Novel coronavirus infection and its effects on heart

To have a comprehensive review on effects of novel coronavirus on heart.

The novel coronavirus may affect cardiac tissue via three main mechanisms: 1- direct myocardial injury and myocarditis caused by the virus, 2- hyper-inflammation and immunopathology, and 3- respiratory failure, acute respiratory distress syndrome, and effects of hypoxemia on cardiac tissue. In a large number of patients, all three mechanisms are involved.
Hypercoagulability is a mechanism for coronary artery stenosis and acute coronary syndrome or myocardial infarction.
Also, blood pressure abnormalities, either hypertension or hypotension are frequent in severely ill patients. A high proportion of critically ill patients develop arrhythmias. Arrhythmias may arise due to hypoxemia, metabolic derangements, systemic inflammation, or myocarditis.
In a postmortem study, real-time polymerase chain reaction analyses on heart tissue detected the viral genome in nearly one third of patients.
Interleukin-6, serum ferritin, brain natriuretic peptide, and high sensitivity cardiac troponin are among the various biomarkers elevated during the course of the disease. It has been shown that as the disease severity increases and in the 3rd stage of the disease- host response- inflammatory and cardiac markers show elevations.
Cardiac involvement ad elevated cardiac biomarkers are prominent features in COVID-19 and associated with a worse prognosis and increased mortality. In a survey in Wuhan, 40% of deaths were attributed to myocardial damage or heart failure, alone or in combination with respiratory failure. In autopsies, mononuclear infiltrates of macrophages and CD4+ T cells have been shown in areas of cardiac necrosis.
It has been proposed that acute cardiac involvement is a stronger risk factor for increased mortality than age, diabetes mellitus, chronic pulmonary disease, or even history of cardiovascular disease.
Since the virus is new- emerging, we do not know much about its long term consequences. So, its effects on heart in the convalescent and chronic phases are not well-known. Delayed myocarditis, cardiac arrest, hyperlipidemia and pulmonary fibrosis are possible long term consequences of the disease.
Conclusion: We have to be aware of cardiac consequences of Covid-19 to manage the disease optimally.

 

Dr. Laleh Hakemi- internist
Medical Committee of Iran Taekwondo Federation