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Coronary microvascular dysfunction (CMD) plays a pivotal role in cardiovascular disease (CVD) and CVD\u2010related risk factors (eg, age, gender, hypertension, diabetes mellitus, and obesity). Equally, these are also risk factors for COVID\u201019. The purpose of this review was to explore CMD pathophysiology in COVID\u201019, based on recent evidence. COVID\u201019 mechanisms were reviewed in terms of imbalanced renin\u2010angiotensin\u2010aldosterone\u2010systems (RAAS), systemic inflammation and immune responses, endothelial dysfunction, and coagulatory disorders. Based on these mechanisms, we addressed CMD pathophysiology within the context of COVID\u201019, from five perspectives. The first was the disarrangement of local RAAS and Kallikrein\u2010kinin\u2010systems attributable to SARS\u2010Cov\u20102 entry, and the concomitant decrease in coronary microvascular endothelial angiotensin I converting enzyme 2 (ACE2) levels. The second was related to coronary microvascular obstruction, induced by COVID\u201019\u2010associated systemic hyper\u2010inflammation and pro\u2010thrombotic state. The third was focused on how pneumonia\/acute respiratory distress syndrome (ARDS)\u2010related systemic hypoxia elicited oxidative stress in coronary microvessels and cardiac sympathetic nerve activation. Fourthly, we discussed how autonomic nerve dysfunction mediated by COVID\u201019\u2010associated mental, physical, or physiological factors could elicit changes in coronary blood flow, resulting in CMD in COVID\u201019 patients. Finally, we analyzed reciprocity between the coronary microvascular endothelium and perivascular cellular structures due to viremia, SARS\u2010CoV\u20102 dissemination, and systemic inflammation. These mechanisms may function either consecutively or intermittently, finally culminating in CMD\u2010mediated cardiovascular symptoms in COVID\u201019 patients. However, the underlying molecular pathogenesis remains to be clarified.<\/jats:p>","DOI":"10.1111\/micc.12718","type":"journal-article","created":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T08:40:24Z","timestamp":1621500024000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Coronary microvascular dysfunction pathophysiology in COVID\u201019"],"prefix":"10.1111","volume":"28","author":[{"given":"Jie","family":"Yin","sequence":"first","affiliation":[{"name":"Institute of Cardiovascular Disease Research Xuzhou Medical University  Xuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoshen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology Affiliated Hospital of Xuzhou Medical University  Xuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Liu","sequence":"additional","affiliation":[{"name":"Institute 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