Post by Nadica (She/Her) on Sept 26, 2024 3:10:22 GMT
Coronary implications of COVID-19 - Published Sept 19, 2024
Abstract
Patients with COVID-19 are at increased risk of incident cardiovascular disease spanning several categories, such as acute myocardial injury/infarction, myocarditis, heart failure and arrhythmias. A growing volume of evidence correlates COVID-19 with myocardial injury, exposing patients to higher mortality risk. SARS-CoV-2 attacks the coronary arterial bed with various mechanisms including thrombosis/rupture of pre-existing atherosclerotic plaque, de novo coronary thrombosis, endothelitis, microvascular dysfunction, vasculitis, vasospasm and ectasia/aneurysm formation. The angiotensin-converting enzyme 2 (ACE2) receptor plays pivotal role on the cardiovascular homeostasis and the unfolding of COVID-19. The activation of the immune system, mediated by proinflammatory cytokines along with the dysregulation of the coagulation system can pose an insult on the coronary artery, which usually manifests as an acute coronary syndrome (ACS). Electrocardiogram, echocardiography, cardiac biomarkers and coronary angiography are essential tools to set the diagnosis. Revascularization is the first-line treatment in all patients with ACS and obstructed coronary arteries whereas in type 2 myocardial infarction treatment of hypoxia, anemia and systemic inflammation is indicated. In patients presenting with coronary vasospasm nitrates and calcium channel blockers are preferred while treatment of coronary ectasia/aneurysm mandates the use of antiplatelets/anticoagulants, corticosteroids, immunoglobulin and biologic agents. It is crucial to untangle the exact mechanisms of coronary involvement in COVID-19 in order to ensure timely diagnosis and appropriate treatment. We review the current literature and provide a detailed overview of the pathophysiology and clinical spectrum associated with coronary implications of SARS-COV-2 infection.
Abstract
Patients with COVID-19 are at increased risk of incident cardiovascular disease spanning several categories, such as acute myocardial injury/infarction, myocarditis, heart failure and arrhythmias. A growing volume of evidence correlates COVID-19 with myocardial injury, exposing patients to higher mortality risk. SARS-CoV-2 attacks the coronary arterial bed with various mechanisms including thrombosis/rupture of pre-existing atherosclerotic plaque, de novo coronary thrombosis, endothelitis, microvascular dysfunction, vasculitis, vasospasm and ectasia/aneurysm formation. The angiotensin-converting enzyme 2 (ACE2) receptor plays pivotal role on the cardiovascular homeostasis and the unfolding of COVID-19. The activation of the immune system, mediated by proinflammatory cytokines along with the dysregulation of the coagulation system can pose an insult on the coronary artery, which usually manifests as an acute coronary syndrome (ACS). Electrocardiogram, echocardiography, cardiac biomarkers and coronary angiography are essential tools to set the diagnosis. Revascularization is the first-line treatment in all patients with ACS and obstructed coronary arteries whereas in type 2 myocardial infarction treatment of hypoxia, anemia and systemic inflammation is indicated. In patients presenting with coronary vasospasm nitrates and calcium channel blockers are preferred while treatment of coronary ectasia/aneurysm mandates the use of antiplatelets/anticoagulants, corticosteroids, immunoglobulin and biologic agents. It is crucial to untangle the exact mechanisms of coronary involvement in COVID-19 in order to ensure timely diagnosis and appropriate treatment. We review the current literature and provide a detailed overview of the pathophysiology and clinical spectrum associated with coronary implications of SARS-COV-2 infection.