Cardiovascular Complications of Viral Respiratory Infections and COVID-19

Abstract

Viral respiratory infections (VRI) are the most prevalent type of infectious diseases and constitute one of the most common causes of contact with medical care. Regarding the pathophysiology of the cardiovascular system, VRI can not only exacerbate already existing chronic cardiovascular disease (such as coronary artery disease or heart failure) but also trigger new adverse events or complications (e.g., venous thromboembolism), the latter particularly in subjects with multimorbidity or disease-related immobilization. In the current paper, we provide a narrative review of diverse cardiovascular complications of VRI as well as summarize available data on the pathology of the circulatory system in the course of coronavirus disease 2019 (COVID-19).

Estimated Respiratory Syncytial Virus-Related Hospitalizations and Deaths Among Children and Adults in Spain, 2016–2019

“…To estimate the incidence of RSV-attributable hospitalizations and deaths in adults, we selected two primary outcomes: all respiratory events, and cardiorespiratory events (all respiratory plus selected subgroup cardiovascular events) that were previously reported to be linked with RSV [ 18 – 20 , 40 – 42 ] and used in other model-based studies [ 23 , 25 , 30 , 31 ]. In addition, we defined four respiratory outcomes (influenza or pneumonia; bronchitis or bronchiolitis; chronic lower respiratory diseases and upper respiratory diseases) and four subgroup cardiovascular outcomes (chronic heart failure exacerbations; ischemic heart diseases; arrhythmias and cerebrovascular diseases) to investigate further the contribution of RSV to those specific outcomes (ICD-10-CM codes provided in Supplementary Table 1).…”

“…Although RSV infection is frequently diagnosed in infants, the disease burden in older children and adults is mostly underestimated due to nonspecific symptoms, limited standard-of-care testing among adults, inadequate diagnostic capacity and lower sensitivity of tests compared to infants [ 8 , 10 – 17 ]. In addition, several studies reported that RSV infection not only causes respiratory diseases but often generates new events or acute exacerbations of chronic cardiovascular diseases (such as congestive heart failure, acute coronary syndrome, and arrhythmias) [ 18 – 20 ], which are not typically considered when assessing RSV burden. Therefore, the estimates based on laboratory-confirmed RSV cases generally underestimate the incidence.…”

Cumulative incidence and mortality rate of cardiovascular complications due to laboratory‐confirmed influenza virus infection: A systematic review and meta‐analysis

“…5,6 Cardiac involvement in various forms, including myocarditis, pericarditis, ischemic heart disease, heart failure (HF), and arrhythmias, has been described. [7][8][9] Cerebrovascular events, including stroke, have also been reported in the literature, 10,11 and influenza has been implicated in the exacerbation of underlying cardiovascular conditions. 12,13 The exact pathophysiologic mechanisms that contribute to the cardiovascular complications of influenza are unclear, but an interplay between inflammatory cytokines, procoagulant agents, vascular endothelial disruption, vasoconstriction, and supply-demand mismatch leading to hypoxemia is the most plausible explanation.…”

Viral Pneumonia: From Influenza to COVID-19

“…6 One important piece of information about respiratory viruses is that they can trigger cardiovascular events, especially in patients with prior cardiovascular disease and in those with multiple comorbidities or an immunocompromised status. 7 8 In fact, during the COVID-19 pandemic, several reports discussed the possible mechanism of SARS-CoV-2 causing myocardial injury, particularly in patients with severe disease. 9 However, before the pandemic, there were reports about severe influenza infections and acute myocardial infarction.…”