Cardiovascular consequences of viral infections: from COVID to other viral diseases

Abstract

Infection of the heart muscle with cardiotropic viruses is one of the major etiologies of myocarditis and acute and chronic inflammatory cardiomyopathy (DCMi). However, viral myocarditis and subsequent dilated cardiomyopathy (DCM) is still a challenging disease to diagnose and to treat and is therefore a significant public health issue globally. Advances in clinical examination and thorough molecular genetic analysis of intramyocardial viruses and their activation status have incrementally improved our understanding of molecular pathogenesis and pathophysiology of viral infections of the heart muscle. To date, several cardiotropic viruses have been implicated as causes of myocarditis and DCMi. These include, among others, classical cardiotropic enteroviruses (coxsackieviruses B), the most commonly detected parvovirus B19, and human herpes virus 6. A newcomer is the respiratory virus that has triggered the worst pandemic in a century, SARS-CoV-2, whose involvement and impact in viral cardiovascular disease is under scrutiny. Despite extensive research into the pathomechanisms of viral infections of the cardiovascular system, our knowledge regarding their treatment and management is still incomplete. Accordingly, in this review we aim to explore and summarize the current knowledge and available evidence on viral infections of the heart. We focus on diagnostics, clinical relevance and cardiovascular consequences, pathophysiology, and current and novel treatment strategies.

Giant cell myocarditis after first dose of BNT162b2 – a case report

“…18 Discussed factors are disturbed angiotensin-converting enzyme 2 signalling, systemic inflammatory damage, cardiometabolic effects, arrhythmias, and ischaemia. 19,20 Here we can only describe a temporal relationship of vaccination and the occurrence of GCM, but no verifiable causal relation. Yet, this case is in line with one recently published case report showing GCM after second vaccination dose of BNT162b2 and another report of fulminant heart failure with heart transplantation after heterologous vaccination of ChAdOx1 nCoV-19 and BNT162b2.…”

Dirty Jobs: Macrophages at the Heart of Cardiovascular Disease

“…Viral myocarditis is a condition that can lead to the development of dilated cardiomyopathy (DCM), and potentially leads to a significant disease burden [ 125 ]. Macrophages are known to be involved with the development of dilated cardiomyopathy due to their role in the chronic impact of viral myocarditis.…”

Coronavirus disease 2019 and the cardiologist

“…Details about cardiac complications of 'long COVID' still need to be better characterized [105]. Given that direct infection of the myocardium by cardiotropic viruses is one of the major etiologies of myocarditis and subsequent dilated cardiomyopathy, long-term follow-up in patients with echocardiographic abnormalities will be key following acute COVID-19 infection as well [106]. The cardiovascular safety of the emerging therapies needs to be closely monitored, particularly in at risks populations.…”