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

Claudio Napoli; Isabella Tritto; Giuditta Benincasa; Gelsomina Mansueto; Giuseppe Ambrosio

doi:10.1016/j.amsu.2020.07.054

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

Ann Med Surg (Lond). 2020 Aug 5:57:236-243. doi: 10.1016/j.amsu.2020.07.054. eCollection 2020 Sep.

Authors

Claudio Napoli^{1

2}, Isabella Tritto³, Giuditta Benincasa¹, Gelsomina Mansueto¹, Giuseppe Ambrosio³

Affiliations

¹ Clinical Department of Internal Medicine and Specialistic Units, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Naples, Italy.
² IRCCS SDN, Naples, Italy.
³ Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria Della Misericordia", Perugia, Italy.

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.

Publication types

Review