COVID-19

=== Cardiovascular system ===
The virus can cause [[Myocardial infarction|acute myocardial injury]] and chronic damage to the [[Circulatory system|cardiovascular system]].<ref>{{#invoke:cite journal || vauthors = Almamlouk R, Kashour T, Obeidat S, Bois MC, Maleszewski JJ, Omrani OA, Tleyjeh R, Berbari E, Chakhachiro Z, Zein-Sabatto B, Gerberi D, Tleyjeh IM, Paniz Mondolfi AE, Finn AV, Duarte-Neto AN, Rapkiewicz AV, Frustaci A, Keresztesi AA, Hanley B, Märkl B, Lardi C, Bryce C, Lindner D, Aguiar D, Westermann D, Stroberg E, Duval EJ, Youd E, Bulfamante GP, Salmon I, Auer J, Maleszewski JJ, Hirschbühl K, Absil L, Barton LM, Ferraz da Silva LF, Moore L, Dolhnikoff M, Lammens M, Bois MC, Osborn M, Remmelink M, Nascimento Saldiva PH, Jorens PG, Craver R, Aparecida de Almeida Monteiro R, Scendoni R, Mukhopadhyay S, Suzuki T, Mauad T, Fracasso T, Grimes Z  | title = COVID-19-Associated cardiac pathology at the postmortem evaluation: a collaborative systematic review | journal = Clinical Microbiology and Infection | volume = 28 | issue = 8 | pages = 1066–1075 | date = August 2022 | pmid = 35339672 | pmc = 8941843 | doi = 10.1016/j.cmi.2022.03.021 }}</ref><ref name="Zheng-2020">{{#invoke:cite journal || vauthors = Zheng YY, Ma YT, Zhang JY, Xie X | title = COVID-19 and the cardiovascular system | journal = Nature Reviews. Cardiology | volume = 17 | issue = 5 | pages = 259–260 | date = May 2020 | pmid = 32139904 | pmc = 7095524 | doi = 10.1038/s41569-020-0360-5 }}</ref> An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China,<ref name="Huang24Jan2020" /> and is more frequent in severe disease.<ref>{{#invoke:Cite web|| title=Coronavirus disease 2019 (COVID-19): Myocardial infarction and other coronary artery disease issues | website=UpToDate | url=https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-myocardial-infarction-and-other-coronary-artery-disease-issues | access-date=28 September 2020}}</ref> Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart.<ref name="Zheng-2020" /> ACE2 receptors are highly expressed in the heart and are involved in heart function.<ref name="Zheng-2020" /><ref>{{#invoke:cite journal || vauthors = Turner AJ, Hiscox JA, Hooper NM | title = ACE2: from vasopeptidase to SARS virus receptor | journal = Trends in Pharmacological Sciences | volume = 25 | issue = 6 | pages = 291–4 | date = June 2004 | pmid = 15165741 | pmc = 7119032 | doi = 10.1016/j.tips.2004.04.001 | doi-access = free | title-link = doi }}</ref>

A high incidence of [[thrombosis]] and [[venous thromboembolism]] occurs in people transferred to [[intensive care unit]]s with COVID‑19 infections, and may be related to poor prognosis.<ref>{{#invoke:cite journal || vauthors = Abou-Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L | title = The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management | journal = Thrombosis Research | volume = 194 | pages = 101–115 | date = October 2020 | pmid = 32788101 | pmc = 7305763 | doi = 10.1016/j.thromres.2020.06.029 | publisher = Elsevier BV }}</ref> Blood vessel dysfunction and clot formation (as suggested by high [[D-dimer]] levels caused by blood clots) may have a significant role in mortality, incidents of clots leading to [[pulmonary embolism]]s, and [[stroke|ischaemic events]] (strokes) within the brain found as complications leading to death in people infected with COVID‑19.<ref name=Science/> Infection may initiate a chain of [[vasoconstriction|vasoconstrictive responses]] within the body, including pulmonary vasoconstriction {{ndash}} a possible mechanism in which oxygenation decreases during pneumonia.<ref name="Science">{{#invoke:cite journal || vauthors = Wadman M |doi=10.1126/science.abc3208 |title=How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes |journal=Science |date=April 2020 |doi-access = free | title-link = doi }}</ref> Furthermore, damage of [[arterioles]] and [[capillaries]] was found in brain tissue samples of people who died from COVID‑19.<ref>{{#invoke:cite news ||title=NIH study uncovers blood vessel damage and inflammation in COVID-19 patients' brains but no infection |url=https://www.nih.gov/news-events/news-releases/nih-study-uncovers-blood-vessel-damage-inflammation-covid-19-patients-brains-no-infection |access-date=17 January 2021 |work=National Institutes of Health (NIH) |date=30 December 2020 }}</ref><ref>{{#invoke:cite journal || vauthors = Lee MH, Perl DP, Nair G, Li W, Maric D, Murray H, Dodd SJ, Koretsky AP, Watts JA, Cheung V, Masliah E, Horkayne-Szakaly I, Jones R, Stram MN, Moncur J, Hefti M, Folkerth RD, Nath A  | title = Microvascular Injury in the Brains of Patients with Covid-19 | journal = The New England Journal of Medicine | volume = 384 | issue = 5 | pages = 481–483 | date = February 2021 | pmid = 33378608 | pmc = 7787217 | doi = 10.1056/nejmc2033369 }}</ref>

COVID{{nbhyph}}19 may also cause substantial structural changes to [[blood cell]]s, sometimes persisting for months after hospital discharge.<ref>{{#invoke:cite journal || vauthors = Kubánková M, Hohberger B, Hoffmanns J, Fürst J, Herrmann M, Guck J, Kräter M  | title = Physical phenotype of blood cells is altered in COVID-19 | journal = Biophysical Journal | volume = 120 | issue = 14 | pages = 2838–2847 | date = July 2021 | pmid = 34087216 | pmc = 8169220 | doi = 10.1016/j.bpj.2021.05.025 | bibcode = 2021BpJ...120.2838K }}</ref> [[Lymphopenia|A low level of blood lymphocytes]] may result from the virus acting through ACE2-related entry into lymphocytes.<ref>{{#invoke:cite journal|| vauthors = Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, Bikdeli B, Ahluwalia N, Ausiello JC, Wan EY, Freedberg DE, Kirtane AJ, Parikh SA, Maurer MS, Nordvig AS, Accili D, Bathon JM, Mohan S, Bauer KA, Leon MB, Krumholz HM, Uriel N, Mehra MR, Elkind MS, Stone GW, Schwartz A, Ho DD, Bilezikian JP, Landry DW |title=Extrapulmonary manifestations of COVID-19 |journal=Nature Medicine |date=July 2020 |volume=26 |issue=7 |pages=1017–1032 |doi=10.1038/s41591-020-0968-3|pmid=32651579 |s2cid=220462000 | doi-access=free | title-link=doi }}</ref>