Cardiovascular Manifestations of COVID-19 Infection

Abstract

SARS-CoV-2 induced the novel coronavirus disease (COVID-19) outbreak, the most significant medical challenge in the last century. COVID-19 is associated with notable increases in morbidity and death worldwide. Preexisting conditions, like cardiovascular disease (CVD), diabetes, hypertension, and obesity, are correlated with higher severity and a significant increase in the fatality rate of COVID-19. COVID-19 induces multiple cardiovascular complexities, such as cardiac arrest, myocarditis, acute myocardial injury, stress-induced cardiomyopathy, cardiogenic shock, arrhythmias and, subsequently, heart failure (HF). The precise mechanisms of how SARS-CoV-2 may cause myocardial complications are not clearly understood. The proposed mechanisms of myocardial injury based on current knowledge are the direct viral entry of the virus and damage to the myocardium, systemic inflammation, hypoxia, cytokine storm, interferon-mediated immune response, and plaque destabilization. The virus enters the cell through the angiotensin-converting enzyme-2 (ACE2) receptor and plays a central function in the virus’s pathogenesis. A systematic understanding of cardiovascular effects of SARS-CoV2 is needed to develop novel therapeutic tools to target the virus-induced cardiac damage as a potential strategy to minimize permanent damage to the cardiovascular system and reduce the morbidity. In this review, we discuss our current understanding of COVID-19 mediated damage to the cardiovascular system.

SARS‐CoV‐2 infection aggravates chronic comorbidities of cardiovascular diseases and diabetes in mice

“…It is reported that hospitalized patients develop acute COVID‐19 cardiovascular syndrome (ACovCS), which is mostly presented as an acute cardiac injury. Myocardial injury is common among patients with COVID‐19 infection and highly correlates with disease severity and in‐hospital mortality 24–27 . Till now, there are several speculations on the specific mechanism of myocardial injury induced by SARS‐CoV‐2 infection.…”

COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment – A narrative review

“…However, as currently there is no evidence proven and disease-specific medical treatment (despite potential beneficial effects of corticosteroids) available, current intensive care treatment for CARDS is mostly symptomatic/supportive and in line with ARDS recommendations. In addition, despite severe hypoxemic respiratory failure, severe COVID-19 may be associated with additional organ dysfunctions, including cardiac/cardiovascular [ 20 , 21 ], neurological/cerebrovascular [ 22 , 23 ], and/or renal dysfunction [ [24] , [25] , [26] ].…”

Spotlight on Cardiovascular Scoring Systems in Covid-19: Severity Correlations in Real-world Setting

“…Precise mechanisms by which hypertension and diabetes are “Covid-19 enhancers” are under investigation [20] . The role of inflammation, oxidative stress, endothelial damage, microvascular damage and cytokine storm alterations may be the link [ 21 , 22 ]. Nevertheless, these explanations are beyond the purpose of our study.…”