(searched for: A Review of Clinical Manifestation of COVID-19 Due to its Effect on the Vascular System)
Frontiers in Cardiovascular Medicine, Volume 7; doi:10.3389/fcvm.2020.598400
The coronavirus pandemic has reportedly infected over 31.5 million individuals and caused over 970,000 deaths worldwide (as of 22nd Sept 2020). This novel coronavirus, officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), although primarily causes significant respiratory distress, can have significant deleterious effects on the cardiovascular system. Severe cases of the virus frequently result in respiratory distress requiring mechanical ventilation, often seen, but not confined to, individuals with pre-existing hypertension and cardiovascular disease, potentially due to the fact that the virus can enter the circulation via the lung alveoli. Here the virus can directly infect vascular tissues, via TMPRSS2 spike glycoprotein priming, thereby facilitating ACE-2-mediated viral entry. Clinical manifestations, such as vasculitis, have been detected in a number of vascular beds (e.g., lungs, heart, and kidneys), with thromboembolism being observed in patients suffering from severe coronavirus disease (COVID-19), suggesting the virus perturbs the vasculature, leading to vascular dysfunction. Activation of endothelial cells via the immune-mediated inflammatory response and viral infection of either endothelial cells or cells involved in endothelial homeostasis, are some of the multifaceted mechanisms potentially involved in the pathogenesis of vascular dysfunction within COVID-19 patients. In this review, we examine the evidence of vascular manifestations of SARS-CoV-2, the potential mechanism(s) of entry into vascular tissue and the contribution of endothelial cell dysfunction and cellular crosstalk in this vascular tropism of SARS-CoV-2. Moreover, we discuss the current evidence on hypercoagulability and how it relates to increased microvascular thromboembolic complications in COVID-19.
Archives of Clinical and Biomedical Research, Volume 4, pp 584-594; doi:10.26502/acbr.50170127
Coronavirus disease 2019 (COVID-19) appears to raise significant public health concerns worldwide. COVID-19 can affect any organ, including the vascular system. Various clinical manifestations of COVID-19, including dermatological and renal manifestations, are likely to indicate vascular involvement. Vasculitis has been associated with COVID-19 as a potential pathological process in multiple cases but is not considered a primary pathology. The immune system produces a tremendous amount of pro-inflammatory cytokines due to COVID-19 infection. These pro-inflammatory cytokines cause endothelial dysfunction and thrombosis, which can lead to vasculitis. Further, COVID-19 can directly cause endothelial dysfunction by binding to angiotensin-converting enzyme 2 receptors of vascular endothelium. Ischemic changes and vessel thrombosis, which are common findings in vasculitis, were reported in histopathological examinations. Proper treatment and management of vasculitis associated with COVID-19 are our new concerns. This review article highlights some important clinical manifestations of COVID-19 infection due to its effect on the vascular system. The article also describes risk factors, pathogenesis, diagnosis, and possible treatment of this manifestation.