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COVID-19 and the heart: what we have learnt so far
  1. Kunal Bikram Shaha1,
  2. Dhiraj Narayan Manandhar2,
  3. Jung Rae Cho3,
  4. Ashok Adhikari1,
  5. Man Bahadur K C4
  1. 1 Internal Medicine, Cardiology., Patan Academy of Health sciences, Lalitpur, Nepal
  2. 2 Nephrology, Nepal Medical College Teaching Hospital, Kathmandu, Nepal
  3. 3 Cardiology, Interventional., Kangnam Sacred Heart Hospital,HUMC, Yeongdeungpo-gu, Korea (the Republic of)
  4. 4 Cardiology, Electrophysiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
  1. Correspondence to Kunal Bikram Shaha, Patan Academy of Health Sciences, Lalitpur, Nepal; drshahakunal19{at}


Since the outbreak of COVID-19 or coronavirus disease caused by severe acute respiratory syndrome coronavirus 2 from Wuhan, China, the cardiology fraternity’s interest has been drawn towards the pandemic with a high case fatality rate of 10.5% and 6% in patients with heart disease and hypertension, respectively. One of the postulated mechanisms for this high fatality rate is the possible abundance of ACE type 2 receptor in the cardiovascular system that strongly binds with the spike protein of COVID-19 and helps internalise into the cell resulting in acute cardiac injury (ACI). More than 7% of cases with COVID-19 are reported to have this type of ACI. A tenfold rise in mortality has been observed in patients with COVID-19 who experience a rise in high-sensitivity (hs)-troponin. All most half of the patients who died of COVID-19 had a rise in hs-troponin. More than 15% of cases with COVID-19 experienced different types of arrhythmias. All these statistics denote how important cardiovascular pathology is in patients with COVID-19. Controversies of renin–angiotensin–aldosterone system inhibitors usage in patients with COVID-19 and meticulous handling of case with acute coronary syndrome categorically stresses cardiologists to bust the myths hovering around and set a standard guideline to counterfeit the fatality with timely diagnosis and treatment of COVID-19–induced ACI. In this review, we sought to summarise the current evidence of COVID-19-associated cardiac injury and suggest the implications for its proper diagnosis and treatment.

  • COVID-19
  • SARS-Cov-2
  • Carditis
  • Arrhythmias
  • Angiotensin receptor blocker

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  • Contributors Those who have participated sufficiently in the intellectual content, conception and design of this work or the analysis and interpretation of the data, as well as the writing of the manuscript, to take public responsibility have been listed as follows: Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; that is, core manuscript writing by KBS. Drafting the work or revising it critically for important intellectual content by DNM and JRC. RAAS blockers in COVID-19 and treatment sections have been revised by DNM. JRC has helped in revision of the manuscript as a whole and has been critical in providing the necessary correction. Essential consideration in COVID-19 and figure designing has been contributed by AA. Arrhythmias in COVID-19 section of the manuscript has been contributed by MBKC. All the authors are liable for the above contribution.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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