Covid 19 remains to be a global health crisis, and cases are still increasing exponentially in India. Cases of heart attack and cardiac arrest have increased in covid era with 20-30% of covid patients having significant heart problems. In one study using Cardiac MRI, signs of heart problems were observed in 78% of patients who had covid infection. Patients who have heart involvement have the worst prognosis than patients without heart problems.
Heart problems in covid patients are not related to the severity of infection, though more common in severe covid infection and patient already having risk factors for heart disease, or pre-existing heart illness. It can occur in mild, or even asymptomatic infection.
Dr Nikesh Jain, Consultant Cardiologist at Jaslok Hospital and Research Centre explains how Covid can damage the heart in multiple ways –
Heart Attacks – It occurs due to 100% blockage of heart vessels by blood clots over pre-existing heart blockages. Covid infection causes plaque instability (covering over heart blockages) and increases tendency of blood to clot, resulting in heart attack. This has also been associated with cardiac arrest.
Myocardial necrosis – Covid can directly infect heart muscle cells and blockage of small vessels of heart causing heart pumping to decrease. This type of injury mimics heart attack on blood test and ECG, though the larger heart vessels may not show any blockage.
Myocarditis – This is a severe form of myocardial necrosis, which is due to an exaggerated immune response to covid infection. It is associated with worst prognosis, causing decreased heart pumping, cardiogenic shock, heart rhythm problems and cardiac arrest.
Stress cardiomyopathy (Takostubo syndrome) – This type of pattern also mimics heart attack, but heart vessels may be normal. Heart muscles become weak secondary to the stress of inflammatory response to covid infection.
It is difficult to predict which patients will have heart involvement, but it is more common in patients with pre-existing risk factors for heart disease, and who already have heart disease. It is important for these subset of patients to take precautions and consult a doctor at earliest manifestation of covid infection or heart disease.
Patients who develop heart attack should be treated on urgent basis by thrombolysis (clot dissolving injection) or Primary Angioplasty – coronary angiography followed heart vessel stenting (preferred treatment). Treatment of other types of heart involvement is supportive care – treating underlying infection, blood thinner injections, supporting blood pressure or even heart support devices like ECMO.
Patients who are at high risk should be preferable admitted and monitored for signs of heart involvement.