COVID-19-Related Cardiovascular Issues
Respiratory issues may come to mind first when thinking about COVID-19, but the coronavirus is also accompanied by a variety of cardiovascular issues.
The cardiovascular system, allows for the circulation of blood and the transportation of nutrients throughout the body. A paper published in the Lancet explains that COVID-19 patients’ cardiovascular systems may become impaired by coagulation abnormalities, leading to obstruction of blood vessels by clots.
The coronavirus may also cause myocarditis, an inflammation of the heart muscle, which can result in heart failure. While patients without preexisting cardiovascular conditions may develop heart-related injuries, patients with preexisting cardiovascular diseases are at an increased risk. 30% of patients with cardiac injury had a history of coronary heart disease.
Researchers have been looking into the different mechanisms that may result in cardiac injury. One of the possibilities is a cytokine storm.
When SARS-CoV-2 enters the body, it binds to the angiotensin-converting enzyme 2 (ACE2) receptor, which is present on the epithelial cells of various organs, including the lungs, intestine, and kidney. When immune cells are overproduced to counter the attack of the virus they release cytokines, or inflammatory molecules, into the blood. These cytokines eventually attack healthy tissue. In the lungs, inflamed alveolar cells are not able to receive adequate oxygen. This leads to acute respiratory distress syndrome (ARDS). The lower oxygen level can result in oxidative stress and ultimately lead to myocardial injury.
Image: How blood clots form in patients with COVID-19.
- ACE2 (angiotensin-converting enzyme 2) plays a crucial role in the cardiovascular system. It catalyzes the hydrolysis of angiotensin II to angiotensin (1-7), which is a vasodilator.
- ACE, on the other hand, cleaves the hormone angiotensin I to generate angiotensin II, a vasoconstrictor.
Another way in which COVID-19 may cause cardiac injury, is by binding to ACE2 receptors. This disturbs the renin-angiotensin system (RAS). RAS is a hormone system that controls blood pressure and vascular resistance. It depends on two different enzymes, ACE2 and ACE.The balance between ACE2 and ACE is crucial to maintaining blood pressure in the body.
COVID-19 causes various cardiovascular problems in patients, especially in those with preexisting conditions. Studying the different mechanisms in which the disease affects the heart and blood-vessels helps to develop better therapies for patients.
Marcel Levi. “Coagulation abnormalities and thrombosis in patients with COVID-19.” The Lancet Heamatology (May 2020).
Bhurint Siripanthong. “Recognizing COVID-19-related myocarditis: the possible pathophysiology and proposed guideline for diagnosis and management.” Heart Rhythm (May 2020).
Shaobo Shi. “Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China.” JAMA Cardiology (March 2020).
Florian Zores. “COVID and the Renin-Angiotensin System: Are Hypertension or Its Treatments Deleterious?” Frontiers in Cardiovascular Medicine (2020).
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