COVID-19, State of the Adult and Pediatric Heart: From Myocardial Injury to Cardiac Effect of Potential Therapeutic Intervention

Abstract

While the COVID-19 pandemic continues to spread rapidly, resulting in considerable morbidity and mortality worldwide, multiple efforts are being made by the international scientific community to understand the pathogenesis of the viral infection and its clinical outcome. Older age and comorbidities have consistently been reported as risk factors for unfavorable prognosis, with cardiovascular disease accounting for up to 10 % of comorbid conditions among the infected patients. An understanding of the mechanism underlying the effect of this infection on patients with cardiovascular disease is essential to manage and improve clinical strategies against the disease in that population. In this review, we summarize the impact of COVID-19 on patients with underlying cardiovascular conditions and the cardiac implications of known and emerging therapeutic strategies. Our future effort will aim to further elucidate how the type and severity of the cardiac disease, with particular regard to Congenital Heart Disease, influences the prognosis and the outcome of the viral infection.

COVID-19 in Pediatric Patients: A Focus on CHD Patients

“…In previously healthy COVID-19 pediatric patients, Kawasakilike disease and myocarditis have been the main cardiovascular manifestations of SARS-CoV-2. These manifestations are triggered primarily by the massive immune response mounted against the viral infection (50)(51)(52)(53)(54)(55). In fact, elevated levels of inflammatory markers have been noted in patients with COVID-19 associated Kawasaki-like disease or myocarditis (52,54,56).…”

“…Kawasaki-like disease may occur following a prior infection of COVID-19 documented by the presence of SARS-CoV-2 IgG antibodies or a known contact with a confirmed case of COVID-19 (58). This suggests the presence of a post-infectious state of immune dysregulation in children previously infected with or exposed to COVID-19 (51,57).…”

“…Besides, compromised lung function may result in compromised cardiac function; this is attributed to numerous COVID-19-induced pulmonary defects denoted by oxidative stress, tissue injury, respiratory failure and ventilation perfusion mismatch (50,51). Cardiac dysfunction may be possibly caused by direct myocardial damage.…”

“…Additionally, as compared to adults, they often exhibit mild disease ranging from flu-like to no symptoms. Nonetheless, children, particularly those with CHD, may develop serious COVID-19 related cardiovascular complications (51,73). CHD patients are more likely to require ICU admission and artificial respiratory support, especially those with cyanotic defects.…”

“…CHD patients are more likely to require ICU admission and artificial respiratory support, especially those with cyanotic defects. In these patients, COVID-19 may lead to worsened hypoxemia and compromised tissue perfusion (51,73). Additionally, patients with complex CHD complicated by depressed myocardial contractility, pulmonary hypertension, immunodeficiencies (i.e., DiGeorge syndrome) among other comorbid conditions may likely develop severe and critical COVID-19 disease (73,74).…”