Coronavirus and Cardiovascular Disease, Myocardial Injury, and Arrhythmia: JACC Focus Seminar

Gennaro Giustino, Sean P. Pinney, Anuradha Lala, Vivek Y. Reddy, Hillary A. Johnston-Cox, Jeffrey I. Mechanick, Jonathan L. Halperin, Valentin Fuster

Research output: Contribution to journalReview articlepeer-review

115 Scopus citations


The cardiovascular system is affected broadly by severe acute respiratory syndrome coronavirus 2 infection. Both direct viral infection and indirect injury resulting from inflammation, endothelial activation, and microvascular thrombosis occur in the context of coronavirus disease 2019. What determines the extent of cardiovascular injury is the amount of viral inoculum, the magnitude of the host immune response, and the presence of co-morbidities. Myocardial injury occurs in approximately one-quarter of hospitalized patients and is associated with a greater need for mechanical ventilator support and higher hospital mortality. The central pathophysiology underlying cardiovascular injury is the interplay between virus binding to the angiotensin-converting enzyme 2 receptor and the impact this action has on the renin-angiotensin system, the body's innate immune response, and the vascular response to cytokine production. The purpose of this review was to describe the mechanisms underlying cardiovascular injury, including that of thromboembolic disease and arrhythmia, and to discuss their clinical sequelae.

Original languageEnglish
Pages (from-to)2011-2023
Number of pages13
JournalJournal of the American College of Cardiology
Issue number17
StatePublished - 27 Oct 2020


  • COVID-19
  • SARS-CoV-2
  • arrhythmia
  • myocardial injury
  • thrombosis


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