New Delhi | Dr Nihar Mehta: The world is facing on of the most deadly and unprecedented pandemic, related to the SARC coronavirus-2. The virus is a very small virus but has got the entire world down to its knees. Although it started in a small province in China, but it has spread across the entire globe, which highlights the infectivity of the virus.
Although the virus is not as deadly as SARC-1 it is very infectious, and as the world corners on millions of cases, India has now over 6 million I.E 60 lakh cases, and we are close to 93 thousand deaths today 26 th September.
What is important to understand is that out of these patients, a large number of patients are affected by cardiac system in 2 ways - the first is the patients who have cardiac diseases or co-morbidities they tend to have worst affliction of Covid. Amongst these it has been seen that covid patients, around 38% of covid patients have high blood pressure (BP) and 19% have high sugar or diabetes, and close to 10-15% have pre-existing heart illnesses.
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These factors increase the rate of fatality or mortality related to covid. If the mortality rate is between 3-6% once you have a co-morbidity that rate can go much higher upto 10-15% depending on different co-morbidities. That’s the first outcome of Covid, people with co-morbidities can have worst outcome because of pre-existing heart diseases.
The second aspect of Covid is that, although we know covid as a respiratory virus (it affects the lungs only), this concept needs to be changed because the virus can affect the heart as a primary involvement as well. What happens to covid when it infects our body. It affects or lung, other organs and releases Cytokines. These are normally released into our body by any kind of infection but covid leads to over stimulation of this process.
So, the body instead of bounding back to only the covid virus, they bound back to anything and everything and therefore it starts seeing its own organs as foreign bodies and starts adversely affecting the heart & lungs. In this situation covid patients, around 10-15% which actually develop a heart problem. Here we are talking about: 1. It can lead to myocarditis or inflammation of the heart: the whole heart becomes swollen and it can’t pump as well. This leads to myocarditis. Patients would develop this issue mainly out of 1 in 3, mainly who have developed myocarditis, succumb to the illness and don’t recover 2.
Second one is Acute Cardiac Injury, which can lead to blockages in your heart or heart attack as we commonly know it. Many patients who have covid, would develop blockages ad heart attack, and can be seen by changes in 2-D echo, ECG, and this Acute Cardiac Injury is very common. The problem we see is that with Covid, there are a lot of limitations on medicines, availability of services like angiography and angioplasty, availability of cardiologist at every place to treat such patients.
Even sometime availability of 2-D echo, ECG can be a problem when it comes to covid patients. Therefore, this has to be taken very seriously as covid can lead to a heart attack, unexpectedly and this should be treated as another heart attack just with the correct precautions. 3. Arrhythmia or fluctuations of heartbeat. And covid can lead to wide variations from being very fast to very slow. So covid can affect the heat beats of nearly 205 of the patients. 4. Heart failure: covid patients with heart problems can develop very weak hearts and can develop pulmonary edema meaning the lungs get congested because of heart
5. Arterial thrombosis- in our arteries or veins we get clots and those clots can spread. If the go into your fingers and hands and they become black if the clots go to your lungs, you can have breathing problems called deep vein thrombosis.
All these things tell us that Covid is not just a respiratory virus but affects the heart a well. If a patient has covid and he has recovered, we think he has become immune to the virus, but this is not the case as we have long covid syndrome (LCD). It refers to the late manifestations of coronavirus. It means even if the person has recovered, whether he had mild or major symptoms, 2-3 months later they develop certain lung and cardiac problems.
What are these kinds of problems- in a MRI, a study done in Germany, out of 100 which had recovered at least 58% or 6/10 patients had residual myocardial damage i.e. there heart was still inflamed even 60-70 days after the recovery and lot of patients developed, lung fibrosis or breathing issues. These patients are also prone to get heartbeat abnormalities and also known the have blockages in the future.so covid is leading to many heart ailments, and the birdmen of heart diseases would go up., even after recovering from covid. If the number of people affected were low, there wasn’t anything to fear.
But as millions of people are affected, and in India out of 60 lakh at least 6 lakh people would develop heart issues. There we should have special OPD for covid recovered patients, lung & cardiac rehabilitation programs so that they can live well, and their future illnesses and diseases are kept at minimal. Covid is still showing its dark side and still not revealed its true nature, along its affected millions of people, we still don’t know, how would it affect us in future, how medicine would change because of covid.
So, it’s important to keep in mind that a good follow-up post covid recovery and despite all the patients who have been affected by covid we must remember the biggest weapons we have is mask, social distancing, hand wash. And not forget these and follow them even if we have recovered. Even if things look dark, there are good chances that a vaccine would soon come and adjusting and evolving. People have stared living normally; things are getting back to normal. Also, patients covid or non-covid should be in touch with their primary doctors and should get regular check-ups done, so that we keep this illness at bay.
(Disclaimer: This article is written by Dr. Nihar Mehta, consultant cardiologist, Jaslok Hospital & Research Centre)