Table 1.
Pathogenetic mechanisms and clinical presentations of cardiovascular involvement seen in COVID-19 patients.
| Cardiovascular disease | Pathogenetic mechanism | Clinical presentation |
|---|---|---|
| ACS STE | Cytokine storm, hypercoagulability, plaque instability | Typical chest pain or atypical pain and/or dyspnea, elevated troponin, ECG changes and LV WMAs related to specific coronary artery territory distribution |
| ACS non-STE | Typical chest pain or atypical pain and/or dyspnea, elevated troponin, ECG changes (possible), LV WMAs (possible) related to specific coronary artery territory distribution | |
| Myocarditis | Cytokine storm, direct cellular damage (possible) | Chest pain (possible), dyspnea (possible), elevated troponin, ECG changes (possible), diffuse LV WMAs not related to specific coronary artery territory distribution |
| Pericarditis | Cytokine storm, direct cellular damage (possible) | Chest pain, dyspnea (possible), elevated troponin, ECG changes, impaired LV diastolic function and/or pericardial effusion |
| TTS | Emotional stress, microvascular and endothelial dysfunction, sepsis, acidosis | Chest pain and/or dyspnea, elevated troponin, ECG changes, LV WMAs not related to specific coronary artery territory distribution (circumferential pattern, apical ballooning most frequently) |
| PE | Hypercoagulability | Chest pain and/or dyspnea, elevated troponin (possible), ECG changes (possible), RV enlargement and dysfunction (McConnell sign, 60/60 sign) |
| Decompensated chronic HF | Hypoxia, elevated metabolic demand | Dyspnea, elevated troponin (possible), LV WMAs without de novo abnormalities |
| Acute myocardial injury | Cytokine storm, direct cellular damage (possible), microvascular and endothelial dysfunction, hypoxia | Chest pain and/or dyspnea (possible), elevated troponin, ECG changes (possible), LV WMAs (possible) not related to specific coronary artery territory distribution (if absence of coexistent CAD) |
ACS, acute coronary syndrome; CAD, coronary artery disease; CMR, cardiac magnetic resonance; CT, computed tomography; ECG, electrocardiogram; HF, heart failure; ICA, invasive coronary angiography; LV, left ventricular; PE, pulmonary embolism; RV, right ventricular; STE, ST-segment elevation; TTE, transthoracic echocardiography; TTS, takotsubo syndrome, WMAs, wall motion abnormalities.