Possible Mechanisms of Cardiovascular Complications and Troponin Elevation in Coronavirus Disease

Abstract

More than 20 million human beings got infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and suffered from coronavirus disease 2019 (COVID-19) disease in the current global pandemic. This disease flow showed a heterogeneous spectrum due to various personalized underlying causes and immunogenetics makeup of an individual. Substantial evidence suggests that the severity of pneumonia, acute respiratory distress syndrome, multi-organ failures, and deaths in COVID-19 is attributable to cytokine storm. Thus, in a cytokine storm, the dysregulated immune system is triggered by superantigen of SARS-CoV-2 to release various cytokines with high speed and increased blood circulation concentrations, leading to diverse clinical manifestations of massive multi-organ destruction and death due to exuberant hyperinflammation at a local and systemic level. SARS-CoV-2 can also significantly affect the cardiovascular system of the infected persons through a systemic outburst of the cytokine storm. SARS-CoV-2 infection accompanies many cardiovascular complications that include myocardial infarction, myocarditis, microangiopathy, venous thromboembolism, and a cytokine storm burden resulting in heart failure. This narrative review attempts to gather all recent evidence by Internet-based literature search with relevant keywords related to coronavirus disease with main objective and focus on possible mechanisms of pathophysiology of troponin elevation and cardiovascular complications, with its diagnosis and recent guidelines for its management.

IL-6 and D-dimer Levels at Admission Predict Cardiac Injury and Early Mortality during SARS-CoV-2 Infection

“…Given the absence of an antiviral treatment that directly targets the cardiac injury associated with the disease, an urgent need exists to develop such alternative therapeutic strategies. SARS-CoV-2 is believed to induce the activation of immune and thrombotic pathways, which may contribute to organ injury [11][12][13]. A higher coagulation status or overactivation of immune pathways has been reported in patients with severe COVID-19 who died than survivors.…”

Hydroxychloroquine Attenuates hERG Channel by Promoting the Membrane Channel Degradation: Computational Simulation and Experimental Evidence for QT-Interval Prolongation with Hydroxychloroquine Treatment

“…The 2019 coronavirus disease (COVID-19) pandemic has drawn extensive global attention [1][2][3][4] and caused a large number of patient deaths [5]. Until now, there are 7,835 clinical studies related to COVID-19 according to the data from ClinicalTrials.gov, covering 708 drugs.…”