Heart of the issue – The New Indian Express

Express News Service

KOCHI: Recent data from Germany shows that 60% of Covsid-19 patient experienced inflammation of the heart independent of pre-existing conditions. Out of this, 16.7% developed abnormal heart rhythms (arrhythmia). Injury of the heart muscles in confirmed Covid-19 cases was reported at 19.7% in another study. The death rate among patients with heart muscle injury was 51.2%, as compared to the 4.5% among those without injuries.

Data shows that 59% of non-survivors had myocardial injury. Injury of the heart muscles is an independent predictor of in-hospital death rate. This injury was defined as a result of higher levels of cardiac enzymes like troponin I (hs-TnI) in the blood, regardless of new abnormalities in electrocardiography (ECG) and echocardiography. Covid-19 studies have shown that myocardial injury, irrespective of the nature of the cardiac enzymes elevation, is associated with a higher risk for death and abnormal heart rhythms. In a study conducted in Wuhan, cardiac conditions, including heart failure (HF), contributed to 40% of the death rate, either acting alone or in conjunction with respiratory failure.

Heart Muscle Injuries can be classified as : (a) Chronic Myocardial Injury : Frequently noticed in Covid-19 patients with older age and pre-existing chronic cardiovascular conditions.(b) Acute Non-ischemic Myocardial Injury : Dynamic rising and/or falling of cardiac enzyme cTn concentration without clinical evidence of decreased blood flow to heart muscles, is probably the predominant mechanism for cardiac enzyme cTn increases in patients with Covid-19.(c) Acute Myocardial Infarction (MI) the heart attack.

11.8% of patients without underlying cardiovascular diseases had substantial heart muscle injury, elevated levels of cardiac enzymes (Troponin-i cTnI) and cardiac arrest during hospitalization. Incidence of cardiovascular symptoms is high in Covid-19,Owing to the systemic inflammatory response and Immune system disorders during disease progression.

Cytokine storm syndromeoriginates when the human bodys immune system acts not only to destroy viruses but also to destroy the healthy cells in the human body and cause various chemical reactions which may contribute to cardiac complications in Covid-19. Immune system activation along with immune-metabolic alterations may result in plaque instability in the blood vessels, contributing to development of heart attack (acute coronary events).Underlying heart disease in SARS-CoV-2 infection might act as a precipitating factor to worsen the condition and lead to increased mortality.

Major Cardiac Complications in COVID-19 : Heart Attack (Acute Coronary Syndrome) prevalence rate was found at 7% to 27.8%. Release of circulatory cytokines & chemokines during inflammatory processes leads to plaque instability. Use of blood clot dissolving injections (Thrombolysis) were widely used in most of the Covid related heart attack cases during initial days but now treatment does not differ from those without Covid-19.

Inflammation of the heart tissues (Myocarditis) Possibly due to direct viral infection of the myocardium and vascular endothelium is one among the major Cardiac Complications in Covid-19. Collection of fluid around the heart (Pericardial Effusion) is seen rarely as a complication.

For Treatment Taking plasma from the blood of recovered patients (Convalescent Plasma containing neutralising antibody) is being used by many centers and it works especially for critically ill patients with Cytokine Storm Syndrome.

Treatment Related Risk: The use of antiviral drugs & hydroxychloroquine HCQs should be monitored. Many antiviral drugs can cause heart failure and abnormal heart rhythm. Blood thinning medications (Anticoagulation): Blood thinning medications like unfractionated heparin or LMWH remain the best choice of anticoagulant for admitted patients. It is possible that these patients may even continue blood thinning agents for a certain period following hospital discharge.

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Heart of the issue - The New Indian Express