COVID-19-induced cardiovascular injury Proposed mechanism of injury
• Acute myocarditis • Direct pathogen invasion
• Indirect cytokine storm
• Instability of coronary atherosclerotic plaques
• Coagulopathy
• Acute MI
• Hypertension
• Left ventricular dilation, hypertrophy and dysfunction
• Arrhythmias (long QT-syndrome, torsade de pointes) • Indirect inflammatory response (Cytokine storm)
• Worsening of heart failure • Indirect inflammatory response (Cytokine storm)
• Volume overload due to impaired sodium and water metabolism
• Disturbance of endothelial function
• Pyroptosis of cardiomyocytes • Hypoxemia
• Activation of the NLRP3 inflammasome
• Severe tachycardia, increased peripheral resistance, hypertension, increased myocardial oxygen requirements and ischemia • Pneumonia-induced increase in sympathetic activity