How Does COVID-19 Impact Patients With Cardiovascular Diseases?

In only a few short months, the COVID-19 pandemic has come to control almost every segment of our lives. Much like other respiratory viruses, SARS-CoV-2 is transmitted via contact, droplets, and aerosols. As such, no one seems to be completely safe. Even healthy people with fully functioning immune systems have succumbed to the novel virus, although the majority of them show only milder symptoms.

Wait, isn’t COVID-19 a respiratory disease?

To enter your cells, where it replicates and continues spreading, coronaviruses need to bind to them by sticking to a receptor on the cell membrane. They do that using the angiotensin-converting enzyme 2 (ACE2), mainly located in the respiratory tract, cardiovascular system, and kidneys, amongst others. This enzyme is a part of the renin-angiotensin-aldosterone system (RAAS), whose main purpose is to regulate blood pressure in the body.

The immune system reacts to the infection with an inflammatory response, which aims to remove the intruder, as well as the damaged host cells. However, if the inflammation is severe, it may disrupt some normal processes in the body. The effects of inflammation are proportional to the severity of the infection. If this happens in the lungs, the alveoli (air sacs) end up being filled with immune cells, fluid, and other debris, causing pneumonia. This makes it hard to breathe, so you receive less oxygen, which explains the need for artificial ventilation in these patients.

Other than regulating blood pressure, the RAAS plays a key role in the process of inflammation in the blood vessels. COVID-19 is thought to disrupt the RAAS, which may further lead to cardiovascular disorders, manifesting as atherosclerosis and high blood pressure. This is why apart from respiratory issues, a number of patients with COVID-19 will develop some kind of heart-related complications. That includes both chronic cardiovascular patients, and to a lesser extent, people who have previously never had any problems of this kind.

Some of these complications are caused by the infection itself, others due to inflammatory response, or even as a response to medications used in the treatment! Each of these mechanisms affects the normal function of the heart, whether we talk about arrhythmias, or even heart failure.

How does COVID-19 affect the cardiovascular system?

Widespread inflammations, such as in pneumonia, can have a serious impact on the cardiovascular system. For example, this process makes plaque in the blood vessels unstable, increasing their odds of detaching and clogging a blood vessel along the way, causing a stroke or a heart attack. 

Because inflammation is a process that requires energy, it also demands a high concentration of oxygen. Unfortunately, since COVID-19 primarily targets the lungs, the gas exchange can’t be efficiently performed, causing inadequate oxygen supply to the body, including the heart, making it even weaker.

Other than the damage caused by generalized inflammation, it seems that the virus can also directly affect the heart, inducing inflammation of the heart muscle (myocarditis). If the inflammation reaches the heart, it may no longer work properly. Eventually an abnormal heart rhythm can result, which, along with the fact that the weakened heart will pump less blood, may eventually lead to heart failure, if untreated.

Finally, it’s important to mention that some medications used to treat patients with COVID-19 may negatively impact the cardiovascular system.

Because of all these factors, it’s not hard to understand why cardiovascular complications are described in nearly one in five COVID-19 patients, especially having in mind that the majority of these patients already had some sort of chronic cardiovascular disease, such as chronic high blood pressure (hypertension) or diabetes.

Managing COVID-19 patients with cardiovascular complications

Furthermore, a debate ensued about the merits of continued ACE inhibitor drug use in COVID-19 patients with hypertension, keeping in mind the relation between the ACE2 receptor and the virus. The idea is that if ACE inhibitors are used, more ACE receptors will be present in the body, allowing the virus to find the cell and infect it more easily.

New studies recommend that, unless said otherwise, antihypertensive therapy should always be continued in chronic patients. The use of ACE inhibitors and statins shows positive, protective effects on the body, protecting the patient’s state as they battle a coronavirus infection. So, in this case, ACE inhibitors are thought to present more benefits than potential risks in COVID-19 patients with an underlying cardiovascular disease.

Since COVID-19 is a relatively new disease, there is simply not that much information on how the infection will affect cardiovascular function in the long term. When the initial wave of the pandemic is over, and the situation allows for more scientific work, the public will have more data, which will help develop more practical recommendations for these patients, according to the current situation.

Until then, it remains important to wash your hands frequently, maintain social distancing, and try to continue physical activity and balanced nutrition, to minimize your risk of contracting COVID-19.

Additionally, cardiovascular patients are advised to control their blood pressure and other heart-related parameters as usual, and try to avoid stress, but nevertheless to stay alert.