Cardiovascular involvement during COVID-19 and clinical implications in elderly patients. A review

Abstract

SARS-CoV-2 betacoronavirus is responsible for the Corona Virus Disease 2019 (COVID-19) which has relevant pathogenic implications for the cardiovascular system. Incidence and severity of COVID-19 are higher in the elderly population (65 years and older). This may be due to higher frequency of comorbidities, but increased frailty and immunosenescence linked with aging may also contribute. Moreover, in elderly individuals, SARS-CoV-2 may adopt different molecular strategies to strongly impact on cardiac aging that culminate in exacerbating a pro-inflammatory state (cytokine storm activation), which, in turn, may lead to pulmonary vascular endothelialitis, microangiopathy, diffuse thrombosis, myocarditis, heart failure, cardiac arrhythmias, and acute coronary syndromes. All these events are particularly relevant in elderly patients, and deserve targeted cardiovascular treatments and specific management of repurposed drugs against COVID-19. We discuss current evidence about the cardiovascular involvement during COVID-19, and elaborate on clinical implications in elderly patients.

Keywords: ACE2; COVID-19; Cardiovascular drugs; Cytokine release syndrome; Heart failure; Inflammation; Myocarditis; SARS-Cov 2; Troponin; Vasculitis.

Fig. 1

Impact of SARS-CoV-2 infection on cardiovascular aging. Pathogenic mechanisms by which viral infection may have detrimental effects on the cardiovascular system, such as direct cardiac injury/stress, direct T cell and endothelium binding, and increased inflammation. By these ways, SARS-Cov-2 might early impact on prior structural heart and metabolic abnormalities characterizing the elderly patients. In the later stages of infection, the detrimental cytokine storm can in turn exacerbate the pro-inflammatory state leading to cardiovascular events and multiorgan failure.