Cardiovascular complications in COVID-19

COVID-19, caused by SARS-CoV-2, is known for its systemic inflammation and pulmonary complications leading to significant morbidity and mortality. However, cardiovascular complications are also a critical aspect of the disease. This study aims to evaluate these cardiovascular complications in the context of COVID-19 infection​​.

Methods: The authors conducted a literature review using databases like PubMed and Google Scholar. They included various types of studies focusing on COVID-19 and its cardiovascular effects and complications. The literature reviewed encompassed case reports, retrospective and prospective studies, systematic reviews, meta-analyses, and clinical guidelines. In total, 45 articles were selected for inclusion in the study​​.

Pathophysiology and Clinical Features: SARS-CoV-2 binds to ACE2 receptors, which are found on lung alveolar epithelial cells and enterocytes of the small intestine. This interaction leads to systemic inflammation, which can result in ARDS and multiorgan dysfunction, including cardiovascular disease (CVD). The prevalence of CVD in COVID-19 patients varies, and preexisting CVD may lead to a more severe infection. Critical cases of COVID-19 may present with multiple cardiovascular complications​​.

Cardiovascular Complications:

  1. Myocardial Injury and Myocarditis: Viral infections, including SARS-CoV-2, can lead to myocardial injury and myocarditis, often indicated by elevated troponin levels. Up to 7% of COVID-19 related deaths may be due to myocarditis. Patients can exhibit symptoms like chest pain, dyspnea, dysrhythmia, and acute left ventricular dysfunction​​.
  2. Acute Myocardial Infarction (AMI): Severe systemic inflammation associated with COVID-19 increases the risk of AMI. This is due to inflammation and hypercoagulability leading to plaque disruption in the arteries. The treatment of AMI in COVID-19 patients is complex and requires careful consideration​​.
  3. Acute Heart Failure and Cardiomyopathy: Acute heart failure may be a primary manifestation of COVID-19, with cardiomyopathy occurring in a significant percentage of patients. Right heart failure can also occur, particularly in patients with ARDS and acute lung injury​​.
  4. Dysrhythmias: A variety of dysrhythmias can be observed in COVID-19 patients, with sinus tachycardia being the most common. These dysrhythmias may arise due to multiple factors like hypoperfusion, fever, hypoxia, and anxiety. The presence of dysrhythmias, especially if associated with elevated serum troponin, can indicate myocardial injury, acute myocarditis, or acute coronary syndrome (ACS)​​.
  5. Venous Thromboembolic Events (VTEs): COVID-19 patients are at increased risk for VTEs due to systemic inflammation, abnormal coagulation status, multiorgan dysfunction, and critical illness. Elevated D-dimer levels are commonly observed in these patients, and the occurrence of pulmonary embolism (PE) has been noted in several cases​​.

Limitations: The study acknowledges several limitations, including heterogeneity in patient selection, outcomes, comparators, and study design. Additionally, much of the literature on this topic is published in preprint form, which has not undergone full peer review. Consequently, further research is needed to fully understand the cardiovascular complications associated with COVID-19​​.

Conclusions: COVID-19 is associated with various cardiovascular complications, including myocardial injury and myocarditis, AMI, heart failure, dysrhythmias, and VTEs. Additionally, certain medications used to treat COVID-19 may interact with cardiovascular drugs and have potential cardiac complications. Emergency clinicians need to be aware of these complications when treating COVID-19 patients to provide effective and safe care​​.

This detailed examination of cardiovascular complications in COVID-19 underscores the multifaceted nature of the disease and highlights the importance of comprehensive patient evaluation and management in the context of this global health crisis.

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