Cardiac complications during the active phase of COVID-19: review of the current evidence

Abstract

Growing reports since the beginning of the pandemic and till date describe increased rates of cardiac complications (CC) in the active phase of coronavirus disease 2019 (COVID-19). CC commonly observed include myocarditis/myocardial injury, arrhythmias and heart failure, with an incidence reaching about a quarter of hospitalized patients in some reports. The increased incidence of CC raise questions about the possible heightened susceptibility of patients with cardiac disease to develop severe COVID-19, and whether the virus itself is involved in the pathogenesis of CC. The wide array of CC seems to stem from multiple mechanisms, including the ability of the virus to directly enter cardiomyocytes, and to indirectly damage the heart through systemic hyperinflammatory and hypercoagulable states, endothelial injury of the coronary arteries and hypoxemia. The induced CC seem to dramatically impact the prognosis of COVID-19, with some studies suggesting over 50% mortality rates with myocardial damage, up from ~ 5% overall mortality of COVID-19 alone. Thus, it is particularly important to investigate the relation between COVID-19 and heart disease, given the major effect on morbidity and mortality, aiming at early detection and improving patient care and outcomes. In this article, we review the growing body of published data on the topic to provide the reader with a comprehensive and robust description of the available evidence and its implication for clinical practice.

Integration and Reanalysis of Four RNA-Seq Datasets Including BALF, Nasopharyngeal Swabs, Lung Biopsy, and Mouse Models Reveals Common Immune Features of COVID-19

“…Similarly, cardiomyopathy observed here is well documented amongst COVID-19 patients, accompanied by a recent longitudinal study on COVID-19 patients as having an increased risk of cardiovascular disease ( 37 ). With reference to the cardiomyopathy KEGG pathways highlighted, the molecular components downregulated are often structural proteins, concurring with clinical observation of cardiomyopathy experiences in COVID-19 patients ( 38 39 ).…”

Effectiveness of a Three-Week Inpatient Pulmonary Rehabilitation Program for Patients after COVID-19: A Prospective Observational Study

“…Persistent lung injury and lung function impairments play a significant role [43][44][45]. However, cardiac [46,47], muscular [48], psychological, and other impairments, such as fatigue or deconditioning, may contribute to the development of persistent dyspnea. Some of these impairments can be positively influenced during pulmonary rehabilitation.…”

Atrial Fibrillation in the Setting of Acute Pneumonia: Not a Secondary Arrhythmia

“…At the beginning of this pandemic, Libby and Lüscher [83] published an interesting review in which they referred to COVID-19 as an "endothelial disease" strictly connected to inflammation. Cardiovascular involvements and cardiac arrhythmias are frequent in patients with SARS-CoV-2 infection and AF is the most common [76][77][78][84][85][86][87][88]. In a meta-analysis recently published by Romiti et al [79], prevalence of AF was 8% in patients with SARS-CoV-2 infection.…”