Myocardial lesion in patients with COVID-19: Not all is in the lung

The COVID-19 pandemic has demonstrated that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infectious agent has an overwhelmingly highly virulent capacity. Case studies with representative samples have found that the inflammatory process is not only located at the lung level. In most cases, the patient’s death is due to complications resulting from other white organ failures such as the heart, endothelium, kidneys or brain. Since the Middle East respiratory syndrome (MERS) epidemic, it became evident that coronaviruses can induce myocarditis and heart failure in numerous patients. Considering that SARS-CoV-2 and MERS have similar pathogenicities, the prognoses of patients with basic cardiovascular diseases were expected to be reflected in the high lethality rates currently observed in this group. These rates result from functional and structural alterations of the cardiovascular system, in addition to the difficulty of establishing effective therapies. Evidently, the degree of cardiac involvement is directly proportional to the severity of the condition. Indeed, higher levels of troponin I, blood pressure, and creatine phosphokinase myocardial band (CPK-MB) were found in patients who were admitted to intensive care units than in those who were not. However, myocardial injury markers prevail, even in those with mild symptoms. Moreover, in some cases, a