Abstract
Coronary heart disease (CHD) is the leading cause of mortality worldwide. One of the main contributions of mortality and morbidity in CHD patients is acute myocardial infarction (AMI), which is the result of abrupt occlusion of an epicardial coronary artery due to a sudden rupture of atherosclerotic plaque, causing myocardial ischemia. In the initial stage of myocardial ischemia, lack of oxygen and nutrient supply results in biochemical and metabolic changes within the myocardium. Depletion of oxygen switches the aerobic cellular metabolism to anaerobic metabolism and impairs the oxidative phosphorylation pathway eventually leading to cardiomyocyte death. Several studies suggest an interlink between COVID-19 and ischemic heart disease. An increased ACE2 receptor expression in the myocardium may partly contribute to the myocardial injuries that are observed in patients affected by SARS-CoV-2. Furthermore, pre-existing cardiovascular disease, in conjunction with an aggravated inflammatory response which causes an up-regulation in pro-inflammatory cytokines. Moreover, patients with atherosclerosis are observed to be more prone to ischemic attacks when affected by COVID-19, due to hypercoagulation in the blood as well as elevated pro-inflammatory markers.
Highlights
Ischemia is caused due to a reduction in blood flow in an area, as a result of a blockage in the blood vessel
One of the main contributions of mortality and morbidity in Coronary heart disease (CHD) patients is acute myocardial infarction (AMI), which is the result of abrupt occlusion of an epicardial coronary artery due to a sudden rupture of atherosclerotic plaque, causing myocardial ischemia
An occlusive thrombus may be formed over a ruptured coronary plaque, caused by inflammation leading to endothelial dysfunction and elevated procoagulant activity of blood and it is safe to hypothesize that preexisting cardiovascular disease, in conjunction with an aggravated inflammatory response may result in cardiac injury, in patients that are infected with SARS-CoV-2
Summary
Ischemia is caused due to a reduction in blood flow in an area, as a result of a blockage in the blood vessel. It has been noted that light should be shone onto the protection of the cardiovascular system while treating patients with COVID-19, as when severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects the host cell, acute myocardial injury is seen to take place, along with chronic damage to the cardiovascular system [17]. Acute respiratory failure causes hypoxemia (reduced oxygen supply) and activates the sympathetic nervous system which increases the heart rate, cardiac output and myocardial contractility—leading to increased oxygen demand. This imbalance can lead to myocardial injury or MI, termed as type 2. S1 and S2 remain non-covalently bound to one another [30]
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