COVID-19 and the Heart: Cardiovascular Risks and Outcomes

This article was exclusively written for The European Sting by Ms. Maria Defante, a Medicine student and researcher at UniRedentor in Brazl. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Even though the predominant clinical manifestations during COVID-19 are respiratory, there are cardiovascular complications associated with COVID-19 in patients previously healthy and in those with previous heart disease. The physiopathology of the disease is a useful tool to understand the cardiovascular effects of COVID-19. The virus SARS-CoV-2 uses its membrane protein spike to bind to the host cell membranes through the receptor angiotensin-converting enzyme 2 (ACE2), present in cells of organs such as the heart, kidneys, lungs, liver and intestine which explains the systemic repercussions of COVID-19.

In the heart, cardiac myocytes and cardiac fibroblasts have the ACE-2 receptor and in the vessels the endothelial cells and the smooth myocytes exhibit this receptor as well. Once the virus SARS-CoV-2 binds to those heart ells, it can lead to cytokine releasing, causing inflammatory infiltrate, myocytes atrophy and edema and when it comes to the vessels the consequences, much more known, are the increase of vascular permeability and activation of the coagulation cascade.

Those molecular aspects are responsible for making COVID-19 survivors more susceptible to cardiovascular risk outcomes, such as thromboembolic disorders, ischemic heart disease, heart failure and arrhythmia. In cases where the patient had preexisting cardiovascular disease, it can be aggravated due to the of COVID-19, worsening the condition or causing acute events such as plaque rupture, which can occur because of the inflammation process associated with the disease. 

Another comorbidities need special attention while in the topic of cardiovascular outcomes of COVID-19. The disorders associated with the metabolic syndrome, such as dyslipidemia, type 2 diabetes mellitus, hypertension, overweight and obesity can categorize a higher risk for the cardiovascular complication of COVID-19. It is important to notice that the mentioned outcomes can be long-term, not only in the course of the disease. 

Considering this, patients recovering from COVID-19 need a careful and meticulous examination of the cardiovascular functions, in order to protect them from having future complications associated with COVID-19 cardiovascular outcomes.  Even though there is a greater risk associated with preexisting conditions, cardiac dysfunction can happen even in a patient with no comorbidities or heart disease. 

References

Bansal, M. (2020). Cardiovascular disease and COVID-19. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14(3), 247-250.

Kubiak, J. Z., & Kloc, M. (2022). Dissecting Physiopathology of COVID-19. International Journal of Molecular Sciences, 23(17), 9602.

Wang, W., Wang, C. Y., Wang, S. I., & Wei, J. C. C. (2022). Long-term cardiovascular outcomes in COVID-19 survivors among non-vaccinated population: A retrospective cohort study from the TriNetX US collaborative networks. EClinicalMedicine, 53, 101619.

About the author

Maria Defante is a Medicine student and researcher at UniRedentor.