Although our respiratory system may be the primary target of SARS-CoV-2, the virus that causes COVID-19, there is growing consensus within the medical community that the virus is also a vascular disease that can wreak havoc on one’s blood vessels and lead to other serious complications.
“COVID-19 is not a respiratory illness alone. It also invades the endothelial cells that line the blood vessels, causing damage and inflammation,” explains Ian Del Conde Pozzi, M.D., cardiologist and director of Vascular Medicine at Miami Cardiac & Vascular Institute, part of Baptist Health South Florida.
A respiratory virus infecting blood cells and circulating through the body is virtually unheard of, according to Dr. Del Conde. “Influenza viruses like H1N1 are not known to do this,” he says, adding that the original SARS virus, a sister coronavirus to the current infection, did not spread past the lung.
In a recent study published in the medical journal The Lancet, researchers discovered that the SARS-CoV-2 virus can infect the endothelial cells that line the inside of blood vessels. Endothelial cells protect the cardiovascular system, and they release proteins that influence everything from blood clotting to the immune response. In the paper, the scientists showed damage to endothelial cells in the lungs, heart, kidneys, liver, and intestines in people with COVID-19.
Researchers found that when the virus enters the lung, it destroys the lung tissue, and people start coughing. The destruction of the lung tissue breaks open some blood vessels, and the virus then starts to infect endothelial cells. This creates a local immune response, and causes inflammation of the endothelium, which can trigger a cascade of other symptoms as the body marshals all of its ammunition to fight off this new virus.
This may explain a myriad of vascular presentations seen with the virus, Dr. Del Conde says. “We’re seeing a lot of patients present with COVID-19 symptoms who also have blood clots. Depending on where these clots are located, they can cause life-threatening conditions such as brain stroke, deep vein thrombosis and pulmonary embolism.”
Another common complication with COVID-19 is inflammation, which can do lasting damage to one’s heart and other organs. According to statistics from the American Heart Association (AHA), approximately 40 percent of all deaths from COVID-19 are related to cardiovascular complications.
Doctors at Miami Cardiac & Vascular Institute have developed specific protocols for managing patients with COVID-19 who present with heart attack or stroke. “Patients who are at greatest risk with COVID-19 are those with significant chronic illnesses such as cardiac disease,” Dr. Del Conde notes. “Most people who die from COVID-19 actually die from multiorgan failure.”
New therapies offer hope for patients suffering from severe COVID-19 and other health issues, according to Dr. Del Conde. “We’re using some of the latest therapies to treat patients here at Miami Cardiac & Vascular Institute and even some of our most critically ill patients have made a full recovery,” he says.
At the same time, Dr. Del Conde cautions anyone with underlying heart disease against avoiding or delaying treatment because of COVID-19. “Complications from untreated cardiac issues may well represent the greatest risk to the health of these patients,” says Dr. Del Conde. “It has been reported – and we have certainly seen this in our practice – that patients experience serious cardiovascular complications from avoiding care.”
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