1,2 Binding of COVID-19 to the angiotensin converting enzyme 2 (ACE2) protein found on the cellular membrane of cardiomyocytes raised theoretical concerns for direct viral injury and myocarditis. The first studies from China described troponin elevation in 20-40% of hospitalized patients.
Here, we review our current understanding of the implications of COVID-19 on the cardiovascular system, both in acute infection (mechanisms of cardiac injury, prognostic implications of troponin elevation, and role of cardiac magnetic resonance imaging ) and resolved infection (considerations for athletes and those with "long COVID").Įarly in the pandemic, the prevalence of cardiac injury during acute COVID-19 emerged. However, with vaccines now available, we can begin to devote some attention to long-term consequences for survivors. The delay until herd immunity and emergence of variants will necessitate that the cardiology community remain up-to-date managing complications of acute infection. We are now at a unique juncture in the pandemic. Our understanding of the cardiovascular consequences of COVID-19, the disease stemming from infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is evolving rapidly. In resolved infection, special attention should be paid to athletes at-risk for exercise-induced arrythmias, as well as survivors with residual cardiopulmonary symptoms.In acute infection, troponin elevation is more commonly a consequence of indirect cardiac injury from critical illness and multi-organ dysfunction than direct viral damage to the heart.COVID-19 infection has both intermediate and long-term consequences for the cardiovascular system.
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