Sun | Dec 3, 2023

Heart disease and COVID-19

Cardiac patients at high risk of morbidity, mortality

Published:Wednesday | January 26, 2022 | 12:05 AMKeisha Hill/Senior Gleaner Writer -
Heart Institute of the Caribbean chairman, Professor Ernest Madu.
Heart Institute of the Caribbean chairman, Professor Ernest Madu.

If you have a heart condition and become infected with the coronavirus, you are more likely to become severely ill. People who have underlying cardiovascular disease actually have a higher mortality rate when it comes to COVID-19, than people who have an underlying chronic respiratory disease.

SARS-CoV-2, the cause of the COVID-19 pandemic, has significantly impacted cardiovascular healthcare. Patients with pre-existing cardiovascular diseases are at higher risk of morbidity and mortality.

The virus may affect the heart directly, and indirectly, with clinical syndromes of acute myocardial injury, myocarditis, acute coronary syndromes, heart failure, arrhythmias, and venous thromboembolism. Blood clots in the lungs have also been seen.

Dr Ernest Madu, founder and chairman of the Heart Institute of the Caribbean and the HIC Heart Hospital, said there is evidence that COVID-19 may lead to cardiovascular complications.

In a journal article on ‘Clinical Cardiology: COVID-19 and The Heart: An Update For Clinicians: 12 June 2020’, Madu and fellow colleagues indicated that patients with pre-existing comorbidities are thought to be at an increased risk of infection with SARS-CoV-2, and also tend to have worse clinical outcomes.

“Specifically, patients with cardiovascular disease, diabetes and hypertension are thought to have a high complication rate, with mortality rate of 10.5 per cent reported in cardiac patients, and mortality rates of 7.3 per cent and 6.0 per cent for diabetes and hypertension patients, respectively,” they said.

According to Madu, symptoms and signs of heart disease in a patient with COVID-19 may result from an acute disease process, from hemodynamic demands in the setting of chronic heart disease, or may be caused by an acute exacerbation of chronic disease.

“There is substantial evidence of the association between pre-existing cardiovascular disease, such as hypertension, diabetes and coronary artery disease, and the risk and severity of COVID-19 infection, including risk of hospitalisation or needing intensive care. The causes of this association are not well understood,” Madu said.

Proposed mechanisms, he said, include impaired physiologic reserve - cardiovascular and pulmonary, impaired immune response, augmented inflammatory response, vulnerability to SARS-CoV-2-induced endothelial dysfunction, and effects mediated by the angiotensin-converting enzyme 2 receptor.

Patients with COVID-19 present with a broad spectrum of clinical cardiac presentations. Some patients manifest no clinical evidence of heart disease, some have no symptoms of heart disease but have cardiac test abnormalities, and some have symptomatic heart disease.

“Cardiac complications include myocardial injury, heart failure, cardiogenic shock, and cardiac arrhythmias, including sudden death from cardiac arrest,” the cardiologist said.

Most patients with COVID-19 who experience abnormalities on cardiac testing have the typical symptoms of COVID-19, including cough, sore throat, fever, myalgia, headache, and shortness of breath.

“A minority of patients with COVID-19 present with symptoms that may suggest heart disease; for example, palpitations or chest pain. These symptoms may or may not be accompanied by prior or concurrent symptoms typical of COVID-19 infection. Symptoms such as dyspnoea and chest pain may be caused by noncardiac and/or cardiac causes,” Madu said.

If someone has had COVID-19 infection, they should be aware that their risk of heart disease is increased, especially in the first several weeks following recovery. It is, therefore, advisable that they see a doctor as soon as possible if they develop worrisome symptoms that suggest cardiac involvement.

Symptoms to watch out for include palpitations, exertional shortness of breath, chest pain, fainting, shortness of breath at rest, especially when associated with chest pain or fatigue. The long-term cardiac complications of COVID are still being studied.

Madu said researchers have found strong evidence that heart attack and stroke risk rise sharply in the weeks following a COVID-19 diagnosis. The findings were published on August 14, 2021, in The Lancet, a leading medical journal.

The study included every person in Sweden diagnosed with COVID-19 from February 1, 2020, to September 14, 2020, totalling nearly 87,000 people. Their median age was 48, and 57 per cent were women. Researchers compared them with more than 348,000 Swedish people of similar age and sex who did not have the virus.

According to Madu, in the week after a COVID-19 diagnosis, the risk of a first heart attack increased by three to eight times. The risk of a first stroke caused by a blood clot multiplied by three to six times. In the following weeks, both risks decreased steadily, but stayed elevated for at least a month.

“Other bacterial and viral infections, such as influenza, are also known to temporarily boost rates of heart attacks and strokes. But COVID-19 infections appear to be especially risky, perhaps because they trigger an exaggerated inflammatory response that makes blood clots more likely,” Madu said.

If you have heart disease, it is particularly important to take special care to stay healthy and avoid getting infected with COVID-19. It is recommended that limiting your interactions with other people as much as possible, practising good hand hygiene, and social distancing -- keeping at least six feet of space between you and others -- can help or reduce infection.

SOURCE: US Centers for Disease Control and Prevention

Heart failure and COVID-19

A diagnosis of heart failure after COVID-19 is rare. But if you have shortness of breath or leg swelling after COVID-19, you should contact your doctor, who may recommend evaluation by a cardiologist if tests indicate you are at risk.

A sign of heart failure is shortness of breath, but this has many other potential causes, including COVID-related pneumonia and other non-cardiac causes. Symptoms of heart failure may include:

· Shortness of breath, especially with exertion;

· Fatigue;

· Shortness of breath when lying down;

· Leg swelling;

· Frequent urination at night. (Note: frequent urination at night in men is a common symptom of an enlarged prostate.)