokine-mediated injury, microvascular injury, and stress-related cardiomyopathy. Despite vaccinations having provided the most effective approach to reducing mortality overall, an adapted treatment paradigm and regular monitoring of cardiac injury biomarkers is critical for improving outcomes in vulnerable populations at risk for severe COVID-19. In this review, we focus on the latest progress in clinic and research on the cardiovascular complications of COVID-19 and provide a perspective of treating cardiac complications deriving from COVID-19 in Emergency Medicine.

Keywords: COVID-19; Cardiovascular disease; Emergency Medicine; SARS- CoV-2.

Figure 1.. Relation of COVID-19 with cardiovascular disease and heart failure.

Since the virus contracted the cells to cause heart failure, the cardiovascular disease progressed in cardiovascular cells. COVID-19, coronavirus disease 2019.

Figure 2.. Relation of COVID-19 with ACS, AMI and heart failure.

A review of the different causes of ACS and AMI was presented, as well as the consequences of heart failure as the end. ACS, acute coronary syndrome; AMI, acute myocardial infarction; COVID-19, coronavirus disease 2019.

Figure 3.. Relation of COVID-19 with venous thromboembolism.

The multiple determinants of risks for thromboembolism formation, which includes abnormal coagulation, systemic inflammation and multi-organ malfunction was presented (Up panel). D-dimer, fibrinogen and fibrin degradation product may serve indicators for the severity of COVID-19 patient. During the formation of thromboembolism, the related mechanisms including activated endothelial cells, immune cells and their interactions with exaggerated cytokines’ production played a significant role (down panel). COVID-19, coronavirus disease 2019; IFN-β, interferon-beta; IL, interleukin; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TNF-α, tumor necrosis factor alpha.

Figure 4.. Mechanisms in diverse cardiovascular disease of COVID-19.

Infection with the SARS-Cov-2 virus leads to multiple organ dysfunctions, including damage to the RAAS and endothelial cells, which in turn contributes to ACS and AMI, as well as the development of chromic cardiovascular disease. ACE2, angiotensin-converting enzyme 2; ACS, acute coronary syndrome; AMI, acute myocardial infarction; COVID-19, coronavirus disease 2019; NRP-1, neuropilin-1; RAAS, renin-angiotensin-aldosterone system; ROS, reactive oxygen species; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TMPRSS2, transmembrane serine protease 2.

Figure 5.. The diagram of diagnosis and treatment of CVD with COVID-19 in Emergency Department.

A sequential diagnosis of COVID-19 and treatment with risk of cardiovascular complications was implemented in the Emergency Room. Detection of nucleic acids along with chest computed tomography will be conducted. Care strategy for acute crisis will include oxygen replenishment and clot prevention steps when necessary. CAG, coronary angiography; COVID-19, coronavirus disease 2019; CT, computed tomography; CVD, cardiovascular disease; ECG, electrocardiogram; PCI, percutaneous coronary intervention.