Coronaviruses and the Cardiovascular System
- Xiong TY, Redwood S, Prendergast B, Chen M.
- Coronaviruses and the Cardiovascular System: Acute and Long-Term Complications. Eur Heart J 2020;Mar 18:[Epub ahead of print].
The following are key points to remember from this viewpoint about coronaviruses and the cardiovascular system:
- Respiratory viruses associated with epidemics include influenza virus, severe acute respiratory syndrome (SARS), Middle East respiratory virus (MERS), H1N1 influenza, and now coronavirus 2019 (COVID-2019).
- Cardiovascular complications of influenza include myocarditis, acute myocardial infarction, and exacerbation of heart failure (HF) — all contributing to increased mortality.
- SARS virus is associated in one study (n = 121) with hypotension, bradycardia, tachycardia, cardiomegaly, and arrhythmia (mostly transient); cardiac arrest and death in another study (n = 15); and subclinical diastolic impairment with systolic involvement on echocardiography (reversible on clinical recovery) in a third report (n = 46).
- MERS virus is associated with acute myocarditis in one patient and acute-onset HF with good recovery.
- COVID-19 case reports suggest that there is increased myocardial injury (as evidenced by elevated high-sensitivity troponin I) in one study where 4 patients out of 41 required intensive care unit (ICU) care and another study (n = 138 patients) reported that 7.2% had acute cardiac injury, 8.7% had shock, and 16.7% had cardiac arrhythmias — most patients required ICU.
- Patients with HF and coronary artery disease are at increased risk of plaque rupture secondary to viral inflammation, so it is important to use plaque stabilizing agents such as statins.
- Procoagulant effects of inflammation can be ameliorated by antiplatelet therapy and anticoagulants.
- Angiotensin-converting enzyme 2 (ACE2) is expressed in the heart and SARS-CoV-2 virus binds to cells expressing receptors, particularly ACE2.
- Cytokine response seen with these viral infections probably mediate multi-organ damage.
- It is unclear whether risk of cardiovascular disease persists, and often overall long-term mortality is influenced by other organ involvement (e.g., lung). Long-term follow-up studies will be needed.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Nonstatins, Novel Agents, Statins, Acute Heart Failure, Echocardiography/Ultrasound
Keywords: Anticoagulants, Arrhythmias, Cardiac, Bradycardia, Cardiomegaly, Coronavirus Infections, COVID-19, Cytokines, Diastole, Dyslipidemias, Echocardiography, Heart Arrest, Heart Failure, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypotension, Inflammation, Influenza, Human, Intensive Care Units, Myocarditis, SARS Virus, Secondary Prevention, Severe Acute Respiratory Syndrome, Systole, Tachycardia, Troponin I
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