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Review
March 27, 2020

Potential Effects of Coronaviruses on the Cardiovascular System: A Review

Author Affiliations
  • 1McGovern Medical School, Department of Medicine, University of Texas Health Science Center at Houston, Houston
  • 2Texas Heart Institute, Houston
  • 3Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 4University of Minnesota, Minneapolis
JAMA Cardiol. Published online March 27, 2020. doi:10.1001/jamacardio.2020.1286
Abstract

Importance  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19) has reached a pandemic level. Coronaviruses are known to affect the cardiovascular system. We review the basics of coronaviruses, with a focus on COVID-19, along with their effects on the cardiovascular system.

Observations  Coronavirus disease 2019 can cause a viral pneumonia with additional extrapulmonary manifestations and complications. A large proportion of patients have underlying cardiovascular disease and/or cardiac risk factors. Factors associated with mortality include male sex, advanced age, and presence of comorbidities including hypertension, diabetes mellitus, cardiovascular diseases, and cerebrovascular diseases. Acute cardiac injury determined by elevated high-sensitivity troponin levels is commonly observed in severe cases and is strongly associated with mortality. Acute respiratory distress syndrome is also strongly associated with mortality.

Conclusions and Relevance  Coronavirus disease 2019 is associated with a high inflammatory burden that can induce vascular inflammation, myocarditis, and cardiac arrhythmias. Extensive efforts are underway to find specific vaccines and antivirals against SARS-CoV-2. Meanwhile, cardiovascular risk factors and conditions should be judiciously controlled per evidence-based guidelines.

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