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26.  Is COVID-19 Primarily a Heart and Vascular Diseases?
 Thus, the once thought asymptomatic patients who luckily dodged a bullet and were spared from the ravages of the disease, may indeed be truly sick. A significant portion of them may develop myocarditis along with vascular vasodilation with resultant hypoxemia. This pathological process could easily be more significant than the pulmonary effects of the virus, since it is present in both symptomatic and asymptomatic patients. And could explain the debilitating symptoms of fatigue and mental fog which “long-haulers” are experiencing, many of which had a mild initial illness. Infection Control Today.  Sept. 8, 2020.   https://www.infectioncontroltoday.com/view/is-covid-19-primarily-a-heart-and-vascular-diseases
    

References
 

(1) Shi S, Qui M, Shen B. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiology. Mar. 25, 2020. https://jamanetwork.com/journals/jamacardiology/fullarticle/2763524 
(2) Klok FA, Kruip MJHA, van der Meer MJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. 2020 Jul;191:145-147. doi: 10.1016/j.thromres.2020.04.013. Epub 2020 Apr 10. https://pubmed.ncbi.nlm.nih.gov/32291094/
(3) Puntmann VO, Carerj ML and Wieters, I. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. Published online July 27, 2020. doi:10.1001/jamacardio.2020.3557 https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916
(4) Upadhyaya P. PSU football doctor clarifies comments on percentage of COVID-positive athletes with myocarditis. Centre Daily Times. Sept. 4, 2020. https://www.centredaily.com/sports/college/penn-state-university/psu-football/article245448050.html
(5) Schultz JC, Hilliard AA, Cooper LT and Rihal CS. Diagnosis and Treatment of Viral Myocarditis. Mayo Clin Proc. 2009 Nov;84(11): 1001-1009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770911/ 
(6) Hazebroek M, Dennert R, Heymans S. Idiopathic dilated cardiomyopathy: possible triggers and treatment strategies. Neth Heart J. 2012 Aug, 20(7-8): 332-335. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402574/ 
(7) Frey T, Arain N. Pediatric Viral Mocarditis – A Review. S D Med. 2018 Jan;71(1):29-34. https://pubmed.ncbi.nlm.nih.gov/29439302/ 
(8) Cooney E. ‘Carnage’ in a lab dish shows how the coronavirus may damage the heart. STAT. Sept. 4, 2020. Accessed on Sept 7, 2020. https://www.statnews.com/2020/09/04/carnage-in-lab-dish-shows-how-coronavirus-may-damage-heart/
(9) Reynolds AS, Lee AG, Renz J, et al. Pulmonary Vascular Dilatation Detected by Automated Transcranial Doppler in COVID-19 Pneumonia. American Journal of Respiratory and Critical Care Medicine. Aug 6, 2020. https://www.atsjournals.org/doi/abs/10.1164/rccm.202006-2219LE 
(10) Cohen J. Report Suggests Some ‘Mildly Symptomatic’ Covid-19 Patients Endure Serious Long-Term Effects. Forbes. Jun 13, 3030. Accessed on Sept. 7, 2020. https://www.forbes.com/sites/joshuacohen/2020/06/13/report-suggests-some-mildly-symptomatic-covid-19-patients-endure-serious-long-term-effects/#10e1dba95979 


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