Does COVID-19 affect the cardiovascular system?
Thursday, April 02, 2020
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19) has reached a pandemic level. As of April 1, the total cases of COVID-19 in the United States reached 186,101 with 3,603 deaths. The numbers change almost hourly. Symptoms of COVID-19 include coughing, fever, and shortness of breath, a sign of possible pneumonia that requires immediate medical attention.
COVID-19 is an illness that can affect a person’s lungs and airways with fatal consequences for those with underlying cardiovascular disease (CVD), evidenced by the large proportion of COVID-19 patients who have CVD. This is concerning because about half of the adults in the U.S. have hypertension, and 1 in every 10 Americans, or 34.2 million across all ages, has diabetes. Both these diseases can factor into CVD, a disease that kills one person every 37 seconds.
Although researchers have known that viral illnesses such as COVID-19 cause respiratory infections that lead to lung damage and sometimes death, their knowledge about the effects on the cardiovascular system is still evolving.
In a series of 44,672 patients from China confirmed with COVID-19, including mild cases, 4.2% had CVD, and 12.8% had hypertension (53% of cases had missing data on comorbid conditions).Patients with CVD composed 4.2% of confirmed cases yet made up 22.7%of all fatal cases, with a case fatality rate of 10.5%.Patients with cardiac injury had a higher mortality rate (51.2% vs. 4.5%) than those without cardiac injury. An observational study in China noted cardiac injury in 19.7% of patients with confirmed COVID-19 and was an independent predictor of in-hospital mortality.
A recent review, however, shows that COVID-19 can cause cardiac injury even in patients without underlying heart conditions. According to Mohammad Madjid, MD, MS, the study's lead author and an assistant professor of cardiology at The University of Texas Health Science Center at Houston (UTHealth), although the risk is higher in those who have already had heart disease, it is likely that even in the absence of previous heart disease, COVID-19 may injure a person’s heart muscle.
Madjid suggests that significant cardiovascular complications linked to COVID-19 will occur in severe symptomatic patients because of the high inflammatory response associated with the illness. Research from previous coronavirus and influenza epidemics have suggested that viral infections can cause acute coronary syndromes, arrhythmias, and the development of, or exacerbation of, heart failure.
Researchers are developing vaccines for prevention of COVID-19 and testing antivirals for treatment of COVID-19. In the meantime,physicians are urged to check the websites of the U.S. Centers for Disease Control and Prevention and professional societies for the latest guidance as knowledge about COVID-19 evolves.
As this virus spreads, the authors of this review suggest that it would be wise to identify the risk factors for the development of cardiac complications in patients with COVID-19. A prospective registry of patients with COVID-19 with a systematic recording of clinical variables and cardiovascular complications would be beneficial to identify the pattern of cardiovascular complications, develop a risk model for cardiac complications, and identify and/or predict response to various treatment modalities.
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