Impact of Covid-19 on Heart Patients | Daily News


 

Impact of Covid-19 on Heart Patients

In December 2019 in the Wuhan state of China, an outbreak of virus causing respiratory infection that range from asymptomatic infection to severe viral pneumonia causing respiratory failure, which was later called by WHO as Covid 19 (CoronaVirus disease 2019). High infectivity causing rapid transmission of the virus to many countries to be considered on March 11, 2020 by WHO as pandemic. Covid-19 has been diagnosed in over 3.5 million worldwide and caused deaths in over 2 lakhs up to date. The numbers are just increasing enormously. The most common organ to be affected by virus infection after lung is heart.

Demographic features

Covid-19 patients were more to be male around 60% with mean age of 56 years, 50% of patients had comorbidities prior to infection, commonly hypertension 30% , diabetes 20%, heart disease 10% , chronic lung disease 3% and a few chronic kidney involvement. Patients with underlying comorbities are more prone to severe diseases.

Cardiovascular manifestation

Dominance of heart involvement just next to lung in this pandemic as cardiac tissues can be damaged directly by virus infiltration. Covid-19 infection can be caused by binding of virus ACE2 receptor which is mainly expressed in heart and lung tissues.

Myocardial (Heart muscle) injury

This is diagnosed with very high level of blood test Troponin T (TnT). Virus causing severe inflammatory status (Cytochrome storm) leads to a decreased coronary blood flow & Oxygen supply and rapture of coronary plaques (Cholesterol deposits) & Coagulation cascade activation with increase thrombosis risk, leading to acute myocardial infarction especially with prior history of coronary heart diseases.

Myocardities

Myocarditis (inflammation of heart muscles) caused by Covid-19 virus and is manifested as severe rapidly deteriorating left ventricular dysfunction and cardiac shock with elevated cardiac enzymes. Mortality rate can reach 70%. Immune injury can be a cause of fulminant myocarditis.

Heart failure

Heart failure was reported in 37% of Covid-19 patients. Heart failure due to immune system disorder & previously described heart muscle injury & myocarditis with acute pulmonary edema (fluid in the lung) was an important predictor of mortality in Covid-19.

Arrhythmia (Irregular rhythm)

Arrhythmia can occur in Covid-19 as part of Myocardial injuries, cardiac dysfunction or due to electrolyte imbalance that occur in critically ill patients in addition to being part of adverse effect of drug used in treating these patients.

Cardiogenic shock

Cardiogenic, septic or mixed cardiac and pulmonary shock in Covid-19 are important to be considered in those admitted in ICU.

Most Covid-19 patients with coronary artery disease are reluctant to come to hospital early because of strict infection control strategies can delay managing these patients. In addition to poor access to hospitals, lack of transportation and already burdened facilities, all can delay managing these patients which subsequently will have devastating impact on outcome.

Most of the cardiac cases either Covid-19 positive or negative are managed medically unless high risk heart attack patients are directed to the cardiac catheterization lab with well equipped proper health care facilities and Personal Protective Equipment (PPE). Elective procedures can be postponed.

In acute coronary syndrome medical management (Thrombolytic) may be a valuable alternative treatment to Primary Percutaneous Coronary intervention (Primary PTCA, ie, Baloon dilatation and stenting of blocked coronary artery In Heart Attack.) to minimize contamination of the catheterization laboratory & to prevent cross infection to the staff members.

Heart transplantation

One area of cardiovascular medicine that remains especially vulnerable in such pandemic is that of heart transplantation. Patients who are recipients of heart transplantation and those awaiting transplantation are both at risk. The eminent risk for the former is more obvious due to their immune compromised state.

Multiple studies revealed the prominent rate of Covid-19 pandemic on cardiovascular health and care on multiple levels with long term cardiovascular impact of this pandemic illness for the studies to adopt a near perspective on learning and training to face this unprecedented crisis.

(The writer is a Consultant Clinical and Interventional Cardiologist)


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