Comprehensive Review of Cardiovascular Involvement in COVID-19

Abstract

COVID-19 has emerged as one of the most devastating and clinically significant infectious diseases of the last decade. It has reached global pandemic status at an unprecedented pace and has placed significant demands on health care systems worldwide. Although COVID-19 primarily affects the lungs, epidemiologic reports have shown that the disease affects other vital organs of the body, including the heart, vasculature, kidneys, brain, and the hematopoietic system. Of importance is the emerging awareness of the effects of COVID-19 on the cardiovascular system. The current state of knowledge regarding cardiac involvement in COVID-19 is presented in this article, with particular focus on the cardiovascular manifestations and complications of COVID-19 infection. The mechanistic insights of disease causation and the relevant pathophysiology involved in COVID-19 as they affect the heart are explored and described. Relevant practice essentials and clinical management implications for patients with COVID-19 with a cardiac pathology are presented in light of recent evidence.

Characteristics and Outcomes of Patients with Acute Coronary Syndrome and COVID-19

“…ACS in the milieu of viral infection and respiratory failure may be related to atherosclerotic plaque rupture, triggered by endothelial cell damage, proinflammatory state, hypoxic injury, coronary spasm [ 4 ], and cytokine storm, which may lead to myocardial injury and disbalance between demand and supply [ 5 ]. Moreover, severe viral infection can cause a systemic inflammatory response [ 6 ] and trigger a procoagulant state which favors coronary artery thrombotic occlusion [ 7 ]. All these can lead to type 1 or 2 myocardial infarction.…”

Cardiovascular Imaging Evaluation in COVID-19 Heart and Vascular Non-Ischaemic Involvement

“…COVID-19 gives severe lung involvement and hemodynamic alterations that therefore induce commonly cardiovascular complications showing a wide spectrum of severity [136]. Clinical studies and several evidences show that patients with severe COVID19, as critically ill patient, generally are affected by the "cytokine storm" which plays a crucial role in the disease progression and severity, and in influencing the COVID-19-associated acute respiratory distress syndrome (ARDS) and multiorgan dysfunction syndrome [137,138].…”

Implementation and Outcomes of an Advanced Nurse Practitioner Telephone Chest Pain Clinic Developed in Response to the COVID-19 Pandemic

“…2 Chest pain is a principal presenting symptom of coronary artery disease (CAD) and places a significant burden on emergency departments (EDs), accounting for approximately 10% of nontrauma visits. 4 Despite the published reduction in presentation with nonspecific chest pain 5 and myocardial infarction during the pandemic, 1 locally ED presentations with chest pain remained consistent in the first 14 weeks of the pandemic despite a 9% reduction in overall ED attendance ( Figure 1 ).

Figure 1 Local overall emergency department (ED) patient attendance and patients with chest pain attendance during the initial pandemic period in 2020, compared with the same period in 2019.

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