Cardiovascular implications of COVID-19

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, is now recognized as a multisystem disease with substantial cardiovascular involvement contributing to both acute and long-term morbidity. Cardiovascular manifestations range from myocardial injury and arrhythmias to thromboembolic disease, acute coronary syndromes, and heart failure, affecting both adult and pediatric populations. This narrative review provides a clinically oriented synthesis of the major cardiovascular manifestations associated with COVID-19. Current evidence indicates that myocardial injury, myocarditis, heart failure, arrhythmias, thromboembolic events, ischemic stroke, acute coronary syndromes, and pericardial disease arise through interconnected mechanisms involving endothelial dysfunction, systemic inflammation, immune dysregulation, and hypercoagulability. Older age, male sex, and pre-existing cardiovascular disease are consistently associated with worse outcomes. Although children generally experience milder disease, cardiovascular complications may occur, particularly in the setting of multisystem inflammatory syndrome in children. Emerging evidence also suggests persistent cardiovascular sequelae following acute infection, underscoring the importance of long-term surveillance and multidisciplinary follow-up, particularly among high-risk individuals. COVID-19 should be regarded as a multisystem disease with important short- and long-term cardiovascular implications. Recognizing shared pathophysiologic mechanisms may facilitate early risk stratification, targeted diagnostic evaluation, and appropriate longitudinal follow-up, particularly among high-risk populations. Further studies are needed to clarify long-term cardiovascular outcomes and optimize preventive and therapeutic strategies.