The virus is neuroinvasive and neurovirulent, and has a tropism to endothelial cells and cardiomyocytes.13,14 Indirect factors are mainly due to a systemic process, including a hyperinflammatory response, hypercoagulable state, and coagulopathy (thromboembolic events and microangiopathy) (Figure 3).15–19 Additional factors include a prolonged intensive care unit (ICU) stay, which may be associated with hypotension and inadequate cerebral perfusion, stress cardiomyopathy and concomitant reduction in left ventricular ejection fraction, and atrial fibrillation.3,20