Zhou Sufeng, Zhang Anchen, Liao Hua, Liu Zhebo, Yang Feiyan
Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Cardiology. 2024;149(1):60-70. doi: 10.1159/000533359. Epub 2023 Aug 16.
The coronavirus disease 2019 (COVID-19) involves all organs of the body, of which the interaction with cardiovascular diseases is the most important.
Numerous studies have reported that COVID-19 patients complicated with cardiovascular comorbidities (hypertension, coronary heart disease, chronic heart failure (HF), cerebrovascular disease) are more likely to develop into critical illness and have higher mortality. Conversely, COVID-19 may also cause myocardial injury in patients through various pathological mechanisms such as direct virus attack on cardiomyocytes, overactivation of immune response, microthrombus formation, which may lead to fatal acute ST-segment elevation myocardial infarction, arrhythmia, acute worsening of chronic HF, etc. In addition, the symptoms of the so-called long-COVID may remain in some patients who survived the acute viral infection. Positional tachycardia has been widely reported, and cardiovascular autonomic disorders are thought to play a pathogenic role.
The review summarizes the interaction between COVID-19 and cardiovascular disease in terms of pathological mechanism, clinical features, and sequelae. Therapeutic and rehabilitation programs after COVID-19 infection are compiled and need to be further standardized in the future.
2019冠状病毒病(COVID-19)累及身体所有器官,其中与心血管疾病的相互作用最为重要。
众多研究报告称,合并心血管疾病(高血压、冠心病、慢性心力衰竭(HF)、脑血管疾病)的COVID-19患者更易发展为危重症且死亡率更高。相反,COVID-19也可能通过多种病理机制导致患者心肌损伤,如病毒直接攻击心肌细胞、免疫反应过度激活、微血栓形成等,这可能导致致命的急性ST段抬高型心肌梗死、心律失常、慢性HF急性加重等。此外,在一些从急性病毒感染中存活下来的患者中,可能会残留所谓的“长新冠”症状。体位性心动过速已被广泛报道,且认为心血管自主神经功能障碍起致病作用。
本综述从病理机制、临床特征和后遗症方面总结了COVID-19与心血管疾病之间的相互作用。编制了COVID-19感染后的治疗和康复方案,未来还需要进一步规范。