Coronaviruses and the Cardiovascular System: Acute and Long-term Implications

Tian-Yuan Xiong; Simon Redwood; Bernard Prendergast; Mao Chen


Eur Heart J. 2020;41(19):1798-1800. 

In This Article

Cardiovascular Complications of Respiratory Virus Infection

Cardiovascular complications of influenza infection, including myocarditis, acute myocardial infarction, and exacerbation of heart failure have been well-recognized during previous historical epidemics and make a significant contribution to mortality.[4] Likewise, previous coronavirus outbreaks have been associated with a significant burden of cardiovascular comorbidities and complications (Table 1). Furthermore, the severity of the primary respiratory syndrome and risk of adverse outcomes is increased in patients with pre-existing cardiovascular diseases.[11] Hypotension, tachycardia, bradycardia, arrhythmia, or even sudden cardiac death are common in patients with SARS. Electrocardiographic changes and troponin elevation may signal underlying myocarditis, and echocardiography frequently demonstrates sub-clinical left ventricular diastolic impairment (with a higher likelihood of the need for mechanical ventilation in those with systolic impairment and reduced ejection fraction).[7,12]

Early COVID-19 case reports suggest that patients with underlying conditions are at higher risk for complications or mortality—up to 50% of hospitalized patients have a chronic medical illness (40% cardiovascular or cerebrovascular disease). In the largest published clinical cohort of COVID-19 to date, acute cardiac injury, shock, and arrhythmia were present in 7.2%, 8.7%, and 16.7% of patients, respectively,[10] with higher prevalence amongst patients requiring intensive care.