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[Cardiovascular diseases and COVID-19 : Pathophysiology, complications and treatment]
Elisabeth Schieffer1, Bernhard Schieffer2, Denise Hilfiker-Kleiner3
1Institut für Sportmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland.
Insights
The COVID-19 pandemic is a hyperinflammatory disease impacting multiple organs, particularly the cardiovascular system. Understanding SARS-CoV-2
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Translational Research
Background:
- Coronavirus disease 2019 (COVID-19) presents as a hyperinflammatory, multi-organ disease, not merely a respiratory infection.
- The cardiovascular system is critically involved, with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) utilizing angiotensin-converting enzyme 2 (ACE-2) for host cell entry.
- Pre-existing cardiovascular conditions like hypertension, diabetes, and obesity significantly worsen COVID-19 severity.
Purpose of the Study:
- To provide an overview of the pathophysiology of SARS-CoV-2, with a specific focus on its impact on the cardiovascular system.
- To summarize current treatment strategies and their underlying pathophysiological principles for COVID-19 patients, particularly those with cardiovascular complications.
Main Methods:
- Review of existing literature on COVID-19 pathophysiology and cardiovascular involvement.
- Analysis of risk factors modulating disease severity, including comorbidities, genetics, and environmental factors.
- Synthesis of current treatment approaches and their scientific basis as of November 2020.
Main Results:
- SARS-CoV-2 infection leads to cardiovascular damage through mechanisms including ACE-2 interaction and hyperinflammation.
- Sequelae such as thrombosis, myocardial infarction, myocarditis, and vasculitis contribute significantly to COVID-19 morbidity and mortality.
- Treatment strategies have evolved, incorporating adaptations for cardiovascular complications observed during the pandemic.
Conclusions:
- COVID-19 poses a significant threat to the cardiovascular system, exacerbating existing conditions and causing new pathologies.
- Translational research, catalyzed by the pandemic, has led to improved, standardized treatments tailored to cardiovascular complications.
- Continued understanding of SARS-CoV-2 pathophysiology is crucial for optimizing patient outcomes and managing long-term cardiovascular sequelae.
Abstract:
The coronavirus disease 2019 (COVID-19) pandemic is a challenge for our healthcare system but at the same time is one of the excellent catalyzers and promoters of successful translational research. The COVID-19 is not only a simple viral infection of the bronchial system but is also a pandemic hyperinflammatory multiorgan disease. The cardiovascular system plays a causal role in this context, as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invades host cells via the angiotensin-converting enzyme 2 (ACE-2), an enzyme in the renin-angiotensin system. Furthermore, cardiovascular comorbidities and risk factors, such as hypertension, diabetes and obesity play an important role in the severity of the course of the disease. Additional risk factors, such as gender, age, genetics and air pollution modulate both the severity of the SARS-CoV‑2 infection as well as cardiovascular diseases. As sequelae of COVID-19, increased thrombosis, myocardial infarction, myocardial inflammation and vasculitis occur, which directly damage the cardiovascular system and substantially contribute to the high morbidity and mortality. Knowledge gained from many studies on the course of the disease in patients infected with SARS-CoV‑2 has led to improved treatment possibilities, which now in the second wave are partly standardized and were, and are, in particular adapted to complications of the cardiovascular system. In this review we provide a short overview on the pathophysiology of the SARS-CoV‑2 in general and also specifically on the cardiovascular system. Furthermore, we summarize the current treatment approaches and their pathophysiological principles (status November 2020).
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