Although COVID-19 was initially thought to be an infectious disease of the lungs, vascular inflammation and heart injury appear to be common features, occurring in 20% to 30% of hospitalized patients and contributing to 40% of deaths. The risk of death from COVID-19-related heart damage appears to be as or more important than other well-described risk factors, including age, diabetes, chronic pulmonary disease, or history of cardiovascular disease.
Compared with other recent major viral outbreaks, including severe acute respiratory syndrome (SARS-CoV-1) in 2002-2003, the COVID-19 pandemic, caused by novel coronavirus, SARS-CoV-2, appears to be less fatal but spreads more easily. Adults over age 60 are more susceptible to transmission with higher mortality, although researchers do not yet know why older individuals are more likely to get sick.
Although the majority of individuals with COVID-19 appear to recover well, a smaller number experience severe exaggerated inflammation throughout the body, known as cytokine storm. This systemic inflammation—carried through and affecting the entire vascular system—is seen in the most severe cases at advanced stage of the illness, leading to widespread blood clottingstroke, and damage to the heart and other organs.
In March, the American Heart Association, the Heart Failure Society of America and the American College of Cardiology jointly recommended continuation of angiotensin converting enzyme inhibitors (ACE-i) or angiotensin receptor blocker (ARB) medications for all patients already prescribed those medications for indications such as heart failure, hypertension, or ischemic heart disease. The statement remains valid today and indicates anyone with cardiovascular disease and COVID-19 should be fully evaluated before adding or removing any treatments. Any changes to treatment should be based on the latest scientific evidence and shared-decision making.
Nearly a quarter (23%) of individuals hospitalized for COVID-19 have experienced serious cardiovascular complications. Studies have shown 8% to 12% of all COVID-19 patients have acute cardiac injury. There are also case studies that indicate COVID-19 may lead to heart attacks, acute coronary syndromes, stroke, blood pressure abnormalities, clotting issues, diffuse myocarditis (heart muscle inflammation) and fatal arrhythmias (irregular heartbeats). Based on studies of similar viruses, researchers speculate that heart complications are possible even after recovery from COVID-19.
James Geyer, MD, and Thomas Patton, MD
Magdalena Szaflarski, PhD
Zehra Farzal, MD; Guillaume Lamotte MD, MSc; Elizabeth Mundel, MD; Laxman B. Bahroo, DO; and Fernando L. Pagan, MD