Authors
Dr Arshad M, MD, DM, FACC (USA), FSCAI, FESC (UK), Director Cathlab services, Senior consultant and Interventional cardiologist, SK Hospital, Trivandrum.
Abstract
Background: Severe COVID-19 is a systemic illness characterized by hyperinflammation, cytokine storm, and significant cardiovascular (CV) injury. This review explores the various cardiovascular manifestations and their implications.
Cardiac Injury and Heart Failure: Acute myocardial injury is reported in 7.2% to 17% of hospitalized COVID-19 patients, manifesting as myocarditis or type 2 myocardial infarction due to oxygen supply/demand mismatch. Heart failure is common in non-survivors (52%). Myocardial injury can develop 10-15 days after symptom onset, potentially driven by T-cell mediated immunity, dysregulated innate effector pathways, systemic inflammation, cytokine storm, and direct viral invasion of cardiac myocytes via ACE2 receptors.
Arrhythmias: Arrhythmias are a frequent serious complication, affecting 16.7% of hospitalized patients. They occur in 7% of non-ICU patients and 44% of ICU patients, including atrial fibrillation, conduction blocks, and ventricular tachy/fibrillation.
Other Cardiovascular Complications: Viral illness can destabilize atherosclerotic plaques, leading to acute coronary syndromes, with type 2 MI being the most common subtype. Coagulation abnormalities, such as disseminated intravascular coagulation (DIC) and pulmonary embolism, are highly prevalent, with elevated D-dimer levels strongly associated with poor prognosis and mortality.
Therapeutic and Healthcare Implications: Potential COVID-19 therapies like Chloroquine and Hydroxychloroquine have weak supporting data and significant cardiac toxicities, particularly conduction disorders. The pandemic has also led to a reduction in routine CV care, deferred elective procedures, and delayed presentation of acute emergencies, likely increasing cardiac morbidity and mortality.
Conclusion: COVID-19 presents a wide spectrum of cardiovascular manifestations, from direct myocardial injury and arrhythmias to thrombotic complications and exacerbation of pre-existing conditions. Understanding these impacts is crucial for patient management and adapting healthcare strategies during the pandemic.