To date, the COVID-19 pandemic remains one of the biggest public health challenges in recent memory. At the moment, more than 600 million people around the world have become its victims. SARS-CoV-2 is characterized by multiple organ damage, but the lungs and heart are most involved in the pathological process. Elevated levels of cardiospecific enzymes are common in patients with COVID-19 infection and indicate myocardial damage. Possible mechanisms of myocardial injury include: 1) renin-angiotensin-aldosterone system dysfunction, 2) direct viral damage to the heart, 3) hyperinflammation and «cytokine storm», 4) endothelial dysfunction, hypercoagulation and development of coronary microvascular thrombosis, 5) hypoxemia and hypoxia, due to both respiratory failure and destabilization of coronary plaques and/or mismatch of supply and demand, leading to ischemia/myocardial infarction. The presence of cardiac pathology in patients with COVID-19 has become one of the most significant predictors of an unfavorable prognosis and made it necessary to single out patients with cardiovascular diseases as a separate risk group. In total, cardiac pathology (heart failure) accounts for approximately 40% of all deaths in patients with COVID-19. In the presence of cardiovascular diseases, lethality was more marked in elderly and senile patients, which is associated with a greater prevalence of cardiac pathology, functional disorders of the immune system, as well as with more frequent cardiotoxicity against the background of reduced metabolism during etiotropic therapy for coronavirus infection.

Keywords: myocardial injury, hypercoagulation, angiotensin-converting enzyme, SARS-CoV-2, COVID-19, coronavirus infection, renin-angiotensin-aldosterone system, cytokines, endothelial dysfunction