Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Int J Biol Sci. 2022 Mar 28;18(7):2703-2713. doi: 10.7150/ijbs.69677. eCollection 2022.
Coronavirus disease 2019 (COVID-19), a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) had resulted in considerable morbidity and mortality. COVID-19 primarily posed a threat to the respiratory system and violated many different organs, including the heart, kidney, liver, and blood vessels with the development of the disease. Severe patients were often accompanied by cardiac injury, and once the heart gets damaged, the mortality of patients will significantly increase. The main clinical manifestations of cardiac injury range from myocarditis, heart failure (HF), arrhythmia, and Takotsubo cardiomyopathy (TCM). A high abundance of angiotensin-converting enzyme II (ACE2) on the membrane of cardiomyocytes makes it possible that the virus can directly attack cardiomyocytes as subsequently evidenced by the detection of spike protein and virus RNA in autopsy cardiac tissues. The secondary myocardial injury through systemic inflammatory and immune response also caused obvious cardiac damage. The pathological manifestations of heart tissue were diverse, varied from mild cardiomyocyte edema, myocardial hypertrophy, cardiomyocyte degeneration, and necrosis to severe myocarditis caused by lymphocyte and macrophage infiltration. However, the mechanism of heart injury was still unclear. Here, we summarized the clinical manifestations and mechanism of SARS-CoV2 mediated cardiac injury, providing a reference for cardiac treatment in critically ill patients.
2019 年冠状病毒病（COVID-19）是一种由严重急性呼吸系统综合征冠状病毒 2（SARS-CoV2）引起的全球大流行疾病，导致了相当高的发病率和死亡率。COVID-19 主要威胁呼吸系统，并随着疾病的发展侵犯许多不同的器官，包括心脏、肾脏、肝脏和血管。重症患者常伴有心脏损伤，一旦心脏受损，患者的死亡率将显著增加。心脏损伤的主要临床表现包括心肌炎、心力衰竭（HF）、心律失常和 Takotsubo 心肌病（TCM）。心肌细胞膜上大量存在的血管紧张素转换酶 2（ACE2）使得病毒有可能直接攻击心肌细胞，随后在尸检心脏组织中检测到刺突蛋白和病毒 RNA 进一步证实了这一点。全身性炎症和免疫反应引起的继发性心肌损伤也导致了明显的心脏损伤。心脏组织的病理表现多种多样，从轻度心肌细胞水肿、心肌肥厚、心肌细胞变性、坏死到淋巴细胞和巨噬细胞浸润引起的严重心肌炎不等。然而，心脏损伤的机制仍不清楚。在这里，我们总结了 SARS-CoV2 介导的心脏损伤的临床表现和机制，为危重症患者的心脏治疗提供了参考。
