Myocardial involvement in coronavirus disease 19

Wang

et al. 2021

Cardiology Discovery

COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection likely ranks among the deadliest diseases in human history. As with other coronaviruses, SARS-CoV-2 infection damages not only the lungs but also the heart and many other organs that express angiotensin-converting enzyme 2 (ACE2), a receptor for SARS-CoV-2. COVID-19 has upended lives worldwide. Dietary behaviors have been altered such that they favor metabolic and cardiovascular complications, while patients have avoided hospital visits because of limited resources and the fear of infection, thereby increasing out-hospital mortality due to delayed diagnosis and treatment. Clinical observations show that sex, age, and race all influence the risk for SARS-CoV-2 infection, as do hypertension, obesity, and pre-existing cardiovascular conditions. Many hospitalized COVID-19 patients suffer cardiac injury, acute coronary syndromes, or cardiac arrhythmia. SARS-CoV-2 infection may lead to cardiomyocyte apoptosis and necrosis, endothelial cell damage and dysfunction, oxidative stress and reactive oxygen species production, vasoconstriction, fibrotic and thrombotic protein expression, vascular permeability and microvascular dysfunction, heart inflammatory cell accumulation and activation, and a cytokine storm. Current data indicate that COVID-19 patients with cardiovascular diseases should not discontinue many existing cardiovascular therapies such as ACE inhibitors, angiotensin receptor blockers, steroids, aspirin, statins, and PCSK9 inhibitors. This review aims to furnish a framework relating to COVID-19 and cardiovascular pathophysiology.

Section: Common Covid-19 Risk Factorsmentioning

confidence: 81%

Section: Common Covid-19 Risk Factorsmentioning

confidence: 99%

COVID-19, the Pandemic of the Century and Its Impact on Cardiovascular Diseases

Wang

et al. 2021

Cardiology Discovery

“…The extrahepatic manifestations are thought to be due to the lymphotropic nature of HCV with the accumulation of circulating immune complexes, activation of autoimmune responses and modulation of host immune response [126]. According to the World Health Organization (WHO) an 58 million people worldwide have chronic hepatitis C virus infection [127], while a high prevalence of HCV infection with cardiac diseases, such as myocarditis and DCM, has been found in 6.3% to 37% of HCV-positive individuals [9][10][11]128,129]. The pathogenesis of HCV-associated myocarditis, DCM and other cardiomyopathies is poorly understood.…”

Section: Hepatitis C Virus and Human Immunodeficiency Virusmentioning

confidence: 99%

Viral Myocarditis—From Pathophysiology to Treatment

Schultheiss

Baumeier

Aleshcheva

et al. 2021

JCM

The diagnosis of acute and chronic myocarditis remains a challenge for clinicians. Characterization of this disease has been hampered by its diverse etiologies and heterogeneous clinical presentations. Most cases of myocarditis are caused by infectious agents. Despite successful research in the last few years, the pathophysiology of viral myocarditis and its sequelae leading to severe heart failure with a poor prognosis is not fully understood and represents a significant public health issue globally. Most likely, at a certain point, besides viral persistence, several etiological types merge into a common pathogenic autoimmune process leading to chronic inflammation and tissue remodeling, ultimately resulting in the clinical phenotype of dilated cardiomyopathy. Understanding the underlying molecular mechanisms is necessary to assess the prognosis of patients and is fundamental to appropriate specific and personalized therapeutic strategies. To reach this clinical prerequisite, there is the need for advanced diagnostic tools, including an endomyocardial biopsy and guidelines to optimize the management of this disease. The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has currently led to the worst pandemic in a century and has awakened a special sensitivity throughout the world to viral infections. This work aims to summarize the pathophysiology of viral myocarditis, advanced diagnostic methods and the current state of treatment options.

Cardiovascular Research

“…38 A recent meta-analysis and literature screening revealed hypertension 39 Moreover, a study including 40 SARS-CoV-2 positive patients confirmed the relationship between the presence of COVID-19 and acute cardiac damage. 40 However, whether cardiac injury is directly induced by SARS-CoV-2 infection is not clarified yet. 41 There are numerous hypotheses assessing the impact of SARS-CoV-2 infection on cardiovascular manifestations.…”

Section: Cardiovascular Involvementmentioning

confidence: 99%

Cardiovascular consequences of viral infections: from COVID to other viral diseases

Schultheiss

Baumeier

Pietsch

et al. 2021

Infection of the heart muscle with cardiotropic viruses is one of the major etiologies of myocarditis and acute and chronic inflammatory cardiomyopathy (DCMi). However, viral myocarditis and subsequent dilated cardiomyopathy (DCM) is still a challenging disease to diagnose and to treat and is therefore a significant public health issue globally. Advances in clinical examination and thorough molecular genetic analysis of intramyocardial viruses and their activation status have incrementally improved our understanding of molecular pathogenesis and pathophysiology of viral infections of the heart muscle. To date, several cardiotropic viruses have been implicated as causes of myocarditis and DCMi. These include, among others, classical cardiotropic enteroviruses (coxsackieviruses B), the most commonly detected parvovirus B19, and human herpes virus 6. A newcomer is the respiratory virus that has triggered the worst pandemic in a century, SARS-CoV-2, whose involvement and impact in viral cardiovascular disease is under scrutiny. Despite extensive research into the pathomechanisms of viral infections of the cardiovascular system, our knowledge regarding their treatment and management is still incomplete. Accordingly, in this review we aim to explore and summarize the current knowledge and available evidence on viral infections of the heart. We focus on diagnostics, clinical relevance and cardiovascular consequences, pathophysiology, and current and novel treatment strategies.