oronaviruses (CoVs) are single-stranded positive-sense RNA viruses, with the capacity for rapid mutation and recombination. Coronaviruses are known to cause respiratory or intestinal infections in humans and animals. 1 Acute respiratory infections, including influenza, respiratory syncytial virus, and bacterial pneumonias, are well-recognized triggers for cardiovascular diseases (CVD), 2,3 and the underlying CVD is usually associated with comorbidities, which may increase the incidence and severity of infectious diseases. 4 The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, which causes coronavirus disease 2019 (COVID-19), has rapidly grown into a pandemic, and a large proportion of affected patients have been reported to have underlying CVD. 5,6 In this report, we briefly review the basics of coronaviruses and their potential effects on the cardiovascular system. Our knowledge of COVID-19 is still evolving rapidly, and this review discusses previous learnings from outbreaks of SARS and Middle East respiratory syndrome (MERS), as well as seasonal influenza, to obtain further insight into effects of coronaviruses on the cardiovascular system. Understanding the effects of COVID-19 on the cardiovascular system is essential for providing comprehensive medical care for cardiac patients.
Coronaviruses in HumansCoronaviruses are named for crownlike spikes on their surface and belong to the Coronavirinae subfamily, which are further classified into 4 groups: the α, β, γ, and δ CoVs by phylogenetic clustering, of which α and β are known to cause infection in humans. 7 Coronaviruses contain 4 major structural proteins: the spike (S) protein (which mediates attachment to the host receptor and subsequent fusion of the virus and cell membrane), the nucleocapsid (N) protein, the membrane (M) protein, and the envelope (E) protein. 8 The first human CoV (HCoV) was identified in the mid-1960s in human embryonic tracheal organ cultures, and until 2003, only 2 HCoV species, HCoV-229E and HCoV-OC43, were recognized. Currently, 7 different CoV strains are known to infect humans, including HCoV-229E, HCoV-NL63, HCoV-OC43, and HCoV-HKU1, which generally cause self-resolving infection. There are also severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East Respiratory Syndrome coronavirus (MERS-CoV), and newly identified SARS-CoV-2, which can cause lethal respiratory infections in humans. 9,10 IMPORTANCE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19) has reached a pandemic level. Coronaviruses are known to affect the cardiovascular system. We review the basics of coronaviruses, with a focus on COVID-19, along with their effects on the cardiovascular system.OBSERVATIONS Coronavirus disease 2019 can cause a viral pneumonia with additional extrapulmonary manifestations and complications. A large proportion of patients have underlying cardiovascular disease and/or cardiac risk factors. Factors associated with mortality include mal...