SARS-CoV-2 as potential cause of cardiac inflammation and heart failure. Is it the virus, hyperinflammation, or MODS?

Excerpt

Coronavirus disease 2019 (COVID-19) is caused by the single-stranded enveloped RNA virus SARS-CoV‑2. It has become a worldwide pandemic since it appeared in Wuhan in December 2019. SARS-CoV‑2 is the seventh human coronavirus, which affects primarily the respiratory tract. Severely ill patients suffer from pneumonia. They might need intensive care and artificial ventilation after developing acute respiratory syndrome (ARDS) or multiple organ dysfunction syndrome (MODS). The main human cellular receptor for the binding of the viral spike proteins is angiotensin-converting enzyme 2 (ACE2), following activation by transmembrane protease serine 2 (TMPRSS2). Angiotensin-converting enzyme 2 is expressed by type II alveolar cells, the predominant portal of entry in the lungs; ACE2 is also expressed in the heart and vasculature. It is upregulated by ACE inhibitors, which are often prescribed for cardiac patients. Their influence on SARS-Cov‑2 infectivity is unclear. …