COVID - 19 - a New Challenging Disease for Intensivists and Cardiologists. From Basic Science to the Clinical Setting

A novel coronavirus causing Acute Respiratory Distress Syndrome (SARS-CoV-2) has been considered the cause of a large number of lower respiratory tract infections leading to severe respiratory failure in many cases. However, the evidence-based hospital reports show that the COVID -19 infestation may range from an asymptomatic or minimally symptomatic course with an almost bizarre deterioration of life parameters (“silent hypoxia”) through to critically ill patients with multiple organ failure including that of the lungs, kidneys, nervous system and other organs. Moreover, this coronavirus disease may cause significant lung damage in asymptomatic COVID-19 positive patients who recover at home. The virus enters through the angiotensin-converting enzyme 2 receptor (ACE2) widely expressed in the cardiovascular system and other organs and tissues, which can result in myocardial injury, myocarditis, acute myocardial infarction, heart failure, arrhythmias, brain stroke, acute pleuritis, pneumonia and venous thromboembolic events. COVID -19 - induced failure of some central mechanisms controlling breathing and the circulation may explain the mismatch between the clinical symptoms and the objective physiologic life parameters in many patients treated by intensivists or cardiologists. The severity of coronavirus disease is dependent on numerous factors including the magnitude of the host immune response, the impairment of central and peripheral nervous system, age, co-morbidities (e.g. diabetes, arterial hypertension, obesity, chronic heart failure) and presumably genetic proclivity. A brand-new treatment approach with use of alternative or experimental therapies such us Extracorporeal Membrane Oxygenation (ECMO), plasmapheresis, proinflammatory interleukins - targeted drugs, covalescent plasma transfusion, virus replication inhibitors is obviously needed in some COVID-19 patients.