COVID-19 and cardiovascular disease

The SARS-CoV-2 causing COVID-19 has reached pandemic levels since March 2020.

By analyzing patients with severe manifestations, it became apparent that 20 to 35% of patients who died had preexisting cardiovascular disease.  This finding warrants the important need to discuss the influence of SARS-CoV2 infection on the cardiovascular system.

The main explanations of this relationship are:
  • re-existing cardiovascular disease weaken the capacity to overcome the stress of the disease
  • pre-existing pathological metabolic conditions (i.e. type 2 diabetes mellitus, obesity), closely related to cardiovascular diseases, induce an alteration of the systemic inflammatory response and consequently an increase in the probability of cardiovascular damage
  • direct damage of the virus to the cardiovascular system
COVID-19 is primarily a respiratory disease, but many patients also have cardiovascular involvement. The host receptor through which SARS-CoV‑2 enters cells to trigger infection is ACE2. In addition to the lungs, ACE2 is highly expressed in human heart and vessel.
The cardiovascular system involvement can occur secondary to pulmonary involvement, especially in patients with previous cardiovascular disease or primarily considering the central role that the ACE2 receptor has in this system.

The pathophysiological mechanism of myocardial damage has not yet been defined. Among the possible mechanisms are cytokine storm damage, hypoxia, microvascular damage or direct myocardial damage by the virus.
The greatest expression of ACE2 in the cardiovascular system is on the pericytes and on the endothelial cells.
The involvement of these components of the cardiovascular system leads to microvascular dysfunction with consequent tissue edema and a pro-coagulant state.

The known acute cardiovascular manifestations are:
  • myocarditis or myocardial damage
  • acute coronary syndromes
  • arrhythmic disorders
  • heart failure
  • thrombo-embolic events
  • Kawasaki disease
Cardiovascular damage screening among patients with previous COVID-19 plays an important role in identifying a group of patient that need of adequate follow-up. For example, in both competitive and non-competitive athletes, identifying the cardiovascular complications of this pathology is necessary for the resumption of sports activity, in line with the protocols of the Italian Sports Medicine Federation.

ProKardia is very sensitive to the health emergency caused by COVID-19 and offers an assistance aimed to ensure:
  • diagnostic management aimed at identifying cardiovascular complications of COVID-19
  • risk stratification
  • therapeutic management and prevention

Reference: Nature Reviews Cardiology volume 17, 543–558(2020)

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