ABC | Volume 114, Nº5, May 2020

Viewpoint COVID-19: Updated Data and its Relation to the Cardiovascular System Filipe Ferrari 1 Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, 1 RS – Brazil Abstract In December 2019, a new human coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS‑CoV-2) or coronavirus disease 2019 (COVID-19) by the World Health Organization, emerged in the city of Wuhan, China. Spreading globally, it is now considered pandemic, with approximately 3 million cases worldwide at the end of April. Its symptoms include fever, cough, and headache, but the main one is shortness of breath. In turn, it is believed that there is a relationship between COVID-19 and damage to the heart muscle, and hypertensive and diabetic patients, for example, seem to have worse prognosis. Therefore, COVID-19 may worsen in individuals with underlying adverse conditions, and a not negligible number of patients hospitalized with this virus had cardiovascular or cerebrovascular diseases. Systemic inflammatory response and immune system disorders during disease progression may be behind this association. In addition, the virus uses angiotensin-converting enzyme (ACE) receptors, more precisely ACE2, to penetrate the cell; therefore, the use of ACE inhibitor drugs and angiotensin receptor blockers could cause an increase in these receptors, thus facilitating the entry of the virus into the cell. There is, however, no scientific evidence to support the interruption of these drugs. Since they are fundamental for certain chronic diseases, the risk and benefit of their withdrawal in this scenario should be carefully weighed. Finally, cardiologists and health professionals should be aware of the risks of infection and protect themselves as much as possible, sleeping properly and avoiding long working hours. Introduction In December 2019, in the city of Wuhan, China, there was an explosion of cases of pneumonia caused by a novel coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 1 identified as the agent that causes the disease called coronavirus disease 2019 (COVID-19), which is the name officially adopted by the World Health Organization. COVID-19 is a condition that can affect the lungs, respiratory tract, and others systems. Phylogenetic data imply a zoonotic origin, 2 and it has been shown that the transmission of the virus occurs from person to person. It has been detected in sputum, saliva, throat and nasopharyngeal swabs. 3 Therefore, it can spread through small droplets released from the nose and mouth of infected individuals. Some of the most observed symptoms are fever, fatigue, dry cough, upper airway congestion, sputum production, myalgia/arthralgia with lymphopenia, and prolonged prothrombin time. 4 However, one of the main symptoms may be shortness of breath. Although evidence on the specific effects of COVID-19 on the cardiovascular system is still little-known, there are reports of arrhythmias, acute cardiac injury, tachycardia, and a high burden of concomitant cardiovascular disease in infected individuals, particularly in those with higher comorbidities and risk factors who require more intensive care. 5 Diagnosis of SARS-CoV-2 can be made by electron microscopy morphology, but the method currently considered the gold standard is detection of nucleic acid in nasal swab, throat samples, or other respiratory tract samples by real time polymerase chain reaction (PCR), which is later confirmed by next generation sequencing. 6 Finally, it should be noted that the best treatment is still prevention, and simple measures such as washing hands with soap, using alcohol gel, and disinfecting surfaces such as cell phones play an essential role in reducing the spread of the virus. Epidemiology Adults and the Elderly More recent data indicate that by April 23 the number of confirmed cases of COVID-19 exceeded 2,700,000 worldwide. 7 On January 30, 2020, 9,976 cases of COVID-19 had been reported in at least 21 countries. 8 One month later, 83,652 cases were confirmed, with 2,791 deaths (3.4% mortality). 9 Cases were reported in 24 countries on 5 continents. 10 In Brazil, specifically, by March 3, 488 suspected cases had been registered, in 23 states. 11 In addition, as of April 23, approximately 49,500 cases and 3,313 deaths had been confirmed by COVID-19 in Brazil. 12 In Italy, on February 20, a young man in the Lombardy Region was hospitalized with an atypical pneumonia that later proved to be COVID-19. In the following 24 hours, there were 36 more cases, none of which had been in contact with the first patient or anyone known to have COVID-19. 13 Unfortunately, despite aggressive containment efforts, the disease continues to spread and the number of affected patients is increasing. The fatality rate is not low, and it is dominated by elderly patients. 12 Therefore, special attention should also be given to this population. Mailing Address: Filipe Ferrari • Universidade Federal do Rio Grande do Sul - Rua Mariana Prezzi, 617, 43B. Postal Code 95034460, Caxias do Sul, RS - Brazil E-mail: ferrari.filipe88@gmail.com Manuscript received March 19, 2020, revised manuscript April 03, 2020, accepted April 03, 2020 Keywords Coronavirus; COVID 19; Acute Respiratory Syndrome; cardiovascular Diseases/complications; Myocarditis; Infectious Diseases; Risk Factors/prevention and control. DOI: https://doi.org/10.36660/abc.20200215 823