Cardiovascular Complications Associated with COVID-19 and Potential Therapeutic~Strategies

Int J Mol Sci. 2020 Sep 16;21(18):6790. doi: 10.3390/ijms21186790.


The outbreak of coronavirus disease 2019 (COVID-19), an infectious disease with severe acute respiratory syndrome, has now become a worldwide pandemic. Despite the respiratory complication, COVID-19 is also associated with significant multiple organ dysfunction, including severe cardiac impairment. Emerging evidence reveals a direct interplay between COVID-19 and dire cardiovascular complications, including myocardial injury, heart failure, heart attack, myocarditis, arrhythmias as well as blood clots, which are accompanied with elevated risk and adverse outcome among infected patients, even sudden death. The proposed pathophysiological mechanisms of myocardial impairment include invasion of SARS-CoV-2 virus via angiotensin-converting enzyme 2 to cardiovascular cells/tissue, which leads to endothelial inflammation and dysfunction, de-stabilization of vulnerable atherosclerotic plaques, stent thrombosis, cardiac stress due to diminish oxygen supply and cardiac muscle damage, and myocardial infarction. Several promising therapeutics are under investigation to the overall prognosis of COVID-19 patients with high risk of cardiovascular impairment, nevertheless to date, none have shown proven clinical efficacy. In this comprehensive review, we aimed to highlight the current integrated therapeutic approaches for COVID-19 and we summarized the potential therapeutic options, currently under clinical trials, with their mechanisms of action and associated adverse cardiac events in highly infectious COVID-19 patients.

Keywords: COVID-19; cardiovascular diseases; treatment strategies.

Publication types

  • Review

MeSH terms

  • Angiotensin-Converting Enzyme 2
  • Antiviral Agents / pharmacology
  • Antiviral Agents / therapeutic use
  • Betacoronavirus / genetics
  • Betacoronavirus / isolation & purification
  • Betacoronavirus / physiology
  • COVID-19
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / etiology
  • Coronavirus Infections / complications
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / pathology*
  • Coronavirus Infections / virology
  • Genome, Viral
  • Humans
  • Lung Diseases / diagnosis
  • Lung Diseases / etiology
  • Lung Diseases / mortality
  • Pandemics
  • Peptidyl-Dipeptidase A / metabolism
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / pathology*
  • Pneumonia, Viral / virology
  • Renin-Angiotensin System
  • SARS-CoV-2
  • Virus Replication / drug effects


  • Antiviral Agents
  • Peptidyl-Dipeptidase A
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2