Decoding the Cardio-vascular Pathophysiology in COVID-19

The global pandemic caused by Coronavirus 19 (SARS-CoV-19) has spread rapidly and affected the entire world with the maximum number of cases reported from the United States, India and Brazil. Coronavirus 19 (SARS-CoV-19) has infected a total of 31,664,104 people and caused 972,221 deaths according to the WHO data as on 24 September 2020 [1].

Globally, the age- normalized death rate due to cardio-vascular disease (CVD) is 272 per one lakh population and in India, it is 235 per one lakh population on an average [2]. People with heart diseases are twelve times more prone to die and six times more prone to be hospitalized due to severe coronavirus disease (Covid-19) than healthy people [3]. Covid 19 disease mainly affects the respiratory system, and other extra-pulmonary complications are acute renal injury, gastrointestinal consequences, hepatocellular damage, hyperglycemia, ketosis, ocular complications, dermatologic manifestations, thrombotic sequelae, acute coronary syndromes, myocardial dysfunction and arrhythmia, neurological illnesses, etc. [4]. Acute cardiac injury is the commonest covid related cardiac abnormality affecting 8-12% of all patients [5]. Elevated level of cardiac troponin is described as acute cardiac injury [6].

Coronavirus leads to increased pro-inflammatory markers, T-lymphocyte-mediated cytotoxicity, increased sympathetic activity, rupture of plaque, myocardial cell invasion and direct myocardial damage augmented by the cytokine storm syndrome. COVID-19 related cardiovascular complications includes acute cardiac injury, acute coronary event, left ventricular systolic dysfunction, acute left ventricular failure, diastolic dysfunction [7], brain medullary cardiorespiratory dysfunction and congestive heart failure (CHF) [8-12], ST-segment elevated myocardial infarction, cardiogenic shock, diffuse myocardial edema, pericarditis, pericardial effusion, cardiac tamponade, venous thromboembolism, and cardiomyopathies mimicking STEMI presentations, sinus bradycardia [13], arrhythmia, cardiac conduction abnormalities [14] and sudden death [15]. Sufficient understanding of the COVID-19 effect on cardiovascular system is important for optimum treatment of covid affected patients and to prevent morbidity and mortality in the patients. The pathophysiology of myocardial complications is still speculative and hence, we have tried to decode the cardiovascular pathophysiology in Covid 19 infection.