Based on a recent meta-analysis, which of the following viruses was associated with the HIGHEST rate of acute cardiac injury among critically ill patients?
The course of illness for patients with COVID-19 caused by SARS-CoV-2 may be complicated by myocardial injury. The mechanism for this complication is unclear. However, a prevailing hypothesis is that the myocardial injury stems from the affinity of the virus for angiotensin-converting enzyme 2 (ACE2) and inhibition of the enzyme. The normal function of ACE2 is to cleave angiotensin II (a potent vasoconstrictor) and convert it to angiotensin (a protein with vasodilatory and anti-inflammatory effects). These receptors are expressed in the lung, heart, kidney, and endothelium, potentially explaining the commonly encountered involvement of lung, cardiac, and kidney injury in patients with COVID-19. Certain other viruses such as severe acute respiratory syndrome coronavirus 1 (SARS-CoV) and influenza A also bind to ACE2 receptors, but to a lesser...
