COVID-19 and the heart: direct and indirect impact

Abstract

Background. The pandemic of severe acute respiratory syndrome COVID-19 drew the attention of researchers and practitioners worldwide to severe cardiovascular injury incurred by the new SARS-CoV-2 coronavirus. Objectives . A review and structuring of recent evidence on the pathophysiological mechanisms of SARS-CoV-2 impact on cardiovascular system and its major acute complications, assessment of indirect pandemic effects on treatment and diagnosis in practical cardiology. Methods . Literature sources were mined in the PubMed database with keywords “COVID-19” and “SARS-CoV-2” and the source type “Clinical Trial”, “Meta-Analysis”, “Review”, “Systematic Review”. The search depth was unrestricted, as the vast majority of publications appeared during the past year. Results . A screening of over 12,000 sources produced 329 most relevant articles available full-text, with 65 included in the review. A key factor of the SARS-CoV-2 penetration into human cell is protein S facilitating the virus—angiotensin-converting enzyme 2 binding and final fusion. Myocardial damage in COVID-19 can occur due to excessive inflammatory response, the disbalance of myocardial oxygen demand and supply, vasculitis, atherosclerotic plaque rupture, coronary spasm, hypoxic vascular damage and endothelial dysfunction, microthrombi formation. The most critical acute cardiovascular complications of COVID-19, apart from myocarditis, are cardiac arrhythmias, acute coronary syndromes, acute heart failure, thrombosis and embolism. The COVID-19 pandemic exerts an indirect negative influence on medical aid in patients with cardiovascular diseases and complications. Conclusion . Knowledge of the pathophysiological mechanisms of SARS-CoV-2 impact on cardiovascular system and major types of its acute complications allows targeted research into the scenarios of their prevention and treatment. A rational balance is expected between the infection control and treatment for critical noncommunicable, particularly, cardiovascular diseases.