Coronaviruses and the cardiovascular system: acute and long-term implications
The study “Coronaviruses and the Cardiovascular System: Acute and Long-term Implications” by Tian-Yuan Xiong, Simon Redwood, Bernard Prendergast, and Mao Chen, published in the European Heart Journal in 2020, provides an in-depth analysis of the implications of coronavirus infections, including COVID-19, on cardiovascular health.
Here’s a detailed summary:
Background and Context
- The study was received for publication in February 2020 and accepted in March 2020, amidst the early stages of the COVID-19 pandemic.
- It addresses the challenge posed by COVID-19, highlighting the need to understand the cardiovascular implications of this and similar viral outbreaks.
- The paper notes that previous epidemics like SARS, MERS, and H1N1 influenza have been associated with significant cardiovascular implications, which are often underestimated.
Cardiovascular Complications of Viral Infections
- The study emphasizes that acute and chronic cardiovascular complications are common in respiratory infections. Conditions such as myocarditis, acute myocardial infarction, and heart failure exacerbation are notable.
- Patients with existing cardiovascular diseases are at increased risk during viral epidemics. Common complications include hypotension, tachycardia, bradycardia, arrhythmia, and even sudden cardiac death.
- The largest COVID-19 cohort study cited in the paper found that acute cardiac injury, shock, and arrhythmia were present in significant percentages of patients, especially those in intensive care.
Viral Pathology and Cardiovascular Links
- The study discusses how chronic cardiovascular diseases can become unstable due to the increased metabolic demand and reduced cardiac reserve during viral infections.
- SARS-CoV-2, the virus causing COVID-19, is particularly noted for its potential to bind to ACE2 receptors, which are also present in the heart. This can lead to myocardial inflammation, lung edema, and respiratory failure.
- Systemic inflammation and the resulting pro-coagulant effects increase the risk of cardiovascular complications, including stent thrombosis.
Long-term Cardiovascular Risks
- The long-term cardiovascular risks post-infection are highlighted, with the paper noting that survivors of respiratory viruses can experience increased cardiovascular disease risk for up to 10 years.
- It cites studies showing long-term metabolic disturbances in SARS survivors and notes the lack of extensive long-term data for COVID-19 survivors.
- The paper underscores the need for more research and long-term follow-up studies to understand the full scope of cardiovascular implications post-infection.
Conclusions and Implications
- The authors conclude that global pandemics like COVID-19 pose significant threats to public health due to their potential to cause both acute and long-term cardiovascular complications.
- They stress the importance of interdisciplinary management and prolonged clinical follow-up, especially for patients with pre-existing cardiovascular diseases.
- The study calls for a heightened awareness of the extra-pulmonary manifestations of viral infections and their long-term consequences on cardiovascular health.
This study is a critical resource in understanding the complex interactions between viral infections like COVID-19 and cardiovascular health, highlighting both immediate and long-term concerns. It underscores the importance of considering cardiovascular implications in the management and research of COVID-19 and similar pandemics.
Read More: https://academic.oup.com/eurheartj/article/41/19/1798/5809453