SARS-CoV-2 can injure many organ systems.16 Some systems are impacted more than others. The Cardiovascular, Respiratory, Brain and Neurological, Renal, and Gastrointestinal tracts appear to be significantly vulnerable.
Cardiovascular System
Up to 20%-30% of patients hospitalized with coronavirus disease 2019 (COVID-19) have evidence of myocardial involvement. Carditis, an inflammation of heart tissue, has been demonstrated to result from damage due to COVID-19 infection. This damage can increase the risk of cardiac complications (e.g., heart failure). An extensive amount of cardiac damage has been determined to result from small blood clots blocking normal blood circulation in the heart. It is probably due to many factors associated with the SARS-CoV-2 virus and possibly due to the release of inflammatory cytokines, which may reduce coronary blood flow and the oxygen supply, which results in the destabilization of coronary plaque.
Although the pathogenesis of cardiovascular involvement in SARS-CoV-2 infection and the potential consequences of tissue damage in long COVID is unknown, several theories have been postulated. ACE2 receptors are exhibited by myocardial cells and can implicate direct cytotoxicity by the SARS-CoV-2 virus on the myocardium leading to myocarditis. Conversely, releasing proinflammatory cytokines such as Interleukin-6 (IL-6) can lead to vascular inflammation, myocarditis, and cardiac arrhythmias.
Research has shown that 60% of people who recovered from COVID-19 had signs of ongoing heart inflammation, which could lead to the common symptoms of shortness of breath, palpitations, and rapid heartbeat.17
Respiratory System
The air sacs, alveoli, in the lungs can have long-standing damage due to COVID-19 infection. Pneumonia can result from this damage. In general, survivors of viral pneumonia are at risk of psychological and physical complications of the disease itself, as well as treatment-related lung damage and other organ injuries. Long-term lung disability is not uncommon in patients who have recovered from severe viral pneumonia. Although most survivors can return to work and everyday life, many will show residual ventilation and blood-gas diffusion abnormalities. Pneumonia and diffuse alveolar damage seem to be the most common forms of lung injury associated with COVID-19, and both evolve in a fairly predictable manner.17 Long-term breathing problems can also be the result of tissue damage and scars.
16. Wu KJ: The Pandemic After the Pandemic, The Atlantic, March 11, 2022.17. Mitrani RD, Dabas N, Goldberger JJ: COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors Heart Rhythm. 2020 Nov;17(11):1984-1990.doi: 10.1016/j.hrthm.2020.06.026.Epub 2020 Jun 26. 18. Salehi, Sana, et al. “Long-term Pulmonary Consequences of Coronavirus Disease 2019 (COVID-19): What We Know and What to Expect.” Journal of thoracic imaging vol. 35,4 (2020): W87-W89. doi:10.1097/RTI.0000000000000534J.
