COVID-19 and Acute Cardiac Injury: Clinical Manifestations, Biomarkers, Mechanisms, Diagnosis, and Treatment
Hui Qiu1, Jiayu Li1, Jingye Li1
1Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Cardiovascular Center, Beijing, China.
Insights
COVID-19 can cause significant cardiac injury, including myocarditis and heart failure, particularly in those with pre-existing heart conditions. Understanding the mechanisms of this myocardial injury is crucial for patient outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathophysiology
Background:
- COVID-19 primarily causes respiratory illness but also affects the heart.
- Myocardial injury is common in COVID-19 patients, especially those with cardiovascular disease.
- Cardiac complications include myocarditis, heart failure, acute coronary syndrome, and arrhythmias.
Purpose of the Study:
- To review the clinical features of COVID-19-related cardiac injury.
- To investigate the mechanisms behind myocardial injury in COVID-19 patients.
Main Methods:
- Literature review of clinical characteristics and pathophysiological mechanisms.
- Analysis of emerging evidence on COVID-19's cardiac impact.
Main Results:
- Elevated inflammation biomarkers, ECG, and echocardiogram abnormalities indicate myocardial injury.
- Mechanisms include hypoxia, systemic inflammation, and direct viral attack via ACE2 receptors.
- Pre-existing cardiovascular disease increases risk and severity of cardiac injury.
Conclusions:
- COVID-19 infection can lead to diverse cardiac injuries through multiple pathways.
- Early recognition and understanding of mechanisms are vital for managing COVID-19 cardiac complications.
- Effective management strategies are needed to reduce mortality.
Purpose Of Review:
This review aims to comprehensively explore the clinical characteristics of COVID-19-related cardiac injury and examine the potential mechanisms underlying cardiac injury in patients affected by COVID-19.
Recent Findings:
The COVID-19 pandemic has primarily been associated with severe respiratory symptoms. However, emerging evidence has indicated that a significant number of COVID-19 patients also experience myocardial injury, leading to conditions such as acute myocarditis, heart failure, acute coronary syndrome, and arrhythmias. The incidence of myocardial injury is notably higher in patients with preexisting cardiovascular diseases. Myocardial injury often manifests with elevated levels of inflammation biomarkers, as well as abnormalities observed on electrocardiograms and echocardiograms. COVID-19 infection has been found to be associated with myocardial injury, which can be attributed to several pathophysiological mechanisms. These mechanisms include injury caused by hypoxia, resulting from respiratory compromise, a systemic inflammatory response triggered by the infection, and direct attack on the myocardium by the virus itself. Furthermore, the angiotensin-converting enzyme 2 (ACE2) receptor plays a crucial role in this process. Early recognition, prompt diagnosis, and a comprehensive understanding of the underlying mechanisms are essential for effectively managing and reducing the mortality associated with myocardial injury in COVID-19 patients.
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