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:

  1. 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).
  2. Cardiovascular complications of influenza include myocarditis, acute myocardial infarction, and exacerbation of heart failure (HF) — all contributing to increased mortality.
  3. 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).
  4. MERS virus is associated with acute myocarditis in one patient and acute-onset HF with good recovery.
  5. 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.
  6. 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.
  7. Procoagulant effects of inflammation can be ameliorated by antiplatelet therapy and anticoagulants.
  8. Angiotensin-converting enzyme 2 (ACE2) is expressed in the heart and SARS-CoV-2 virus binds to cells expressing receptors, particularly ACE2.
  9. Cytokine response seen with these viral infections probably mediate multi-organ damage.
  10. 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, COVID-19 Hub, 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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