Cardiovascular damage in COVID – 19 patients: literature review

Liveta Straigytė1, Monika Briliūtė1

1Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania


The pandemic caused by Coronavirus (COVID – 19) infection has led to a major global crisis of the health system.  The most common symptoms of severe acute respiratory syndrome coronavirus 2  (SARS – CoV – 2) are fever, dry cough, dyspnea, fatigue, headache, and myalgia. The main focus of this literature review is to analyze the main possible mechanisms of cardiovascular damage in patients infected by COVID – 19. The most important risk factor for severe COVID – 19 infection is cardiovascular diseases. It is noticed that COVID – 19 patients with cardiovascular diseases tend to have higher mortality rates compared to those who do not have cardiovascular dysfunction. Although COVID – 19 infection primarily affects the respiratory system, it can also damage the cardiovascular system by both direct and indirect mechanisms. The following mechanisms of myocardial dysfunction have been described in the literature: interaction of the virus with angiotensin – converting enzyme 2 (ACE – 2), inflammatory prothrombotic effect to blood vessels, microvascular dysfunction and overactive and exaggerated immune response to inflammation called “cytokine storm”. Moreover, cardiovascular complications may be caused by still an experimental, but widely used treatment for COVID – 19 infection.  The usage of the antimalarial drugs chloroquine/hydroxychloroquine, with or without azithromycin to treat COVID – 19, has been reported to prolong the QTc interval on the ECG for patients with COVID –  19. The myocardial damage contributes to severe arrhythmias due to QTc prolongation, and the risk of cardiac arrhythmias is particularly increased by combined therapy (chloroquine/hydroxychloroquine with azithromycin).

Keywords : COVID – 19, myocardium, SARS – CoV –  2, coronavirus.