COVID-19 and its impact on the cardiovascular system

Abstract

ObjectivesThe clinical impact of SARS-CoV-2 has varied across countries with varying cardiovascular manifestations. We review the cardiac presentations, in-hospital outcomes and development of cardiovascular complications in the initial cohort of SARS-CoV-2 positive patients at Imperial College Healthcare National Health Service Trust, UK.MethodsWe retrospectively analysed 498 COVID-19 positive adult admissions to our institute from 7 March to 7 April 2020. Patient data were collected for baseline demographics, comorbidities and in-hospital outcomes, especially relating to cardiovascular intervention.ResultsMean age was 67.4±16.1 years and 62.2% (n=310) were male. 64.1% (n=319) of our cohort had underlying cardiovascular disease (CVD) with 53.4% (n=266) having hypertension. 43.2%(n=215) developed acute myocardial injury. Mortality was significantly increased in those patients with myocardial injury (47.4% vs 18.4%, p<0.001). Only four COVID-19 patients had invasive coronary angiography, two underwent percutaneous coronary intervention and one required a permanent pacemaker implantation. 7.0% (n=35) of patients had an inpatient echocardiogram. Acute myocardial injury (OR 2.39, 95% CI 1.31 to 4.40, p=0.005) and history of hypertension (OR 1.88, 95% CI 1.01 to 3.55, p=0.049) approximately doubled the odds of in-hospital mortality in patients admitted with COVID-19 after other variables had been controlled for.ConclusionHypertension, pre-existing CVD and acute myocardial injury were associated with increased in-hospital mortality in our cohort of COVID-19 patients. However, only a low number of patients required invasive cardiac intervention.

Nutritional Immunity, Zinc Sufficiency, and COVID-19 Mortality in Socially Similar European Populations

“…Furthermore, Zn overdoses would have the potential to negatively affect the activity of different Zndependent antioxidative system components leading to oxidative stress and tissue damage; e.g., the R213G polymorphism of superoxide dismutase 3 (SOD3), a key member of the extracellular reactive oxygen species (ROS) neutralization system, found in 2%-6% of the population, is known to make the R213G carrier population prone to oxidative stress, promoted hypertension, and increased risk of cardiovascular infractions and thrombosis (REFs in OMIM #185490 "SUPEROXIDE DISMUTASE 3; SOD3" https://www.omim. org/entry/185490; additional info at http://www.wikigenes.org/ e/gene/e/6649.html)-some conditions frequently associated with COVID-19 adverse events (51). Moreover, the Zn overdose is not uncommon in the highly impacted aged population of the developed countries that are more receptive to supplementation with or without a prescription (52).…”

Who said differentiating preeclampsia from COVID-19 infection was easy?

“…Recent reports have raised the question whether the SARS-CoV-2 virus selectively targets the vascular endothelium and kidneys to explain the high frequency of newly diagnosed hypertension and kidney dysfunction associated with COVID-19 infection. [5] , [6] However, for pregnant patients any newly identified hypertension generates concern due to overlapping symptomatology with gestational hypertension and preeclampsia making differentiation between two condition impossible on clinical grounds alone. Our study demonstrates that women who are positive for COVID-19 undergo work-up for preeclampsia more frequently due to clinical uncertainty but do not seem to have a higher frequency of symptomatology or laboratory abnormalities than expected for the COVID-negative group with preeclampsia.…”

In-hospital cardiac arrest in Intensive Care Unit versus non-Intensive Care Unit patients with COVID-19. A systematic review and meta-analysis

“…This can be explained by the fact that COVID-19 patients are at high risk due to rapidly worsening respiratory failure, eventually leading to IHCA if not promptly treated. Furthermore, direct effects of the virus on the cardiovascular system might contribute to the increased risk for IHCA [5,19–21]. In the literature, the incidence of IHCA amongst COVID-19 patients ranges between 1.3% and 19.8%.…”