IMR Press / RCM / Volume 24 / Issue 5 / DOI: 10.31083/j.rcm2405125
Open Access Review
COVID-19 and Cardiac Implications—Still a Mystery in Clinical Practice
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1 Department of Pediatrics I, “George Emil Palade'' University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania
*Correspondence: lory_chimista89@yahoo.com (Lorena Elena Meliț)
Rev. Cardiovasc. Med. 2023, 24(5), 125; https://doi.org/10.31083/j.rcm2405125
Submitted: 24 December 2022 | Revised: 31 January 2023 | Accepted: 6 February 2023 | Published: 24 April 2023
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Although initially the evolution of Coronavirus disease 2019 (COVID-19) seemed less severe in pediatric patients, in the three years since the beginning of the pandemics, several severe cases have been described, pediatric inflammatory multisystem syndrome (PIMS) has been defined, pathogenesis is being continuously studied, and many aspects regarding the long-term evolution and multi-organ damage are still unexplained. Cardiac injuries in COVID-19 represent most-likely the second cause of mortality associated with the infection. A wide-spectrum of cardiac abnormalities were reported to be associated with COVID-19 in children including ventricular dysfunction, acute myocardial dysfunction, arrhythmias, conduction abnormalities, coronary artery dilation or aneurysms, and less common pericarditis and valvulitis. Risk factors for severe COVID-19 in children should be identified, laboratory tests and imaging techniques should be performed to reveal cardiac injury as soon as possible. The aim of this review was to highlight the great value of repeated cardiological monitoring in patients with COVID-19, underlining also the peculiarities in terms of pediatric population. This review is looking for answers on questions like ‘Why do some, but not all, patients with COVID-19 develop cardiac injury or severe hyperinflammatory status?’, ‘Which factors are involved in triggering COVID-19 associated cardiac injury?’, ‘What are the mechanisms involved in the etiology of cardiac injury?’, ‘Is there a clear relationship between hyperinflammation and cardiac injury?’, ‘Is hyperinflammatory status the pre-stage of cardiac injury in COVID-19 patients?’ which still lack clear answers. The understanding of mechanisms involved in the development of COVID-19 associated cardiac injury might shed light on all the above-mentioned mysteries and might increase the likelihood of favorable evolution even in severe cases.

Keywords
children
COVID-19
cardiac injury
myocarditis
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