Coronavirus disease‐19 and cardiovascular disease: A risk factor or a risk marker?

Abstract

Severe acute respiratory syndrome coronavirus-2 causes the clinical syndrome of coronavirus disease of 2019 (COVID-19) which has become a global pandemic resulting in significant morbidity and mortality. While the virus primarily affects the respiratory system, it also causes a wide variety of complex cardiac manifestations such as acute myopericarditis, acute coronary syndrome, congested heart failure, cardiogenic shock and cardiac arrhythmias. There are numerous proposed mechanisms of cardiac injury, including direct cellular injury, pro-inflammatory cytokine storm, myocardial oxygen-demand mismatch, and systemic inflammation causing multi-organ failure. Additionally, medications commonly used to treat COVID-19 patients have various cardiovascular side effects. We aim to provide a succinct review about the pathophysiology and cardiac manifestations of COVID-19, as well as treatment considerations and the various adaptations made to the current healthcare structure as a result of the pandemic.

The Potential Impact of COVID-19 Virus on the Heart and the Circulatory System

“…While the virus mainly affects the respiratory system, it also causes acute myopericarditis, acute coronary syndrome, congestive heart failure, cardiogenic shock, cardiogenic shock, and cardiac arrhythmias. 8 COVID-19 is caused by SARS-CoV2, a virus that penetrates cells through ACE2, which is expressed in certain organs. Emerging epidemiological data indicates that COVID-19 patients have higher illness severity and death because of cardiovascular risk factors.…”

Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

“…A recent systematic review that focused on the cardiac safety of CQ and HCQ in COVID-19-affected patients has also shown an important association between CQ and HCQ use and the risk of drug-induced QT prolongation with a relatively higher incidence of torsade de pointes, ventricular tachycardia, or cardiac arrest [ 286 ]. Beyond the medication effects, several cardiac manifestations have been described in patients with COVID-19 including acute myopericarditis, acute coronary syndrome, congested heart failure, cardiogenic shock, and cardiac arrhythmias as a result of the injuries caused by the virus and systemic inflammation [ 287 ]. These cardiac manifestations were not only shown with CQ or HCQ use, but also with other drugs used in the treatment of COVID-19 such as corticosteroids, rivabirin, LPVr, and AZM [ 288 , 289 , 290 , 291 ].…”

Effects of COVID-19 on Cardiovascular System and Nursing Care

“…İnterlökin (IL)-6, interlökin (IL)-7 ve diğer sitokinlerin düzensiz olarak salınımı ile T hücresi aktivasyonunun dengesizliğinden kaynaklı meydana gelen sitokin fırtınası, plak kararlılığının bozulmasına, miyokard hasarına ve akut koroner sendromun gelişimine neden olabilmektedir. [14] Anjiyotensin dönüştürücü enzim-2 (ACE2), kalp, akciğer, bağırsak ve böbreklerde yüksek oranda bulunan ve birçok fizyolojik işlevi olan bir zar proteinidir. ACE2, kardiyovasküler sistemin nörohormonal düzenlenmesinde önemli bir rol oynar.…”