SARS-CoV-2-Induced Damage on the Cardiovascular System: Molecular Mechanisms

Since its emergence in late December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - the causative agent of coronavirus disease 2019 (COVID-19) - has spread rapidly world-wide, becoming a global pandemic in March 2020 that is still active. In addition to the severe pulmonary damage, clinical studies have reported that COVID-19 is associated with the development of cardiovascular alterations such as myocardial injury, particularly in its most severe manifestations. At the same time, pre-existing cardiovascular conditions in COVID-19 cases have been related to an increased risk of adverse outcomes. To date, several mechanisms have been described to participate in the development of cardiovascular damage related to COVID-19, including direct SARS-CoV-2 infection of the cardiovascular system, Angiotensin-Converting Enzyme 2 (ACE2) downregulation, cytokine storm, coagulation abnormalities, hypoxia and drug-induced cardiotoxicity. However, the large amount of information gathered so far makes it difficult to keep up with this new pandemic. In the present review, we provide a clear insight of the extensive literature available and summarize the current understanding of COVID-19-related mechanisms behind SARS-CoV-2-induced damage to the cardiovascular system.