Interaction of COVID-19 With Common Cardiovascular Disorders

Abstract

The onset and widespread dissemination of the severe acute respiratory syndrome coronavirus-2 in late 2019 impacted the world in a way not seen since the 1918 H1N1 pandemic, colloquially known as the Spanish Flu. Much like the Spanish Flu, which was observed to disproportionately impact young adults, it became clear in the early days of the coronavirus disease 2019 (COVID-19) pandemic that certain groups appeared to be at higher risk for severe illness once infected. One such group that immediately came to the forefront and garnered international attention was patients with preexisting cardiovascular disease. Here, we examine the available literature describing the interaction of COVID-19 with a myriad of cardiovascular conditions and diseases, paying particular attention to patients diagnosed with arrythmias, heart failure, and coronary artery disease. We further discuss the association of acute COVID-19 with de novo cardiovascular disease, including myocardial infarction due to coronary thrombosis, myocarditis, and new onset arrhythmias. We will evaluate various biochemical theories to explain these findings, including possible mechanisms of direct myocardial injury caused by the severe acute respiratory syndrome coronavirus-2 virus at the cellular level. Finally, we will discuss the strategies employed by numerous groups and governing bodies within the cardiovascular disease community to address the unprecedented challenges posed to the care of our most vulnerable patients, including heart transplant recipients, end-stage heart failure patients, and patients suffering from acute coronary syndromes, during the early days and height of the COVID-19 pandemic.

COVID-19 and the Cardiovascular System: Requiem for a Medical Minotaur

“…The impact of COVID-19 on cardiovascular disease outcomes and treatment was profound, as detailed by Boulos et al 3 in this Compendium. Reluctance of patients to seek care for serious conditions, deferral or modification of necessary procedures, an increase in thrombotic disorders related to procoagulant effects of SARS-CoV-2 and its invoked inflammatory response, led to the exacerbation of underlying conditions, such as heart failure, as well as interaction with pharmacological treatments, such as immunosuppression regimens in transplant patients.…”

“…In any case, during the pandemic, the adaptation and performance of cardiovascular clinical care teams as well as the professional societies charged with issuing and updating COVID-19-related guidelines was nothing short of heroic. 3 When it comes to the pathophysiology of COVID-19, a striking observation at the forefront of SARS-CoV-2 infection was the increased risk of thrombotic outcomes in patients. These included intravascular coagulation, macrothrombosis, organ microthrombosis, bleeding, and profound coagulopathy, and in certain cases an associated myocarditis.…”

“…Reluctance of patients to seek care for serious conditions, deferral or modification of necessary procedures, an increase in thrombotic disorders related to procoagulant effects of SARS-CoV-2 and its invoked inflammatory response, led to the exacerbation of underlying conditions, such as heart failure, as well as interaction with pharmacological treatments, such as immunosuppression regimens in transplant patients. 3 Others 4 have described the profound impact of COVID-19 on basic and clinical cardiovascular research. Clinical trials are one example of this, as recruitment fell precipitously in many of them in 2020.…”

“…In any case, during the pandemic, the adaptation and performance of cardiovascular clinical care teams as well as the professional societies charged with issuing and updating COVID-19-related guidelines was nothing short of heroic. 3…”

The Potential Mechanisms of Arrhythmia in Coronavirus disease-2019

“…It is noteworthy that respiratory failure has emerged as a leading cause of mortality associated with COVID-19 13 . With the emergence of a large number of clinical cases, it has been shown that the cardiovascular system is also vulnerable 14 . Numerous patients experience complications related to serious heart diseases, such as myocardial injury, arrhythmias, acute coronary syndrome and others 11 , 14 , 15 .…”