COVID-19 and Cardiovascular Disease: Issues of Diagnosis and Treatment


Oleksii Korzh


COVID-19 affects not only the respiratory system, but also the cardiovascular system. The damage to the cardiovascular system in COVID-19 is multifactorial and several mechanisms are involved, including direct invasion, inflammation, thrombosis, autoantibody synthesis, and oxygen imbalance. The inflammation causes the release of cytokines, especially interleukin-6, and damage to cardiomyocytes. The overproduction of cytokines leads to an abnormal inflammatory response called a cytokine storm, which is believed to be the culprit in cardiovascular events in COVID-19 patients.

Cardiovascular disease is common in patients with COVID-19, and these patients are at increased risk of morbidity and mortality. There is still no data on cardiac dysfunction due to myocardial damage in patients recovering from COVID-19. Most often, this is normal heart function after complete recovery. But often there are myocardial damage and an increased level of troponin as a marker of the severity of the disease associated with a cytokine storm, hypoxia, vasopressors and blood clotting disorders. It is important for every physician to make a differential diagnosis between decompensated heart failure complicated by pulmonary infection and COVID-19 infection. Monitoring and influencing myocardial injury is extremely important in critically ill patients.

Treatment of COVID-19 patients with cardiovascular complications is mostly supportive. The role of pharmacological blocking of the reninangiotensin-aldosterone system in patients with cardiovascular disease and COVID-19 infection requires further research as the relationship appears to be very complex. To date, professional cardiological societies do not recommend canceling ACE inhibitors or agiotensin II receptor antagonists for patients taking these drugs for other indications. Special care should be taken about the potential cardiovascular side effects of the various therapies used to treat viral infections. When using them, daily monitoring of the QT interval on the ECG is proposed.


Distance learning
Author Biography

Oleksii Korzh, Kharkiv Medical Academy of Postgraduate Education

Oleksii M. Korzh,

Department of General Practice-Family Medicine


Hendren NS, Drazner MH, Bozkurt B, Cooper Jr LT. Description and proposed managemen of the acute COVID-19 cardiovascular syndrome. Circulation. 2020; 141:1903–14. doi:

Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic J Am Coll Cardil. 2020; 7:2352–71. doi:

Geng Y, Wei Z, Qian H, Huang J, Lodato R, Castriotta RJ. Pathophysiological characteristics and therapeutic approaches for pulmonary injury and cardiovascular complications of coronavirus disease 2019. Cardiovasc Pathol. 2020; 47:107228. doi:

Ge H, Wang X, Yuan X, Xiao G, Wang C, Deng T, et al. The epidemiology and clinical information about COVID-19. Eur J Clin Microbiol Infect Dis. 2020; doi:

Ruslie RH, Darmadi D. Coronavirus disease-19 and mental health. Open Access Maced J Med Sci. 2020;8: 268–71.

Siregar GA, Siregar GP, Darmadi D, Ruslie RH. Coronavirus Disease-19 and Liver Injury. Open Access Maced J Med Sci. 2020;8: 154–7.

Zhao M, Wang M, Zhang J, Ye J, Xu Y, Wang Z, et al. Advances in the relationship between coronavirus infection and cardiovascular disease. Biomed Pharmacother. 2020; 127:110230. doi:

Srivastava K. Association between COVID-19 and cardiovascular disease. Int J Cardiol Heart Vasc. 2020; 29:100583. doi:

Guzik TJ, Mohiddin SA, Dimarco A, Patel V, Savvatis K, Mareli-Berg FM, et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res. 2020; 30:cvaa106. doi:

Lazaridis C, Vlachogiannis NI, Bakogiannis C, Spyridopoulos I, Stamatelopoulos K, Kanakakis I, et al. Involvement of cardiovascular system as the critical point in coronavirus disease 2019 (COVID-19) prognosis and recovery. Hellenic J Cardiol. 2020; 20:30093-102. doi:

Siregar GA, Siregar GP, Darmadi D. Gastrointestinal Aspects of COVID-19: A Review. Open Access Maced J Med Sci. 2020;8: 52–4.

Ruslie RH, Darmadi D, Siregar GA. Pediatric immunization practice during coronavirus disease-2019 pandemic. Open Access Maced J Med Sci. 2020; 8: 258–60.

Ruslie RH, Darmadi D, Siregar GA. Susceptibility of coronavirus disease-19 in pediatric population. Open Access Maced J Med Sci. 2020; 8: 363–5.

Hafiane A. SARS-CoV-2 and the cardiovascular system. Clin Chim Acta. 2020; 510:311–6. doi:

de Vries AAF. SARS-CoV-2/COVID-19: a primer for cardiologists. Neth Heart J. 2020; 28:366–83. doi:

Tan W, Aboulhosn J. The cardiovascular burden of coronavirus disease 2019 (COVID-19) with a focus on congenital heart disease. Int J Cardiol. 2020; 309:70–7. doi:

Nishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol. 2020;17:543–58. doi:

Wu L, O’Kane AM, Peng H, Bi Y, Motriuk-Smith D, Ren J. SARS-CoV-2 and cardiovascular complications: from molecular mechanisms to pharmaceuti cal management. Biochem Pharmacol. 2020;178:114114. doi:

World Health Organization. Coronavirus disease (COVID-19) outbreak situation. Available from: Accessed: November 5, 2020.

Kang Y, Chen T, Mui D, Ferrari V, Jagasia D, Scherrer-Crosbie M, et al. Cardiovascular manifestations and treatment considerations in covid-19. Heart. 2020; 106:1132–41. doi:

Hu H, Ma F, Wei X and Fang Y. Coronavirus fulminant myocarditis saved with glucocorticoid and human immunoglobulin. Eur Heart J. March 16, 2020. doi: 10.1093/eurheartj/ehaa190. [epub ahead of print].

Hanley B, Lucas SB, Youd E et al. Autopsy in suspected COVID-19 cases. J Clin Pathol 2020;0:1–4.

Kai-Cai Liua, Ping Xub, Wei-Fu Lvc, et al. CT manifestations of coronavirus disease-2019: A retrospective analysis of 73 cases by disease severity. European Journal of Radiology 126 (2020) 108941.

Mehra MR, Ruschitzka F, COVID-19 Illness and Heart Failure: A Missing Link?, JACC: Heart Failure (2020), doi:

Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; doi:10.1001/jama.2020.1585

Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020. [epub ahead of print].

Han Y, Zeng H, Jiang H, et al. CSC Expert Consensus on Principles of Clinical Management of Patients with Severe Emergent Cardiovascular Diseases during the COVID-19 Epidemic. Circulation. 2020;48:189–194.

Sanders JM, Monogue ML, Jodlowski TZ, et al. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19) A Review. JAMA. doi:10.1001/jama.2020.6019

ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak. Available at: [Accessed 15 April 2020].

Oren O, Kopecky SL, Gluckman TJ et al. Coronavirus Disease 2019 (COVID-19): Epidemiology, Clinical Spectrum and Implications for the Cardiovascular Clinician. Available at: [Accessed 10 April 2020].