Cardiovascular system and COVID-19: perspectives from a developing country

Abstract

A novel coronavirus, SARS-CoV-2, thought to have originated from bats causes COVID-19 infection which was first reported from Wuhan, China in December 2019. This virus has a high infectivity rate and has impacted a significant chunk of the population worldwide. The spectrum of disease ranges from mild to severe with respiratory system being the most commonly affected. Cardiovascular system often gets involved in later stages of the disease with acute cardiac injury, heart failure and arrhythmias being the common complications. In addition, the presence of cardiovascular co-morbidities such as hypertension, coronary artery disease in these patients are often associated with poor prognosis. It is still not clear regarding the exact mechanism explaining cardiovascular system involvement in COVID-19. Multiple theories have been put forward however, more robust studies are required to fully elucidate the “heart and virus” link. The disease has already made its presence felt on the global stage and its impact in the developing countries is going to be profound. These nations not only have a poorly developed healthcare system but there is also a huge burden of cardiovascular diseases. As a result, COVID-19 would adversely impact the already overburdened healthcare network leading to impaired cardiovascular care delivery especially for acute coronary syndrome and heart failure patients.

Cardiovascular complications and its impact on outcomes in COVID-19

“…1 SARS-CoV-2 is a part of the Coronaviridae family and is quite similar to the two other coronaviruses SARS and MERS. 2 COVID-19 predominantly affects the respiratory system with pneumonia and acute respiratory distress syndrome (ARDS) being the predominant manifestation. However, recent reports have highlighted the impact of SARS-CoV-2 on the cardiovascular (CV) system.…”

SGLT-2 inhibitors as cardioprotective agents in COVID-19

“…The disease has a varied spectrum of presentation with respiratory system being most commonly affected followed by the cardiovascular (CV) system in later stages of the disease. 1 Multiple risk factors accounting for an adverse outcome include older age, male sex and presence of comorbidities such as diabetes, hypertension, chronic kidney disease and obesity. 1 , 2 Acute respiratory failure and fulminant myocarditis have been reported as the most common causes of death.…”

“… 1 Multiple risk factors accounting for an adverse outcome include older age, male sex and presence of comorbidities such as diabetes, hypertension, chronic kidney disease and obesity. 1 , 2 Acute respiratory failure and fulminant myocarditis have been reported as the most common causes of death. 1 A lack of a specific therapy for COVID-19 has ushered in a global race for development of new drugs and vaccines.…”

“… 1 , 2 Acute respiratory failure and fulminant myocarditis have been reported as the most common causes of death. 1 A lack of a specific therapy for COVID-19 has ushered in a global race for development of new drugs and vaccines. Emergence of the novel coronavirus also led to repurposing of several drugs such as anti-malarial drugs chloroquine and hydroxychloroquine, anti-HIV drugs viz.…”

“…Viral replication leads to a dysregulated immune response with a release of several pro-inflammatory cytokines such as IL-1, IL-2, IL-6 culminating in a cytokine storm resulting in acute respiratory distress, myocarditis, thromboembolic complications, multiorgan failure and death. 1 In addition, this inflammatory milieu leads to an increased production of free radicals and hence increased levels of oxidative stress. Use of anti-inflammatory and immunomodulatory agents such as corticosteroids, IL-6 inhibitors (tocilizumab, sarilumab) have shown to be promising therapies for COVID-19 infection.…”