The cardiovascular system is often involved in SARS-CoV-2 infection, and patients with underlying cardiovascular disease (CVD) or with new onset cardiovascular complications need prompt diagnosis and treatment, as their prognosis is usually poorer ( Table 1). 2 The proinflammatory milieu may contribute to microvascular dysfunction and diffuse intravascular coagulation. 1 Of importance, host immune system dysregulation, which is a consequence of viral infection, has recently been found to be important in determining exaggerated cytokine release and inflammasome activation, which are respiratory and non-respiratory consequences of the disease. The SARS-CoV-2 host cell receptor, the angiotensin-converting enzyme 2 (ACE-2), is widely expressed in several organs, including the lung, heart, endothelial cells, kidney and intestine, thus explaining the detection of viral particles in cardiac pericytes and urinary and faecal samples. The mechanisms underlying the pathophysiology of COVID-19 and its systemic manifestations are not well understood. Even though the leading clinical manifestations of SARS-CoV-2 infection involve the respiratory tract, with a risk of worsening dyspnoea, oxygen blood desaturation and frequent need for orotracheal intubation, the involvement of other organs and systems, such as the cardiovascular system and the gastrointestinal tract, can lead to multiorgan failure with fatal consequences.
Over the past few months, health systems worldwide have been put to the test with the uncontrolled diffusion of a completely new disease with different levels of severity, and frequently, poor prognosis. Finally, on 11 March 2020, the WHO declared the coronavirus outbreak a pandemic. Within a few weeks, the contagion spread through China and South Korea, and the outbreak rapidly extended worldwide due to asymptomatic cases and modern travel.
In December 2019, several cases of interstitial pneumonia of unknown origin were detected in Wuhan, China, and on 9 January 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the causative agent of coronavirus disease 2019 (COVID-19).
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