COVID-19 (coronavirus SARS 2) is obviously an infection that primarily affects the lungs. As we know, this is a pandemic that has affected all our lives. Does it have any cardiac issues directly or indirectly?
Direct Problems
- COVID-19 has been known to cause weakening of the heart in some cases. Thankfully this is rare, but it is because it seems to cause a myocarditis (inflammation of the heart). It is not yet clear whether this is directly from the virus attacking the heart or from the inflammation caused by the infection. The receptors in the lungs that the virus targets to attack are also present in the heart. So it is possible that this is a direct infiltration by the virus. It is also known that this infection provokes a severe inflammatory response. A lot of the lung damage may be from this inflammatory response. This causes a lot of the lung damage too. The heart gets very weak, and heart failure can happen. Interestingly, unlike other viral infections causing heart damage, this appears to gradually improve as long we can ride the storm.
- Troponin, a biomarker often checked in hospitals for heart attacks, is often high in COVID-19 patients, and not because of a heart attack. Indeed, almost all hospitals in the USA have policies to avoid heart catheterizations in COVID-19 patients unless the evidence for the heart attack is so strong.
- Acute Myocardial infarction: The stress of infection can cause heart attacks due to plaque rupture. In some hospitals heavily affected by COVID-19, this is being treated with clot-breaking agents and not stents.
- Heart arrhythmias: Some patients with COVID-19 can present with heart arrhythmias.
Indirect Problems
- Stress related: We know that stress increases the risk of heart attacks and strokes and if a pandemic doesn’t cause you to be stressed, what will?
- Treatments: Many of you must have heard of the potential risk of life threatening heart arrhythmias with Chloroquine, hydroxychloroquine and Azithromycin. Since older and more sick patients are afflicted, this risk is increased.
- Risk for patients with underlying heart trouble: This has multiple implications. First, patients with heart trouble have a higher risk of complications with this disease. Second, since “elective” procedures are allowed, patients with angina, slow heart rates, weak heart rates, etc. cannot get the procedures needed until this clears unless their situations become an emergency! Third, patients needing defibrillators cannot have this done, and fourth, patients needing heart transplants or LVADS cannot be done because those are generally suspended.
BIO: Dr. Kollagunta Chandrasekhar, better known as Dr. Sekhar (pronounced Shaker) has been practicing cardiology in Winter Haven for 20 years. Dr. Sekhar is the Chief of Sta at Bay Care Winter Haven Hospital as well as the Director of the Heart Function Clinic and the Cardiac Rehabilitation program at Bay Care Winter Haven Hospital and the Chairman of Cardiology at Advent Hospital in Lake Wales. He is a member of the Heart Failure Society of America, the American Heart Association, the American College of Physicians, and the American Society of Nuclear Cardiology. To schedule an appointment, please call (863) 508-1101.