PMC:7102662 / 2105-5784 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7102662","sourcedb":"PMC","sourceid":"7102662","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7102662","text":"1 Introduction\nThe emergence of novel coronavirus, officially known as Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has presented an unprecedented challenge for the healthcare community across the world. High infectivity, ability to get transmitted even during asymptomatic phase and relatively low virulence have resulted in rapid transmission of this virus beyond geographic regions, leading to a pandemic. The first case of this disease, known as coronavirus disease 2019 (COVID-2019), occurred on December 8, 2019 in the Hubei province of China [1]. Since then, within a short span of just over 3 months, the infection has spread to 177 countries/area/territories across the world, with 266073 confirmed cases and 11184 deaths (World Health Organization statistics as on March 21, 2020) [2] .\nTable 1 Cardiovascular complications in coronavirus disease 2019.\nManifestation Incidence Remarks\nAcute cardiac injury∗ (most commonly defined as elevation of cardiac troponin I above 99th percentile upper reference limit) 8–12% on average [10] • Most commonly reported cardiovascular abnormality\n• Can result from any of the following mechanisms-•Direct myocardial injury\n•Systemic inflammation\n•Myocardial oxygen demand supply mismatch\n•Acute coronary event\n•Iatrogenic\n• Strong adverse prognostic value\nAcute coronary event Not reported, but appears to be low Potential mechanisms-• Plaque rupture due to inflammation/increased shear stress\n• Aggravation of pre-existing coronary artery disease\nLeft ventricular systolic dysfunction Not reported Any of the causes of myocardial dysfunction mentioned above can lead to acute left ventricular systolic dysfunction\nHeart failure Reported in one study- 52% in those who died, 12% in those who recovered and were discharged [5] • Any of the causes of myocardial dysfunction mentioned above can lead to acute heart failure\n• Increased metabolic demand of a systemic disease can cause acute decompensation of pre-existing stable heart failure\nArrhythmia 16.7% overall; 44.4 in severe illness, 8.9% in mild cases [8] Both tachyarrhythmia and bradyarrhythmia can occur but exact nature not described\nPotential long-term consequences Too early to assess Too early to ascertain for coronavirus disease 2019. However, patients recovering from a similar earlier illness- Severe Acute Respiratory Syndrome- continued to have long-term abnormalities of lipid and glucose metabolism and of cardiovascular homeostasis [12]\n∗ Acute cardiac injury is a non-specific term with significant overlap with other cardiovascular manifestations; however, it is listed here because of how reporting has been done in most of the studies on coronavirus disease 2019.\nRespiratory involvement, presenting as mild flulike illness to potentially lethal acute respiratory distress syndrome or fulminant pneumonia, is the dominant clinical manifestation of COVID-19. However, much like any other respiratory tract infection, pre-existing cardiovascular disease (CVD) and CV risk factors enhance vulnerability to COVID-19. Further, COVID-19 can worsen underlying CVD and even precipitate de novo cardiac complications.\nThis review is aimed at providing overview of various CV manifestations in patients presenting with COVID-19. The impact of pre-existing CVD and new onset cardiac complications on clinical outcomes in these patients is also discussed. Since our understanding on this subject is only evolving at this stage, the information contained in the subsequent text is based mainly on the limited early experience with COVID-19 and learnings from the previous coronavirus illnesses, namely SARS and Middle-East Respiratory Syndrome 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