Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Aug 8;13(8):252.
doi: 10.3390/diseases13080252.

Cardiovascular Complications of COVID-19 Disease: A Narrative Review

Andrea Denegri  1 , Valeria Dall'Ospedale  2 , Marco Covani  2 , Michal Pruc  3 , Lukasz Szarpak  4   5   6 , Giampaolo Niccoli  1   2
Affiliations
Review

Cardiovascular Complications of COVID-19 Disease: A Narrative Review

Andrea Denegri et al. Diseases. .

Abstract

Background: The coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has had a profound impact on global health, extending beyond pulmonary complications. Cardiovascular involvement in COVID-19 is multifactorial and may be influenced by viral load, inflammatory response, and pre-existing comorbidities.

Discussion: Acute complications include myocardial injury, arrhythmias, acute coronary syndromes (ACS), heart failure, Takotsubo cardiomyopathy, myopericarditis, and cardiac arrest. Notably, atrial fibrillation (AF) emerges as a frequent arrhythmic complication, particularly among critically ill patients, and is associated with increased mortality. COVID-19-patients with concomitant ACS present more severe clinical profiles and higher rates of thrombotic events, including stent thrombosis. Cardiac arrest predominantly presents with non-shockable rhythms and is associated with dismal outcomes. COVID-19 also exacerbates heart failure, both by aggravating existing cardiac dysfunction or by precipitating de novo heart failure. Takotsubo cardiomyopathy and myocarditis, although less frequent, have been reported and are often underdiagnosed due to subtle clinical presentations. Right ventricular dysfunction, linked to pulmonary involvement, has emerged as a key prognostic marker. Post-COVID-19 syndrome include persistent cardiac abnormalities such as reduced ventricular function and myocardial inflammation. Cardiac magnetic resonance imaging and strain echocardiography have proven useful in identifying subclinical cardiac involvement.

Conclusions: Early recognition and monitoring of cardiovascular complications are crucial for improving outcomes in patients affected by COVID-19. This review summarizes current evidence regarding cardiovascular manifestations associated with COVID-19.

Keywords: COVID-19; Takotsubo cardiomyopathy; acute coronary syndrome; arrythmias; cardiac arrest; cardiovascular complications; heart failure; myopericarditis; right ventricular disfunction.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Illustrative figure of acute and long-term COVID-19 manifestations.
Figure 2
Figure 2
COVID-19 and HF: the multifactorial interplay, involving direct myocardial injury, systemic inflammation, endothelial dysfunction, and alterations in hemodynamic load.
See this image and copyright information in PMC

References

    1. Dzieciatkowski T., Szarpak L., Filipiak K.J., Jaguszewski M., Ladny J.R., Smereka J. COVID-19 challenge for modern medicine. Cardiol. J. 2020;27:175–183. doi: 10.5603/CJ.a2020.0055. - DOI - PMC - PubMed
    1. Blagova O., Varionchik N., Zaidenov V., Savina P., Sarkisova N. Anti-heart antibodies levels and their correlation with clinical symptoms and outcomes in patients with confirmed or suspected diagnosis COVID-19. Eur. J. Immunol. 2021;51:893–902. doi: 10.1002/eji.202048930. - DOI - PubMed
    1. Pollack A., Kontorovich A.R., Fuster V., Dec G.W. Viral myocarditis—Diagnosis, treatment options, and current controversies. Nat. Rev. Cardiol. 2015;12:670–680. doi: 10.1038/nrcardio.2015.108. - DOI - PubMed
    1. Giustino G., Pinney S.P., Lala A., Reddy V.Y., Johnston-Cox H.A., Mechanick J.I., Halperin J.L., Fuster V. Coronavirus and Cardiovascular Disease, Myocardial Injury, and Arrhythmia: JACC Focus Seminar. J. Am. Coll. Cardiol. 2020;76:2011–2023. doi: 10.1016/j.jacc.2020.08.059. - DOI - PMC - PubMed
    1. Wang C., Xie J., Zhao L., Fei X., Zhang H., Tan Y., Nie X., Zhou L., Liu Z., Ren Y., et al. Alveolar macrophage dysfunction and cytokine storm in the pathogenesis of two severe COVID-19 patients. EBioMedicine. 2020;57:102833. doi: 10.1016/j.ebiom.2020.102833. - DOI - PMC - PubMed

LinkOut - more resources