Cardiac diseases following COVID-19 in children and adults: A narrative review on mechanisms and medical implications

Objectives: In December 2019, SARS-CoV2 outbreak from China resulted in Covid-19 worldwide. The involvement of different organs, especially, heart disease can lead to hospitalization and enhance the rate of mortality and morbidity among severe patients. In a narrative review, we aimed to investigate the involvement of heart in adult and children with COVID-19 in critically ill patients. Methods: The clinical and paraclinical manifestation of diseases in adults and children were searched in standard databases, such as PubMed, Google Scholar, Scopus, est. Also, the possible underlying mechanisms were investigated. Results: The CVDs in COVID-19 patients has been characterized by several abnormalities such as myocarditis, acute myocardial injury, acute coronary syndrome, heart failure, arrhythmias, sudden cardiac arrest, coagulation abnormalities, thrombosis, and Kawasaki disease. The most probable mechanisms are attributed to SARS-CoV2 direct and indirect effects. The presence of angiotensin-converting enzyme 2 (ACE2) was confirmed in the cardiac tissue, confirming the direct attack of virus. Moreover, the cytokine storm as a result of enhanced levels of inflammatory mediators and infiltration of inflammatory cells into the cardiac disease, coagulation abnormalities, and endothelial dysfunction contribute to disease. Conclusion: Cardiac diseases are seen in children and adults with COVID-19, related to the different mechanisms, mainly direct attack of virus and cytokine storm. Increasing the knowledge of cardiologists about the cardiac manifestations of COVID-9 in children and adults and underlying mechanisms can improve the consequences and reduce the mortality and morbidity rate among hospitalized patients.