Clinical Implications of SARS-CoV-2 Interaction With Renin Angiotensin System: JACC Review Topic of the Week.

Severe acute respiratory-syndrome coronavirus-2 (SARS-CoV-2) host cell infection is mediated by binding to angiotensin-converting enzyme 2 (ACE2). Systemic dysregulation observed in SARS-CoV was previously postulated to be due to ACE2/angiotensin 1-7 (Ang1-7)/Mas axis downregulation; increased ACE2 activity was shown to mediate disease protection. Because angiotensin II receptor blockers, ACE inhibitors, and mineralocorticoid receptor antagonists increase ACE2 receptor expression, it has been tacitly believed that the use of these agents may facilitate viral disease; thus, they should not be used in high-risk patients with cardiovascular disease.

Triple left ventricular outflow tract obstruction.

A 59-year-old man had, over a period of 5 years, three different clinical scenarios which led to dynamic left ventricular outflow tract obstruction (LVOTO). Initially, this man who suffered from hypertrophic cardiomyopathy presented with asymmetric septal hypertrophy and systolic anterior motion (SAM) of the anterior mitral leaflet, along with mitral regurgitation. He was treated by septal myectomy and mitral valve repair with insertion of an artificial mitral ring.