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World J Cardiol. Oct 26, 2021; 13(10): 556-565
Published online Oct 26, 2021. doi: 10.4330/wjc.v13.i10.556
Coronavirus and cardiovascular manifestations- getting to the heart of the matter
Monika Bhandari, Akshyaya Pradhan, Pravesh Vishwakarma, Rishi Sethi
Monika Bhandari, Akshyaya Pradhan, Pravesh Vishwakarma, Rishi Sethi, Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
Author contributions: Pradhan A and Bhandari M conceived the project; Pradhan A and Vishwakarma P did the literature review; Bhandari M prepared the first draft; Sethi R critically reviewed it; Bhandari M and Vishwakarma P prepared the revised manuscript; Pradhan A submitted the original manuscript and collaborated with Bhandari M for revising the manuscript and submitted it.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Akshyaya Pradhan, MBBS, MD, DM, FACC, FSCAI Additional Professor, Department of Cardiology, King George's Medical University, Shahmina Road, Chowk, Lucknow 226003, Uttar Pradesh, India. akshyaya33@gmail.com
Received: June 21, 2021
Peer-review started: June 21, 2021
First decision: July 30, 2021
Revised: August 7, 2021
Accepted: September 16, 2021
Article in press: September 16, 2021
Published online: October 26, 2021
Processing time: 121 Days and 22.7 Hours
Abstract

Coronavirus disease has unarguably been the largest pandemic of recent times. Over 150 million cases have occurred worldwide, and more than 3 million have succumbed to the disease. Cardiac manifestations can have varied presentations from an asymptomatic troponin rise to fulminant myocarditis. The pathogenesis of myocardial damage could be direct or indirect, including inflammation, coronary spasm, plaque rupture, and cytokine storm. Thromboembolism is also an important feature of cardiovascular affliction with both arterial and venous systems being affected. Hence, anticoagulation has also been a matter of debate. Fulminant myocarditis is the most severe form and can lead to circulatory shock with a high mortality. Management of cardiac patients with coronavirus disease 2019 (COVID-19) infection is not considerably different from non-COVID-19 cardiovascular disease, but interaction between cardiovascular drugs and anti-COVID-19 therapy requires careful attention. More recently, vaccines have emerged as a ray of hope for the disease. But simultaneously, there have been reports of thromboembolism following vaccination. In this review, we discuss the various aspects of coronavirus disease affecting of heart and its management.

Keywords: Myocarditis, Cytokine storm, Angiotensin-converting enzymes-2, Acute coronary syndrome, Hypercoagulable state, Vaccine

Core Tip: Coronavirus affects various parts of cardiovascular (CV) system. Acute coronary syndromes, myocarditis, tachyarrhythmia, heart failure and shock can be the various manifestations. The mechanism of cardiac involvement can be direct or indirect via cytokine storm ,inflammation and thromboembolism. Thromboembolism is particularly more common in coronavirus disease (COVID) infection and so is bleeding making anticoagulation a daunting task. Management of cardiac manifestations is not very different from a non COVID patient and needs diligent effort due to the need for preventing transmission to health care workers. Undoubtedly, cardiac involvement portends poor prognosis and antecedent cardiovascular disease is abundant among non-survivors. Adequate control of CV risk factors, prompt recognition of symptoms, timely management and early vaccination hold the key to victory against the coronavirus onslaught on the heart. Reports of thromboembolism have also emerged after COVID-19 vaccination but the incidence is rare.