Section 1: Introduction (from DOI: 10.1007/s11886-020-01292-3)
From publication: "Cardiovascular Complications in Patients with COVID-19: Consequences of Viral Toxicities and Host Immune Response" published as Curr Cardiol Rep; 2020 04 21 ; 22 (5) 32. DOI: https://doi.org/10.1007/s11886-020-01292-3
Section 1: Introduction
Coronavirus disease of 2019 (COVID-19), caused by infection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread across the world as a serious pandemic. SARS-CoV-2, an enveloped virus with non-segmented, single-stranded, positive-sense RNA genome, is a member of the Coronaviridae (CoV) family which causes a predominantly respiratory illness with a wide range of clinical severity, ranging from asymptomatic or mildly symptomatic (fever, cough, dyspnea, myalgias, fatigue, and diarrhea) in a large proportion of patients to severe acute respiratory distress syndrome (ARDS) and fatal multi-organ failure . The disease has a case-fatality rate that ranges from less than 0.5% to more than 7% (average, ~ 3.8%), with an infectivity greater than that of influenza. Its high transmissibility and relatively high rate of causing serious complications has led COVID-19 to become a serious public health threat worldwide.
Among various physiological consequences of severe COVID-19, cardiovascular complications have emerged as some of the most significant and life threatening. COVID-19 may present with respiratory failure from pneumonia and ARDS, with or without distributive +- cardiogenic shock , and severe cardiac injury manifesting as markedly elevated troponin and heart failure . Cardiac injury has also been associated with increased mortality . In a cohort study of 416 patients with confirmed COVID-19, elevated troponin was present in 19.7% of patients during hospitalization and was found to be an independent risk factor for in-hospital mortality . The increased incidence of cardiac injury among those with severe systemic inflammatory response syndromes (SIRS) and shock in the setting of COVID-19 also highlights an important relationship between the immune response to the virus and the cardiovascular system. In addition, a high prevalence of pre-existing cardio-metabolic disease has been noted among those with severe COVID-19, and those with pre-existing cardiovascular conditions suffer increased mortality during COVID-19 infection. In particular, the reported case fatality rates for COVID-19 are 10.5% in patients with cardiovascular disease, 7.3% in patients with diabetes, and 6.0% in those with hypertension, higher than the case-fatality rate of 3-4% observed world-wide for patients without these co-morbidities . Last but not least, the increased frequency of adverse cardiovascular events following the resolution of COVID-19, similar to other viral infections such as influenza, may also play a role in worsening the mortality of patients with COVID-19. Thus, understanding the relationship between the viral-host immune response and the cardiovascular system will be critically important in our care and management of patients with COVID-19 going forward.
