Dr Arun Kalyanasundaram, Chief, Division of Cardiology, Promed Hospital writes on how COVID-19 has assumed centre stage, while other health conditions particularly cardiovascular disease are sidelined and the precautions that heart patients need to take during a pandemic.

Patients who are infected with COVID-19 develop heart-related problems either de novo or as a complication of pre-existing cardiac disease. Even early on from patients in Wuhan, China, there have been reports of cardiac injury manifested by the release of cardiac troponin — a protein released in the blood by the injured heart muscle — and abnormalities on electrocardiograms and echocardiograms. Since then, other reports have affirmed that cardiac injury can be part of coronavirus-induced harm. Several reports as detailed clinical scenarios in which patients’ initial symptoms were cardiovascular rather than respiratory in nature. Personally, as an interventional cardiologist, I have dealt with a few patients whose presenting symptoms of COVID-19 was a heart attack.

How does the coronavirus cause cardiac damage?

First and perhaps most importantly, people with pre-existing heart disease are at a greater risk for severe cardiovascular and respiratory complications from COVID-19.

Second, in people with existing heart-vessel blockages, infection, fever, and inflammation can destabilize previously asymptomatic fatty plaques inside the heart vessels. Also, fever and inflammation also render the blood more prone to clotting, while also interfering with the body’s ability to dissolve clots.

Third, some people may experience heart damage that is similar to heart attack injury even if their arteries lack the fatty, calcified flow-limiting blockages known to cause classic heart attacks. Such scenarios can occur when the heart muscle is starved for oxygen, triggered by a mismatch between oxygen supply and oxygen demand. The impaired gas exchange due to the affected lung can further diminish oxygen supply to the heart muscle.

Finally, there is a subset of people with COVID-19 — some of them previously healthy and with no underlying cardiac problems — who develop fulminant inflammation of the heart muscle known as ‘myocarditis’ as a result of the virus directly affecting the heart. This type of inflammation could lead to heart rhythm disturbances and cardiac muscle damage as well as interfere with the heart’s ability to pump blood optimally. The cardiac involvement in COVID-19 is yet another striking example of the widespread effects of inflammation on multiple organs and systems. Inflammation is a critical defense response during infection, but it has a dark side. Infections can set off a cascade of immune signals that affect various organs.

Also read: World Heart Day: Cardiovascular disease management amid Corona outbreak

There have been several patients who have had heart attacks in India due to the COVID-19 infection.

Patients not seeking care:

Preventive and regular check-ups have become infrequent due to patients’ fear of COVID-19 causing them to avoid hospitals. Secondly, logistical challenges such as health care workers and infrastructure being allocated to COVID-19 has sometimes made appropriate resource allocation to cardiac disease management a challenge.

So patients with cardiovascular disease, need to remember

• Patients with heart disease are at higher risk for complications from COVID -19 and have a higher risk of death
• Patients with heart disease should be extra careful and take all the precautions in order to try and not get infected in the first place.
• All the precautions that we keep hearing about – social distancing, masks, and going outside only when absolutely essential is especially important in cardiac patients.
• Even the hearts of healthy patients can be affected due to COVID-19
• This can happen even after they have apparently ‘recovered’ – as part of the post-COVID sequel
• The heart can be affected in a multitude of ways – heart attacks, inflammation of the heart, rhythm problems
• ACE inhibitors should be continued in those patients who are on them
• Some patients might benefit from blood thinners to prevent clot formation both during infection and even during the post-COVID phase.
• Please stay in touch with your cardiologist (heart doctor) at least through a tele consult
• Eat healthy, stay active, and don’t forget your medications!
• Do not ignore symptoms such as chest pain, shortness of breath, or profound fatigue. Stay SAFE!

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