Cardiovascular Complications in Patients with COVID-19: a comprehensive overview

ABSTRACT

Although COVID-19 initially affects the respiratory system, several studies have drawn significant attention to the growing hypothesis that the infection is associated with direct and indirect cardiovascular complications that may negatively influence the outcome of diseased patients. We review the current literature to investigate the complications caused by COVID-19 in the heart and the vascular system. We also analyse the proposed mechanisms of cardiovascular involvement. The cardiovascular complications include myocarditis, myocardial injury, heart failure, arrhythmias as well as venous and arterial thrombosis, which are associated with elevated morbidity risk and adverse outcomes. The pathophysiological mechanisms that explain the cardiovascular complications include inflammation, endothelial dysfunction, an excessive storm cytokine release, coagulation disturbances, and cell hypoxia. Patients with underlying cardiovascular disease (CVD) tend to have worse outcomes compared to those without CVD. Arterial thrombosis seems to be associated with coagulopathy and increased D-dimer concentrations and can manifest in patients with no pre-existing comorbidities, atherosclerosis, or blood-clotting disorders. The rate of successful revascularization is lower than expected and is associated with a virus-related hypercoagulable state. Due to these adverse events critical diseased patients often require care from a multidisciplinary care team.