Cardiac diseases following COVID-19 in children and adults: A narrative review on mechanisms and medical implications
DOI:
https://doi.org/10.22317/imj.v5i3.1044Keywords:
COVID-19, SARS-CoV2, Cardiac diseases, ACE2, InflammationAbstract
Objectives: In December 2019, SARS-CoV2 outbreak from China resulted in Covid-19 worldwide. The involvement of different organs, especially, heart disease can lead to hospitalization and enhance the rate of mortality and morbidity among severe patients. In a narrative review, we aimed to investigate the involvement of heart in adult and children with COVID-19 in critically ill patients.
Methods: The clinical and paraclinical manifestation of diseases in adults and children were searched in standard databases, such as PubMed, Google Scholar, Scopus, est. Also, the possible underlying mechanisms were investigated.
Results: The CVDs in COVID-19 patients has been characterized by several abnormalities such as myocarditis, acute myocardial injury, acute coronary syndrome, heart failure, arrhythmias, sudden cardiac arrest, coagulation abnormalities, thrombosis, and Kawasaki disease. The most probable mechanisms are attributed to SARS-CoV2 direct and indirect effects. The presence of angiotensin-converting enzyme 2 (ACE2) was confirmed in the cardiac tissue, confirming the direct attack of virus. Moreover, the cytokine storm as a result of enhanced levels of inflammatory mediators and infiltration of inflammatory cells into the cardiac disease, coagulation abnormalities, and endothelial dysfunction contribute to disease.
Conclusion: Cardiac diseases are seen in children and adults with COVID-19, related to the different mechanisms, mainly direct attack of virus and cytokine storm. Increasing the knowledge of cardiologists about the cardiac manifestations of COVID-9 in children and adults and underlying mechanisms can improve the consequences and reduce the mortality and morbidity rate among hospitalized patients.
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3. Sahu KK, Mishra AK, Lal A. Comprehensive update on current outbreak of novel coronavirus infection (2019-nCoV). Ann Transl Med. 2020;8(6):393-.
4. Vuorinen V, Aarnio M, Alava M, Alopaeus V, Atanasova N, Auvinen M, et al. Modelling aerosol transport and virus exposure with numerical simulations in relation to SARS-CoV-2 transmission by inhalation indoors. Saf Sci. 2020;130:104866-.
5. Zhang H, Kang Z, Gong H, Xu D, Wang J, Li Z, et al. The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes. BioRxiv. 2020.
6. Xiao S, Luo D, Xiao Y. Survivors of COVID-19 are at high risk of posttraumatic stress disorder. Global Health Research and Policy. 2020;5(1):29.
7. Lei F, Liu YM, Zhou F, Qin JJ, Zhang P, Zhu L, et al. Longitudinal Association Between Markers of Liver Injury and Mortality in COVID-19 in China. Hepatology. 2020;72(2):389-98.
8. Baud D, Qi X, Nielsen-Saines K, Musso D, Pomar L, Favre G. Real estimates of mortality following COVID-19 infection. Lancet Infect Dis. 2020.
9. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney international. 2020.
10. Chen J, Zhang Z-Z, Chen Y-K, Long Q-X, Tian W-G, Deng H-J, et al. The clinical and immunological features of pediatric COVID-19 patients in China. Genes & Diseases. 2020.
11. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020.
12. Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nature Medicine. 2020;26(7):1017-32.
13. Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola A, et al. Management Of Patients On Dialysis And With Kidney Transplant During SARS-COV-2 (COVID-19) Pandemic In Brescia, Italy. Kidney International Reports. 2020.
14. Bansal M. Cardiovascular disease and COVID-19. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020;14(3):247-50.
15. Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P, et al. Coronavirus infections and immune responses. J Med Virol. 2020;92(4):424-32.
16. Prasad A, Prasad M. SARS-CoV-2: the emergence of a viral pathogen causing havoc on human existence. Journal of Genetics. 2020;99(1).
17. Diaz JH. Hypothesis: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19. J Travel Med. 2020.
18. Zhu Z, Lian X, Su X, Wu W, Marraro GA, Zeng Y. From SARS and MERS to COVID-19: a brief summary and comparison of severe acute respiratory infections caused by three highly pathogenic human coronaviruses. Respiratory research. 2020;21(1):1-14.
19. Zhang X-Y, Huang H-J, Zhuang D-L, Nasser MI, Yang M-H, Zhu P, et al. Biological, clinical and epidemiological features of COVID-19, SARS and MERS and AutoDock simulation of ACE2. Infectious Diseases of Poverty. 2020;9(1):99.
20. Yan R, Zhang Y, Li Y, Xia L, Guo Y, Zhou Q. Structural basis for the recognition of SARS-CoV-2 by full-length human ACE2. Science. 2020;367(6485):1444-8.
21. Kuba K, Imai Y, Ohto-Nakanishi T, Penninger JM. Trilogy of ACE2: a peptidase in the renin-angiotensin system, a SARS receptor, and a partner for amino acid transporters. Pharmacol Ther. 2010;128(1):119-28.
22. Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive care medicine. 2020:1-5.
23. Mokhtari T, Hassani F, Ghaffari N, Ebrahimi B, Yarahmadi A, Hassanzadeh G. COVID-19 and multiorgan failure: A narrative review on potential mechanisms. Journal of Molecular Histology. 2020:1-16.
24. Mohammad M, Payam S, Scott D, Orly V. Potential Effects of Coronaviruses on the Cardiovascular System A Review. JAMA Cardiol doi.10.
25. Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, et al. COVID-19 and cardiovascular disease. Circulation. 2020;141(20):1648-55.
26. Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. Journal of the American College of Cardiology. 2020;75(18):2352-71.
27. Zheng Y-Y, Ma Y-T, Zhang J-Y, Xie X. COVID-19 and the cardiovascular system. Nature Reviews Cardiology. 2020;17(5):259-60.
28. Bansal M. Cardiovascular disease and COVID-19. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020.
29. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020;395(10223):497-506.
30. Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. Jama. 2020;323(14):1406-7.
31. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet. 2020.
32. Guo T, Fan Y, Chen M. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19)[e-pub ahead of print]. JAMA Cardiol. 2020.
33. Deng Q, Hu B, Zhang Y, Wang H, Zhou X, Hu W, et al. Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China. International journal of cardiology. 2020.
34. Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D, et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA cardiology. 2020.
35. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet respiratory medicine. 2020;8(4):420-2.
36. Tavazzi G, Pellegrini C, Maurelli M, Belliato M, Sciutti F, Bottazzi A, et al. Myocardial localization of coronavirus in COVIDâ€19 cardiogenic shock. European journal of heart failure. 2020.
37. Oudit G, Kassiri Z, Jiang C, Liu P, Poutanen S, Penninger J, et al. SARSâ€coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. European journal of clinical investigation. 2009;39(7):618-25.
38. Bangalore S, Sharma A, Slotwiner A, Yatskar L, Harari R, Shah B, et al. ST-segment elevation in patients with Covid-19—a case series. New England Journal of Medicine. 2020.
39. Stefanini GG, Montorfano M, Trabattoni D, Andreini D, Ferrante G, Ancona M, et al. ST-elevation myocardial infarction in patients with COVID-19: clinical and angiographic outcomes. Circulation. 2020.
40. Libby P, Tabas I, Fredman G, Fisher EA. Inflammation and its resolution as determinants of acute coronary syndromes. Circulation research. 2014;114(12):1867-79.
41. Bentzon JF, Otsuka F, Virmani R, Falk E. Mechanisms of plaque formation and rupture. Circulation research. 2014;114(12):1852-66.
42. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. Bmj. 2020;368.
43. Mehra MR, Ruschitzka F. COVID-19 Illness and Heart Failure: A Missing Link? JACC Heart Failure. 2020.
44. Fried JA, Ramasubbu K, Bhatt R, Topkara VK, Clerkin KJ, Horn E, et al. The variety of cardiovascular presentations of COVID-19. Circulation. 2020.
45. Prabhu SD. Cytokine-induced modulation of cardiac function. Circulation research. 2004;95(12):1140-53.
46. Liu K, Fang Y-Y, Deng Y, Liu W, Wang M-F, Ma J-P, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chinese medical journal. 2020.
47. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Jama. 2020;323(11):1061-9.
48. Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, et al. Out-of-hospital cardiac arrest during the Covid-19 outbreak in Italy. New England Journal of Medicine. 2020.
49. De Rosa S, Spaccarotella C, Basso C, Calabrò MP, Curcio A, Filardi PP, et al. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. European heart journal. 2020;41(22):2083-8.
50. Guan W-j, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x, et al. Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine. 2020;382(18):1708-20.
51. Wichmann D, Sperhake J. Lütgehetmann Met al. Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study Ann Intern Med2020 Doi. 2020;10:M20-2003.
52. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. The Lancet Infectious Diseases. 2020.
53. Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. The Lancet. 2020.
54. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. The Lancet. 2020;395(10237):1607-8.
55. Novel CPERE. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua liu xing bing xue za zhi= Zhonghua liuxingbingxue zazhi. 2020;41(2):145.
56. Ranabothu S, Onteddu S, Nalleballe K, Dandu V, Veerapaneni K, Veerapandiyan A. Spectrum of COVIDâ€19 in children. Acta paediatrica. 2020;109(9):1899-900.
57. Consiglio CR, Cotugno N, Sardh F, Pou C, Amodio D, Rodriguez L, et al. The immunology of multisystem inflammatory syndrome in children with COVID-19. Cell. 2020.
58. Dolhnikoff M, Ferranti JF, de Almeida Monteiro RA, Duarte-Neto AN, Gomes-Gouvêa MS, Degaspare NV, et al. SARS-CoV-2 in cardiac tissue of a child with COVID-19-related multisystem inflammatory syndrome. The Lancet Child & Adolescent Health. 2020;4(10):790-4.
59. Deza Leon MP, Redzepi A, McGrath E, Abdel-Haq N, Shawaqfeh A, Sethuraman U, et al. COVID-19–associated pediatric multisystem inflammatory syndrome. Journal of the Pediatric Infectious Diseases Society. 2020;9(3):407-8.
60. Maisch B. Cardio-Immunology of Myocarditis: Focus on Immune Mechanisms and Treatment Options. Front Cardiovasc Med. 2019;6:48.
61. Turner AJ, Hiscox JA, Hooper NM. ACE2: from vasopeptidase to SARS virus receptor. Trends in pharmacological sciences. 2004;25(6):291-4.
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Published
2021-09-26
How to Cite
Hassanzadeh, N., Ebrahimi, B., Moshkdanian, G., & Hosseinjani, E. (2021). Cardiac diseases following COVID-19 in children and adults: A narrative review on mechanisms and medical implications. Iraq Medical Journal, 5(3), 70–74. https://doi.org/10.22317/imj.v5i3.1044
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Review