COVID - 19 - a New Challenging Disease for Intensivists and Cardiologists. From Basic Science to the Clinical Setting


  • Robert Skalik Wroclaw Medical University, Wroclaw, Poland



COVID-19, Symptoms, Pathophysiologic mechanisms, Cardiovascular diseases, New Therapies


A novel coronavirus causing Acute Respiratory Distress Syndrome (SARS-CoV-2) has been considered the cause of a large number of lower respiratory tract infections leading to severe respiratory failure in many cases. However, the evidence-based hospital reports show that the COVID -19 infestation may range from an asymptomatic or minimally symptomatic course with an almost bizarre deterioration of life parameters (“silent hypoxia”) through to critically ill patients with multiple organ failure including that of the lungs, kidneys, nervous system and other organs. Moreover, this coronavirus disease may cause significant lung damage in asymptomatic COVID-19 positive patients who recover at home.

The virus enters through the angiotensin-converting enzyme 2 receptor (ACE2) widely expressed in the cardiovascular system and other organs and tissues, which can result in myocardial injury, myocarditis, acute myocardial infarction, heart failure, arrhythmias, brain stroke, acute pleuritis, pneumonia and venous thromboembolic events. COVID -19 - induced failure of some central mechanisms controlling breathing and the circulation may explain the mismatch between the clinical symptoms and the objective physiologic life parameters in many patients treated by intensivists or cardiologists. The severity of coronavirus disease is dependent on numerous factors including the magnitude of the host immune response, the impairment of central and peripheral nervous system, age, co-morbidities (e.g. diabetes, arterial hypertension, obesity, chronic heart failure) and presumably genetic proclivity. A brand-new treatment approach with use of alternative or experimental therapies such us Extracorporeal Membrane Oxygenation (ECMO), plasmapheresis, proinflammatory interleukins - targeted drugs, covalescent plasma transfusion, virus replication inhibitors is obviously needed in some COVID-19 patients.


Krajewska J, Krajewski W, Zub K et al. COVID-19 in otolaryngologist practice: a review of current knowledge. Eur Arch Otorhinolaryngol. 2020; doi: 10.1007/s00405-020-05968-y.

Radovanovic D, Rizzi M , Pini S et al. Helmet CPAP to Treat Acute Hypoxemic Respiratory Failure in Patients with COVID-19: A Management Strategy Proposal. J Clin Med. 2020;9: doi: 10.3390/jcm9041191.

Richardson S , Hirsch JS , Narasimhan M et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA 2020; doi: 10.1001/jama.2020.6775.

Gattinoni L, Coppola S, Cressoni M et al. Covid-19 Does Not Lead to a "Typical" Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2020;doi: 10.1164/rccm.202003-0817LE.

Deng Q , Hu B, Zhang Y et al. Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China. Int J Cardiol. 2020; doi: 10.1016/j.ijcard.2020.03.087.

Long B, Brady WJ, Koyfman A et al. Cardiovascular complications in COVID-19. Am J Emerg Med. 2020; doi: 10.1016/j.ajem.2020.04.048.

Całkosiński I, Skalik R, Borodulin-Nadzieja L et al. Influence of Inflammatory Reaction on Blood Concentration of Cholesterol And Other Biochemical Values With Regard To Cardiac Muscle Damage in Rats. Bull Vet Inst Pulawy. 2004; 48: 477-480.

Netland J, Meyerholz DK,Moore S et al. Severe acute respiratory syndrome coronavirus infection causes neuronal death in the absence of encephalitis in mice transgenic for human ACE2. J Virol. 2008;82:7264–7275.

Li YC , Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020; doi: 10.1002/jmv.25728.

Zhuang J, Zang N, Ye C et al. Lethal avian influenza A (H5N1) virus replicates in pontomedullary chemosensitive neurons and depresses hypercapnic ventilatory response in mice. Am J Physiol Lung Cell Mol Physiol. 2019;316:L525-L536.

Ponikowski P, Chua TP, Piepoli M et al. Augmented peripheral chemosensitivity as a potential input to baroreflex impairment and autonomic imbalance in chronic heart failure. Circulation. 1997;96:2586-2594.

Beitler JR, Malhotra A and Thomson BT. Ventilator-Induced Lung Injury. Clin Chest Med. 2016; 37: 633–646.

Rizzo P, Vieceli Dalla Sega F, Fortini F et al. COVID-19 in the heart and the lungs: could we "Notch" the inflammatory storm? Basic Res Cardiol. 2020 ;115:31.

Shewan LG, Coats AJS, Henein MY. Authors’ Responsibilities and Ethical Publishing. International Cardiovascular Forum Journal 2018;13:3-4, DOI: 10.17987/icfj.v13i0.525


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