COVID-19 and myocardial injury

  • AS Herrey Barts Heart Centre Barts NHS Trust and University College London
  • SA Mohiddin Barts Heart Centre Barts NHS Trust and University College London
  • p Letuka Division of Cardiology Department of Medicine Hatter Institute for Cardiovascular Research in Africa Groote Schuur Hospital and University of Cape Town
  • NAB Ntusi Division of Cardiology Department of Medicine Hatter Institute for Cardiovascular Research in Africa Cape Universities Body Imaging Centre Wellcome Centre for Infectious Diseases Research in Africa Faculty of Health Sciences Groote Schuur Hospital and University of Cape Town

Abstract

The 2019 coronavirus pandemic (COVID-19), caused by SARS-CoV-2, has affected millions globally and has accounted for a multitude of deaths. Cardiovascular involvement with myocardial injury is common and is associated with severe morbidity and mortality. The pathophysiology of acute myocardial injury is complex and may include type I and type II myocardial infarction, direct damage to the cardiomyocytes, systemic inflammation, myocardial interstitial fibrosis, interferon mediated immune response, exaggerated cytokine response by Type 1 and 2 helper T cells, in addition to hypoxia. Angiotensin converting enzyme-2 receptors (ACE2-R) play a pivotal role in mediating viral entry into cells. Disruption of receptor signalling may also be the principal mechanism facilitating viral pathogenicity and altered ACE2-R biology may be a reason why patients with cardiovascular disease are more likely to be infected with SARS-CoV-2 and more likely to develop severe symptoms. New-onset hypertension, arrhythmia, myocarditis, heart failure, cardiomyopathy and coronary heart disease are among major cardiovascular disease comorbidities and complications seen in severe cases of COVID-19. As a surrogate for myocardial injury, multiple studies have shown increased cardiac biomarkers, mainly cardiac troponins I and T, in the infected patients – especially those with severe disease. Myocarditis is another cause of morbidity among COVID-19 patients.
Published
2020-11-04
Section
Articles