Cardiac Manifestations in COVID-19 Patients: A Focus on the Pediatric Population

Figure 1

An Interplay between angiotensin II and SARS-CoV-2. SARS-CoV-2 cellular uptake is mediated primarily by the ACE2 receptor. Viral internalization is then followed by viral replication, assembly, and release. ACE2 is involved in converting angiotensin II (ATII) into angiotensin 1-7 (AT1-7). Unlike ATII, AT1-7 has anti-inflammatory, cardioprotective, and pulmoprotective effects with vasodilatory properties. Interestingly, SARS-CoV-2 binding to ACE2 provokes ACE2 internalization and downregulation. Consequently, this increases the circulatory levels of ATII and upregulates numerous proinflammatory, fibrotic, and vasoconstrictory pathways.