Cardiovascular complications of the coronavirus disease (COVID-19)

Abstract

A new coronavirus infection (COVID-19), which has spread widely in the human population in the past few years, is often complicated by a damage to the cardiovascular system, central nervous system, gastrointestinal tract, and respiratory system organs. The review describes the features of the clinical course and treatment of SARS-CoV-2 infection, which can lead to the development of cardiac complications both in the early and long-term periods. It is assumed that there are three main causes for the development of such complications (the affinity of the virus to endothelial proteins, the damage to blood vessels and the heart as a result of the immune response of the body and the toxic effects of drugs used to treat infection). Among the pathogenic mechanisms of the course of a new coronavirus infection that can lead to the development of cardiovascular complications, the following can be distinguished: manifestations of systemic vasculitis, coagulopathy, thrombosis, the phenomenon of “cytokine storm”, the direct cytotoxic damage to the myocardium, metabolic disorders, imbalance of the ionic composition of the blood, hypoxia and its consequences. The most common complications include myocarditis with arrhythmia (sinus tachycardia, bradycardia, atrial fibrillation and flutter, QTc prolongation, sudden cardiac death), cardiomyopathy (biventricular, isolated dysfunction of the right or left ventricle), cardiogenic shock, coagulopathy, thromboembolism (including strokes), vasculitis. Following recovery from COVID-19, many patients retain (or develop) the symptoms caused by the heart damage: a pain in the region of the heart, palpitations, appearance or aggravation of chronic heart failure, decompensation of hypertension, acute coronary syndrome. The main proposed directions for minimizing the risk of developing cardiac complications in COVID-19 patients include ECG monitoring (assessment of the QT interval, rhythm, conduction and repolarization), echocardiography in patients at risk, 24-hour ECG recording in patients who report palpitations. In addition, it is recommended to adjust the dosages of cardiotoxic drugs and to be cautious when prescribing anticoagulant therapy.