Covid-19 and cardiovascular system
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Negin Golestani eraghi,1,*
1. Undergraduate student, Farhangian University, Shahid Rajaei High Education Center, Isfahan, Iran
- Introduction: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and coronavirus disease (COVID-19) has become a serious global threat to public health in a short time, since the first case was reported at the end of 2019, in China. Infected patients show a variety of symptoms. These symptoms include fever, cough, fatigue, sputum production, shortness of breath, myalgia or arthralgia, sore throat, headache, and diarrhea. Although most clinical presentations are related to the respiratory system, the disease may also affect the cardiovascular system. I investigate the effect of covid-19 on the heart and cardiovascular system in this review article.
- Methods: In this review study, three databases include Google scholar, pub med, and Science direct; and keywords like COVID-19, SARS-COV-2, cardiovascular system, heart, and arrhythmias used for collecting the articles. I reviewed all articles and removed those were not relevant to the study domain from the study process.
- Results: Besides the respiratory system, angiotensin-converting enzyme 2 (ACE2) is expressed in the human cardiovascular system (such as the heart) and SARS-CoV-2 may cause myocardial damage or other damages by several mechanisms. SARS-CoV-2 infects humans by using the spike protein to bind to the ACE2 receptors on the surface of the myocardial cell membrane. Animal studies have shown that cellular ACE2 levels decrease due to SARS-CoV infection and also affect cardiomyocytes and conduction system disease. It has been reported that patients with the SARS-CoV infection experience different cardiac manifestations, including arrhythmias and sudden death. Sinus bradycardia, sinus tachycardia, and atrial fibrillation were the most common cardiac arrhythmia observed in patients with COVID-19 infection according to reports and one survey. Further, other arrhythmias, including atrial and ventricular arrhythmias, have been observed in COVID-19 patients, without any history of arrhythmia. Arrhythmias in COVID-19 can be caused by myocarditis, hypoxia, or abnormal host immune response, and secondarily as a result of myocardial ischemia, myocardial strain, autonomic imbalance, electrolyte disturbances, intravascular volume imbalances, and drug side effects. Arrhythmias are not just because of the direct effect of COVID-19 infection, but probably as a result of systemic illness.
- Conclusion: Although respiratory distress is the most important symptom of COVID-19, cardiac complications have also been reported in patients with COVID-19. The cardiac complications include heart failure, myocarditis, and acute coronary syndrome. There is several evidences showing that arrhythmias are also one of the major complications. It is necessary to increase the awareness of interactions between drugs, monitor electrocardiogram (ECG), and provide special considerations for patients with COVID-19 to manage arrhythmias and other heart diseases.
- Keywords: COVID-19 , SARS-COV-2 , cardiovascular system , heart, , arrhythmias
