Abstract

ZANATTA, João Marcos de Menezes  and  FALCAO, Luiz Menezes. The Impact of COVID-19 Outbreak on Cardiovascular Disease. Medicina Interna [online]. 2021, vol.28, n.1, pp.43-51.  Epub Mar 15, 2021. ISSN 0872-671X.  https://doi.org/10.24950/r/163/20/1/2021.

SARS-CoV-2, the novel coronavirus, surprised the world with its capacity of infection, causing a public health emergency concern with more than 3 million people affected in only four months and forcing public institutions to search for ways of obtaining the contention of the virus. The mortality rate is very different among the countries, considering their age structure and the percentage of comorbidities. Elderly and people with underlying diseases are more susceptible to develop severe cases of COVID-19 and have higher case fatality rate. Cardiovascular diseases have a particular importance, given that their prevalence is elevated and considering the infection pathophysiology. Virus uses angiotensin-converting enzyme (ACE) 2 receptors to invade the human cells. These receptors are mainly in the lungs and the heart. Besides the direct viral insult, hypoxia, cytokines storm and catecholamine’s liberation also affect these organs. In the heart, studies have shown that COVID-19 can cause myocarditis, ventricular arrhythmias, acute coronary syndrome and heart failure. Moreover, the cardiovascular insult may be the first manifestation of viral infection in some cases, which is a matter of increased concern during this pandemic. ACE inhibitors and angiotensin receptor blockers (ARB) are drugs of paramount importance in the treatment of cardiovascular diseases. However, studies suggested concern about these medications in COVID-19 because they could cause an ACE2 upregulation and increase the severity of the infection. To the best of our knowledge, no study demonstrated that ACE inhibitors or ARB are harmful and the main cardiovascular societies are recommending the continuity of the treatment.

Keywords : Cardiovascular Diseases; Coronavirus Infections; COVID-19; SARS-CoV-2.

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