Covid-19 Affects The Heart Too — Dr Malar Velli Segarmurthy Et Al

Covid-19 can increase the risk of heart complications, cardiovascular ailments, and mortality among those infected.

The pandemic is reshaping our world, and with it comes new knowledge. The emergence of the novel coronavirus has presented an unprecedented challenge globally. As soon as the pandemic was declared, the health care and scientific communities have worked round the clock for a better understanding of this deadly virus. 

Contrary to common myth, Covid-19 does not just affect the lungs alone, but has a devastating effect on our hearts as well, with potential long-term effects. Research has shown that there is a mutual relationship between Covid-19 and cardiovascular diseases (CVDs). This infection can either worsen underlying CVDs or precipitate de novo (new) cardiac complications.

Globally, there are about 1.7 billion people with at least one underlying health condition, including CVDs, and Covid-19 can increase the risk of heart complications, cardiovascular ailments, and mortality among those infected.

Patients with underlying medical conditions such as hypertension, diabetes mellitus, myocardial injury and heart failure, are shown to have a higher risk (by five times) of contracting severe Covid-19, resulting in death, as compared to those without prior CVDs.

Survivors too have a higher chance of developing cardiovascular complications, post-recovery. About 87 per cent of the Covid-19-related deaths in Malaysia in 2020 had at least one underlying medical condition, including hypertension (61.4 per cent), followed by diabetes mellitus (41.3 per cent). 

Hypertension is the most common complication reported, followed by acute cardiac injury and arrhythmia. While most patients will recover completely, few might continue to experience symptoms after their initial recovery. Patients can continue to be very ill, and can spend weeks convalescing in bed.

Fulminant myocarditis, a clinical condition involving diffuse cardiac inflammation often leading to death, has been reported among a few normal viral load patients, within weeks after their discharges. 

These issues will increase the burden on an already congested health care system. Proactive health care is needed to ensure that patients with underlying non-communicable diseases (NCDs), as well as those with a risk of post-Covid-19 cardiovascular complications, are adequately cared for.

This will benefit both the population as well as decongest the health care system by preventing unnecessary hospital admissions and cut costs, as well as prevent the burnout of health care workers. 

In order to ensure Covid-19 patients with either underlying or new cardiovascular complications have better chances of survival, here are some practical recommendations based on general guidelines from the World Heart Federation:

  • Covid-19 patients should be managed based on the severity of their conditions, so that patients with moderate or severe disease are admitted to a separate ward for closer monitoring.
  • Patients should be informed and educated on lingering symptoms and warning signs like fatigue, shortness of breath, cough, joint pain, palpitation, chest discomfort, and should be advised to seek immediate medical attention if these symptoms worsen.
  • Upon discharge, high-risk patients should have a repeat echocardiogram within three months, and have regular follow-ups for a minimum period of six months at their local government clinics.
  • Encourage healthy lifestyles (such as stopping smoking, being physically active, and having healthy and balanced diets) to reduce the risk of developing cardiovascular ailments that can make them vulnerable to severe forms of Covid-19.
  • Patients recovering from Covid-19 can benefit from physical therapy and breathing exercises.

Patients with underlying CVDs are clinically vulnerable, and since the health care system is currently overburdened; hence prevention is better than cure.

The country’s health care service should be empowered to reach out to those who are vulnerable. Empowering the population and encouraging healthy lifestyles can improve the quality of lives, reduce the congestion on the health care system, and avoid the devastating effects of Covid-19. The ones who are most at risk should be actively involved in online awareness campaigns.

A proper triage system should also be established in health care facilities to identify those who are in need of further care without delay.

General practitioners and primary care doctors in government clinics should also be trained to monitor Covid-19 survivors with potential cardiac complications, post-discharge.

Prevention and post-discharge monitoring are vital to ensure that the quality of lives are maintained. This should be a shared responsibility brone by both the health care system and the people. Let us do our part and care for our hearts, because our health is our real wealth.

References

  1. Corrales-Medina, V. F., Alvarez, K. N., Weissfeld, L. A., Angus, D. C., Chirinos, J. A., Chang, C. C., Newman, A., Loehr, L., Folsom, A. R., Elkind, M. S., Lyles, M. F., Kronmal, R. A., & Yende, S. (2015). Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. JAMA313(3), 264–274.
  2. Dhainaut, J. F., Claessens, Y. E., Janes, J., & Nelson, D. R. (2005). Underlying disorders and their impact on the host response to infection. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America41 Suppl 7, S481–S489.
  3. Kaos, Joseph (2020, November 23). Covid-19: About 87% of those who died in M’sia had underlying health condition, says Health Ministry. The Star
  4. Corrales-Medina, V. F., Alvarez, K. N., Weissfeld, L. A., Angus, D. C., Chirinos, J. A., Chang, C. C., Newman, A., Loehr, L., Folsom, A. R., Elkind, M. S., Lyles, M. F., Kronmal, R. A., & Yende, S. (2015). Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. JAMA313(3), 264–274.
  5. Honka, H., Solis-Herrera, C., Triplitt, C., Norton, L., Butler, J., & DeFronzo, R. A. (2021). Therapeutic Manipulation of Myocardial Metabolism: JACC State-of-the-Art Review. Journal of the American College of Cardiology77(16), 2022–2039.

Dr Malar Velli Segarmurthy, Dr Kalaashini Ramachandran, Prof Dr Moy Foong Ming, Prof Dr Noran Naqiah Hairi are from the Public Health Department, University Malaya Medical Centre.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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