By Dr Vivek Mahajan
The COVID19 pandemic is the most unprecedented crisis faced by mankind in our living memories. The virus is also a complex puzzle and poses a formidable challenge for medical practitioners. In this second wave, the damaging effect of the virus is becoming more and more clear. Lung affection in the form of severe Viral Pneumonia which leads to poor oxygenation of the various body organs and the requirement of supplementary oxygen & ventilator support, is a common form of presentation among moderate to severe COVID19 patients. It is also a common cause for death. However, this is only one of the many ways in which COVID19 infection can harm the patient. The impact on the cardiovascular system is very common and can prove fatal even in mild COVID19 infections. Let’s try to understand this in greater detail.
COMORBIDITIES MAKE PEOPLE MORE VULNERABLE TO SEVERE COVID INFECTION: The virus infects vital organs like the Heart, Lungs, blood vessels, and Kidneys in a more severe way if these organs are unhealthy prior to COVID19 infection. Various conditions like high blood pressure, Diabetes, previous Heart Attacks, weak Heart, overweight and Obesity, Chronic Lung Disease, Asthma, Chronic Kidney Disease, etc., result in an easier entry of the virus in these vital organs and lead to a more severe infection. Lack of exercise, faulty dietary patterns, smoking, alcohol overuse, excessive snoring, poor blood pressure, and blood glucose control, being overweight and Obese make these vital organs diseased and more vulnerable to COVID19. There is a lot of hype on various unproven therapies touted to prevent COVID19 infection. However, the most effective strategy to prevent a severe COVID19 infection is regular aerobic exercise, healthy diets, weight control, BP and blood glucose control and cessation of smoking & alcohol overuse.
THE LINK BETWEEN CARDIOVASCULAR COMPLICATIONS AND COVID: COVID19 virus directly infects the lining of the blood vessels both carrying the pure blood to the organs (Arteries) and the impure blood from various organs to the Heart (Veins). This can also cause blood clots in the veins of the leg leading to a condition called Deep Vein Thrombosis. These clots may dislodge and travel to the Lung vessels via the Heart, blocking the blood supply to the Lungs. This is a condition called Pulmonary Thromboembolism and is life-threatening if the clot is a large one. If similar clotting occurs in the arteries of the Heart, then it could lead to a debilitating stroke which can be life-threatening. The arteries of the Heart are particularly vulnerable to choking by clot formation, Heart Attacks and these are commonly seen among COVID19 patients. These clotting complications may occur even in milder forms of infection even a few weeks or months after the recovery. Blood thinners like Rivaroxaban may be beneficial to prevent these complications in selected patients at a higher risk.
HOW COVID CAUSES A HEART ATTACK? The virus may directly infect the muscles of the heart and lead to a condition called Myocarditis. Complaints of palpitation are very common after COVID-related Myocarditis. Patients often exhibit fluctuation in heart rate from very fast to extremely slow for few weeks to months after recovery. Some patients tend to have a severe infection of the Heart muscle and can lead to extreme weakness of the Heart leading to Heart Failure. This can lead also to dangerously fast disturbances of Heart rhythm called ‘Arrhythmias’ and these can lead to sudden cardiac arrest.
HOW TO PROTECT SUCH PATIENTS? Patients having features of palpitations or breathlessness should be evaluated for the involvement of the heart muscle. 2D echo, MRI of the Heart, and blood tests for Heart muscle damage assessment like Troponin may be advised. 24-hour monitoring of the heart rhythm with a Holter monitor may help in detecting Heart rhythm disturbances. Steroids and antiarrhythmic drugs can be particularly helpful in such conditions to prevent Heart rhythm disturbances. A weakened Heart can lead to Heart failure post-COVID which can give rise to shortness of breath and swelling all over the body and particularly in the feet. This can happen in people with pre-existing weak Hearts. Various drugs which remove the excessive water through urine and improve the functioning of the Heart can be helpful in such conditions.
The Heart and the blood vessels are particularly vulnerable after a COVID infection and the risk persists for quite some time after recovery. Although we have therapies to reduce the risk of these Heart-related complications, prevention of severe COVID infection through a healthy lifestyle and appropriate correction of pre-existing chronic illness is a more desirable option. Vaccination should serve as major protection against severe COVID19 infection and the resulting Heart-related complications.
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About the Author
Dr Vivek Mahajan is the Consultant – Cardiac Surgery at Fortis Hospital Kalyan
