Mechanisms of COVID-19-induced cardiovascular disease, is sepsis or exosome the missing link?

COVID-19 (Coronavirus disease 2019) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has reached a pandemic level, spreading across the globe by affecting over 33 million people and causing over 1,009,270 deaths. SARS-CoV-2 is highly infectious with a high basic reproduction number (R 0 ) of 2.2–5.7 that has led to its exponential spread and very little is known about it in terms of immunogenicity and its molecular targets. SARS-CoV-2 causes acute respiratory distress syndrome, followed by multiple organ failure and death in a small percentage of individuals. Cardiac injury has emerged as another dreaded outcome of COVID-19 complications. However, a thorough understanding of the pathogenesis of SARS-CoV-2 is lacking. In this review, we discuss the virus, possible mechanisms of COVID-19-induced cardiac injury, potential therapeutic strategies, and explore if exosomes could be targeted to treat symptoms of COVID-19. Furthermore, we discuss the virus-induced sepsis, which may be the cause of multiple organ failure, including myocardial injury.