At the heart of COVID‐19

Abstract

Coronavirus disease (COVID‐19) first presented in Wuhan, Hubei province, China in December 2019. Since then, it has rapidly spread across the world, and is now formally considered a pandemic. The disease does not discriminate but increasing age and the presence of comorbidities are associated with severe form of the disease and poor outcomes. Although the prevalence of COVID‐19 in patients with cardiovascular disease is under‐reported, there is evidence that pre‐existing cardiac disease can render individuals vulnerable. It is thought that COVID‐19 may have both a direct and indirect effect on the cardiovascular system; however, the primary mechanism of underlying cardiovascular involvement is still uncertain. Of particular interest is the role of angiotensin‐converting enzyme 2, which is well known for its cardiovascular effects and is also considered to be important in the pathogenesis of COVID‐19. With a range of different drug candidates being suggested, effective anti‐virals and vaccines are an area of on‐going research. While our knowledge of COVID‐19 continues to rapidly expand, this review highlights recent advances in our understanding of the interaction between COVID‐19 and the cardiovascular system.

Cardiac manifestations in COVID‐19 patients—A systematic review

“…Systemic inflammation can increase vascular shear stress at the level of the coronary arteries resulting in plaque rupture and myocardial infarction 57 . Another explanation for the observed incidence of myocardial injury has been postulated to be due to poorly understood pro‐thrombotic inflammatory sequelae from viral infections, 58,59 with myocardial infarction well established in influenza infections at similar prevalence, suggesting that the pro‐thrombotic effects observed in COVID‐19 patients are a result of the overall inflammatory state rather than a COVID‐19 specific phenomenon. Previous studies have shown an association between influenza and myocardial infarction, myocarditis and exacerbated heart failure 60 …”

The impact of COVID‐19 on the provision of cardiac surgical services

“…The underlying mechanisms of how COVID‐19 causes myocardial injury are ongoing, with an accelerated number of pharmacological management options entering clinical trials in an attempt to provide answers in how to best manage this condition 15‐17 . With delays across a wide array of cardiac pathologies, the selection of treatment strategies may also have been affected, by opting for angiographic intervention due to the lower associated intensive care utilization, despite the proven surgical benefit in certain subgroups of patients.…”

Prosthetic aortic valve endocarditis complicated by COVID‐19 and hemorrhage

“…The natural disease process can be complicated by acute respiratory distress syndrome, multiorgan failure, and ultimately death. The prevalence of COVID‐19 in patients with underlying cardiovascular disease is under‐reported with evidence that pre‐existing cardiac disease can render patients more vulnerable to the disease process 3 . We report the first case of active prosthetic valve endocarditis complicated by COVID‐19.…”