Int J Biol Sci 2022; 18(7):2703-2713. doi:10.7150/ijbs.69677 This issue


Manifestations and Mechanism of SARS-CoV2 Mediated Cardiac Injury

Si-chi Xu, Wei Wu, Shu-yang Zhang

Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

This is an open access article distributed under the terms of the Creative Commons Attribution License ( See for full terms and conditions.
Xu Sc, Wu W, Zhang Sy. Manifestations and Mechanism of SARS-CoV2 Mediated Cardiac Injury. Int J Biol Sci 2022; 18(7):2703-2713. doi:10.7150/ijbs.69677. Available from

File import instruction


Graphic abstract

Coronavirus disease 2019 (COVID-19), a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) had resulted in considerable morbidity and mortality. COVID-19 primarily posed a threat to the respiratory system and violated many different organs, including the heart, kidney, liver, and blood vessels with the development of the disease. Severe patients were often accompanied by cardiac injury, and once the heart gets damaged, the mortality of patients will significantly increase. The main clinical manifestations of cardiac injury range from myocarditis, heart failure (HF), arrhythmia, and Takotsubo cardiomyopathy (TCM). A high abundance of angiotensin-converting enzyme II (ACE2) on the membrane of cardiomyocytes makes it possible that the virus can directly attack cardiomyocytes as subsequently evidenced by the detection of spike protein and virus RNA in autopsy cardiac tissues. The secondary myocardial injury through systemic inflammatory and immune response also caused obvious cardiac damage. The pathological manifestations of heart tissue were diverse, varied from mild cardiomyocyte edema, myocardial hypertrophy, cardiomyocyte degeneration, and necrosis to severe myocarditis caused by lymphocyte and macrophage infiltration. However, the mechanism of heart injury was still unclear. Here, we summarized the clinical manifestations and mechanism of SARS-CoV2 mediated cardiac injury, providing a reference for cardiac treatment in critically ill patients.

Keywords: COVID-19, SARS-CoV2, Heart, Cardiac injury, Myocarditis