COVID-19 Pandemic: Cardiovascular Complications and Future Implications

Dhrubajyoti Bandyopadhyay; Tauseef Akhtar; Adrija Hajra; Manasvi Gupta; Avash Das; Sandipan Chakraborty; Ipsita Pal; Neelkumar Patel; Birendra Amgai; Raktim K. Ghosh; Gregg C. Fonarow; Carl J. Lavie; Srihari S. Naidu

Disclosures

Am J Cardiovasc Drugs. 2020;20(4):311-324. 

In This Article

Abstract and Introduction

Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is now a global pandemic with the highest number of affected individuals in the modern era. Not only is the infection inflicting significant morbidity and mortality, but there has also been a significant strain to the health care system and the economy. COVID-19 typically presents as viral pneumonia, occasionally leading to acute respiratory distress syndrome (ARDS) and death. However, emerging evidence suggests that it has a significant impact on the cardiovascular (CV) system by direct myocardial damage, severe systemic inflammatory response, hypoxia, right heart strain secondary to ARDS and lung injury, and plaque rupture secondary to inflammation. Primary cardiac manifestations include acute myocarditis, myocardial infarction, arrhythmia, and abnormal clotting. Several consensus documents have been released to help manage CV disease during this pandemic. In this review, we summarize key cardiac manifestations, their management, and future implications.

Introduction

Coronavirus disease 2019 (COVID-19) is a rapidly spreading novel infectious disease of the human respiratory system caused by a newly discovered enveloped RNA β-coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1] Coronavirus has been responsible for previous epidemics, such as SARS-CoV and the Middle East Respiratory Syndrome (MERS)-CoV (Table 1). Since diagnosis of the index case, linked to the seafood and wet animal wholesale market in Wuhan, Hubei Province, China, in December 2019,[2] the disease has spread to involve more than 200 countries. As of 29 May 2020, the total number of cases in the US was 1,719,827, including 101,711 deaths.[3] The first case of COVID-19 was reported in the US on 30 January 2020, and, since then, more than 1.5 million cases have been diagnosed. Given the substantial morbidity and mortality caused by this disease within a short timeframe and the high rate of human-to-human transmission, the World Health Organization (WHO) declared COVID-19 a pandemic on 11 March 2020.[4]

It is noteworthy that COVID-19 has a lower fatality rate than the previous outbreak of SARS, but has a more remarkable capacity to spread quickly, thus making it an ideal infection to result in a pandemic. Our understanding of this disease is still evolving; however, a substantial amount of data has emerged recently indicating not just pulmonary involvement but significant involvement, both direct and indirect, of the cardiovascular (CV) system.[5–7] Interestingly, cardiac complications are not only prevalent but also signify a poor prognosis and may develop late in the course of more severe cases of the disease. In this review, we briefly discuss the pathogenesis, clinical manifestations, and diagnosis of COVID-19, with an emphasis on cardiac involvement, management strategies, and potential future implications, understanding that this is an area where information is accruing and changing rapidly.

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