Pathophysiology of Cardiovascular Complications in COVID-19

Abstract

Numerous recent studies have shown that patients with underlying cardiovascular disease (CVD) are at increased risk of more severe clinical course as well as mortality of COVID-19. Also, the available data suggests that COVID-19 is related to numerous de novo cardiovascular complications especially in the older population and those with pre-existing chronic cardiometabolic conditions. SARS-CoV-2 virus can cause acute cardiovascular injury, as well as increase the risk of chronic cardiovascular damage. As CVD seem to be the major comorbidity in critically unwell patients with COVID-19 and patients often die of cardiovascular complications, we review the literature and discuss the possible pathophysiology and molecular pathways driving these disease processes: cytokine release syndrome, RAAS system dysregulation, plaque destabilization and coagulation disorders with the aim to identify novel treatment targets. In addition, we review the pediatric population, the major cause of the cardiovascular complications is pediatric inflammatory multisystem syndrome that is believed to be associated with COVID-19 infection. Due to the increasingly recognized CVD damage in COVID-19, there is a need to establish clear clinical and follow-up protocols and to identify and treat possible comorbidities that may be risk factors for the development of cardiovascular complications.

Pre-Anesthesia Re-Evaluation in Post COVID-19 Patients Posted for Elective Surgeries: an Online, Cross-Sectional Survey.

“…Myocarditis, myocardial infarction, cardiomyopathies, arrythmias, shock and cardiac arrest are some of the complications associated with COVID-19 infection, necessitating cardiac status evaluation in COVID-19 recovered patients [14,15]. Both SARS and MERS have been associated with myocardial injury and myocarditis with elevated troponin levels.…”

“…Apart from electrocardiogram and echocardiography, Bui et al have included NT proBNP assessment for all symptomatic (during COVID-19) patients posted for minor and all patients posted for major surgeries [1]. Akin to pulmonary fibrosis, the cardiovascular complications are more likely to occur in geriatric populations [15]. Studies performed in pediatric populations with COVID-19 reveal a normal cardiac laboratory profile [4,15].…”

“…Akin to pulmonary fibrosis, the cardiovascular complications are more likely to occur in geriatric populations [15]. Studies performed in pediatric populations with COVID-19 reveal a normal cardiac laboratory profile [4,15]. There is no specific data of outcomes of obstetric patients who have recovered from COVID-19.…”

SARS-COV-2 Colonizes Coronary Thrombus and Impairs Heart Microcirculation Bed in Asymptomatic Positive Subjects with Acute Myocardial Infarction

“…The occurrence of venous thrombus-embolic complications, both clinically apparent and subclinical, appears to be an important manifestation of the COVID-19 and related to disease severity and outcome (23). Increased thrombogenicity in acute ischemic stroke has also been described (24). Moreover, emerging data from large COVID-19 cohorts without STEMI (25) suggests that anticoagulation confers mortality bene t in this patient group.…”

Susceptibility and Severity of Viral Infections in Obesity: Lessons from Influenza to COVID-19. Does Leptin Play a Role?

“…The obesity-related chronic low-grade inflammation, characterized by raised levels of pro-inflammatory molecules (such as leptin, resistin, chemokine (C-C motif) ligand 2 (CCL2), interleukin (IL)-6, IL-1β, IL-8, tumor necrosis factor (TNF)-α) and decreased levels of adiponectin, may have negative effects on the lung parenchyma and bronchi [ 72 ]. This chronic inflammatory milieu, together with T-helper (Th)1 (antiviral action of interferon gamma –IFN-γ-) to Th2 (anti-inflammatory interleukins such as IL-4, -5, -10, and -13) immune response shift induced by viruses to evade host immunity, can be detrimental to the endothelium leading to vascular complications [ 73 ].…”