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Covid-19 Primary Care Resources

What are the cardiac manifestations of Covid-19 and when in the course of the illness do these occur?

Advice from a Consultant Cardiologist

This information is sourced from Dr Amit Bhan, Consultant Cardiologist

Q.  What are the cardiac manifestations of Covid-19?


  • It has become clear that patients with cardiovascular risk factors (male sex, advanced age, diabetes, hypertension and obesity), and those with established cardiovascular disease have heightened vulnerability to Covid-19 infection
  • From the limited available evidence, the cardiovascular complications appear to be similar to those seen in Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS)
  • Myocardial injury is common in Covid-19 and is usually defined as elevation of high sensitivity Troponin and/or new ECG or echocardiographic findings
  • Myocardial injury can be secondary to acute coronary syndromes (arterial and venous thrombosis is seen frequently), myocarditis, stress cardiomyopathy or the so-called cytokine storm, as well as other causes
  • Arrythmia may also occur, either secondary to ischaemia or as a result of any myocardial injury
  • In addition, treatment sometimes used in Covid-19 (in particular hydroxychloroquine or certain antibiotics) may result in QT prolongation which increases the chance of ventricular arrythmia

Q. When in the course of the illness do these occur? 


  • Cardiac manifestations can occur anywhere in the course of the disease although it stands to reason that the risk is highest during the acute inflammatory phase
  • It is not unusual for patients to present with a cardiovascular manifestation such as acute coronary syndromes and pulmonary embolism, but equally these can occur at varying times during, what can be a very lengthy inpatient stay

Q.  Do cardiovascular manifestations occur in patients who have mild or severe Covid-19 illness?


  • It appears that the severity of Covid-19 infections correlates with cardiovascular manifestations, so that those with milder disease are less likely to be affected in such a way
  • Whether that is because those that have more severe disease tend to be those with higher baseline cardiovascular risk is unclear

Further reading:

European Society of Cardiology

BMJ summary guidance