Coronavirus predominantly affects lungs and airways, but it can also impact heart especially with pre-existing heart disease patients. These are the patients with hypertension, previous heart attacks, post angioplasty/bypass surgery, valvular heart disease or rhythm disorders of heart like atrial fibrillation. Diabetes also has higher evidence of heart disease hence is a risk factor for coronavirus.
Asked about how the novel coronavirus is making its way into the heart muscle, Dr Ashish Agarwal, senior consultant, HOD, Cardiology, Aakash Healthcare & Super Speciality Hospitals, Dwarka replies, “The Covid-19 virus has been found to affect the heart in various ways. Most commonly, it exacerbates heart conditions in people who already have it. Those with undiagnosed and rather silent heart conditions may develop complications such as fever and inflammation which make the blood more prone to clotting and interferes with the body’s ability to dissolve clots.”
Recovered Covid-19 patients should not ignore chest pain, shortness of breath, palpitation, excess sweating and fatigue as these may mean the risk of heart disease. Being aware of the symptoms is the first step to make an informed choice, thereby, seeking early medical attention immediately. Covid-19 patients with pre-existing heart diseases, even those who are cured, are at greater risk. Their condition can trigger further complications and even cardiac arrests. However, such patients can recover with suitable treatments.
“A 35-year-old man came with severe chest pain to Fortis Escorts Heart Institute Emergency at 10 pm. His ECG was suggestive of an acute heart attack. Within minutes of his arrival, he suffered cardiac arrest and could be revived after multiple shocks and cardiopulmonary resuscitation. He was further treated with primary angioplasty to open the blocked vessel. The second day his RT PCR test for SARS-CoV-2 came positive. The patient was discharged after seven days of treatment. This patient suffered from near-fatal complications of Covid-19 affecting his heart,” says Dr Vishal Rastogi, additional director, Interventional Cardiology & head, Advanced Heart Failure Program, Fortis Escorts Heart Institute, Okhla.
Dr Rastogi adds that some people may also experience myocardial infarction type 2, which can occur when the heart muscle is starved for oxygen, triggered by a mismatch between the supply and demand for oxygen in the heart. Covid-19 has been found to cause uncommon and rare problems such as fulminant inflammation of heart muscles and viral myocarditis which can weaken the heart muscle and may lead to heart failure.
New studies
As more and more patients are getting affected by the disease, knowledge about the SARS-CoV-2 virus is also increasing and almost daily more and more baffling new research is coming up. Dr Agarwal highlights, “As cases from Italy showed, the infection in the heart and heart muscle may occur even after the acute phase of Covid-19 infection has resolved and no damage is done to lungs.”
In one such study in Germany, it was found that out of 100 middle-aged patients who had recovered from so-called ‘mild’ Covid-19 disease and did not have any cardiac symptoms, 78 patients had abnormal findings in the heart as detected on Cardiac Magnetic Resonance (CMR) two to three months after testing positive for the virus. These patients are at risk of continued damage to the heart. Dr Rastogi explains,
“With time it became apparent that microvascular injury and thrombosis play an important part in the disease process. After being swamped with severelyill patients in the first few months of the pandemic, researchers are now focusing on signs of lasting damage, not just to lungs but also the heart and other organs.”
Early care
Cases of cured Covid-19 patients developing heart problems are rapidly increasing. Several of them encounter common cardiac symptoms ranging from chest pain to dizziness and pain in other parts of the body too. However, with early care and attention, these risks can be minimised. Dr Bipeenchandra Bhamre, cardio-thoracic surgeon, Sir HN Reliance Foundation Hospital and Research Centre says, “Consulting the doctor immediately is advised. We witness patients showing classical heart attack symptoms and ECG changes, coming in an emergency, later to find out having Covid-19 infections. Fortunately, they do recover with appropriate treatments.”
Patients should regularly get their blood pressure and blood sugar checked at home by home monitoring tools. Besides this, regular exercises, weight control, reduced alcohol consumption and no tobacco use are some of the precautions which ensure good heart health. Dr Subhash Chandra, chairman & HoD, Cardiology, BLK Heart Centre, Delhi says: “These existing patients, who have recovered from a mild or severe form of Covid-19, have to ensure regular intake of prescribed medications, submit for regular blood biochemistry tests: lipid profile, kidney function test, thyroid profile and sugar examination in case of diabetes.”
The common cardiac manifestations due to Covid-19 are myocardial infarction (heart attack), heart failure, myocarditis (inflammation of the muscle) and arrhythmias (irregular heartbeat). The novel coronavirus has greater infectivity, high fatality rate and has caused significant morbidity and mortality so there’s a need for continued monitoring after discharge among patients who have recovered from the virus, believes Dr Srichandran Lakshminarayanan, senior consultant interventional cardiologist, MGM Healthcare, Chennai. He adds, “Whether these symptoms will eventually resolve or there can be permanent damage remains unknown. However, people with persistent Covid-19 symptoms shouldn’t assume that they will stay ill for a long time. We reassure everyone not to worry and to seek early medical care if symptoms worsen.”
Dr Surya Prakash Rao, consultant cardiologist, CARE Hospitals, Hyderabad opines, “Heart patients are at a greater risk of contracting and succumbing to the effects of the coronavirus. Such patients with pre-existing medical conditions should be extra careful and take extra measures of safety and strictly follow and maintain social distancing protocols.” He suggests regular consultation with the doctor and not to stop the treatment process.
