COVID-19 And Heart Attack
COVID-19 And Heart Attack
Just a few months into the pandemic last year, scientists recognized a pattern emerging. People with cardiovascular disease were at increased risk of getting severe forms of COVID-19 compared to a healthy population.
Now in the second wave of this devastating pandemic, it is clear that having a heart disease is a predictor of poor outcome in patients who get COVID-19 infection.
Diabetics are also at high risk because of their poor immune system and people with asthma have poor outcomes in COVID because of their poor functional lung capacity. But how does heart disease affects COVID -19 outcome?
The first explanation is that heart conditions, like damaged heart muscle or blocked heart arteries, compromise the body’s ability to survive the stress of the illness. COVID-19 infection causes an inflammatory response that leads to fever, increased heart rate, low oxygen saturation. A person with heart disease will not be able to cope with the increased metabolic demand created by COVID-19 infection.
The second explanation is that patients with heart disease more likely to have obesity and Type 2 diabetes. These conditions increase the risk of blood clot formation and cOVID-19 also increases the risk of clotting thus compounding the problem.
Mechanism of heart damage in COVID-19 infection
The virus may directly invade the heart muscles and cause damage, it may indirectly damage the heart muscles by causing hypoxia in the muscles, which may be measured by elevated levels of the enzyme troponin in the bloodstream. This has been detected in about one-quarter of patients hospitalized with severe COVID-19 illness. About one-third have a pre-existing cardiac condition.
Inflammatory injury to heart muscles
Almost 80% of COVID-19 patients will have minor symptoms and will recover completely. However, about 20% will develop chest infection, and about 5% will develop severe disease. In the severe form of COVID-19, the body self-defense system releases an excess of chemicals called cytokine. This "cytokine storm” can damage the heart along with other organs.
Inflammation of the heart muscle is called myocarditis. Myocarditis can result from cytokine storms or direct heart invasion by the virus itself. When this occurs, the heart may not be able to pump enough blood called heart failure leading to low blood pressure and fluid in the lungs. A milder form of heart muscle inflammation may be much more common than previously recognized. A recent study showed that in patients with severe COVID-19 infection up to three-quarters of patients who had recovered from severe COVID-19 had evidence of cardiac injury on magnetic resonance imaging.
COVID-19- raises the risk of clotting of blood in the blood vessels when this type of clot formation happens in the arteries supplying blood to the heart than heart these clots in the large and small arteries of the heart cut off its supply of oxygen. The increased thrombotic tendency can also lead to blood clots in the lungs, which can cause a drop in blood oxygen levels. Severe pneumonia drops blood oxygen further. When the oxygen demand of the heart muscles exceeds the supply, then the heart muscle gets damaged.
People with cardiovascular disease who adopt a healthy lifestyle can strengthen their defenses against COVID-19 while also reducing the long-term risk from the cardiovascular disease itself. This means increased physical activity and following a healthy diet like the Mediterranean diet, measure your blood pressure at home. Avoid COVID-19 infection by correct masking, keeping distance, and getting a vaccine.
Dr. Rakesh Rai.
MS, FRCS, MD, CCST (UK), ASTS Fellow (USA).