Covid19 and the heart

The Novel Coronavirus targets the lungs primarily. But it also poses a risk to people who have a fatty build-up known as plaque in their arteries, potentially resulting in the blockage of an artery feeding blood to the heart, and thus putting patients at risk of a heart attack. We talk to experts about the safety measures needed during this time

COVID-19, the disease caused by the novel Coronavirus, can be asymptomatic at one end of the scale, and, on the other end, be a grave illness affecting multiple organs of the body, including the heart, leading to death in a small minority of patients. “Of particular concern is the increased risk of severe disease in people with pre-existing heart disease or risk factors like hypertension and diabetes mellitus. The scientific community is trying to identify the various manifestations of COVID-19. Given the relatively recent onset, there is still limited data and a lot needs to be discovered,” says Dr Varada Rajasekar, Senior Interventional Cardiologist & Electrophysiologist, Yashoda Hospitals.
“What we have learnt so far is that, after its entry into the lungs and heart, the virus attaches itself to receptors on cells which are targets for commonly-used drugs (ACE inhibitors) to control high blood pressure. The initial apprehensions about the safety of the continued use of these medications was unfounded, and now they are seen as an essential part of management. In fact, stopping them entails more risk,” says Dr Rajasekar.

Blockages in arteries due to COVID-19, resulting in heart attacks, is seen in only 40 percent of Coronavirus-infected cardiac patients. “The other 60 percent of such patients suffer heart attacks due to routine issues, not related to COVID-19,” says Dr R.K. Jain, Consultant Cardiologist, KIMS Hospital.

Cardiac patients, including those who have undergone heart procedures like angioplasty and by-pass surgeries, or have suffered damage to the heart, and whose hearts have weak pumping should be extra careful. “If a cardiac patient gets infected with COVID-19, the chances of that person having to be admitted in an ICU and needing the ventilator are very high. It is better that cardiac patients are isolated in their homes even when there is no Coronavirus positive patient nearby. It is highly recommended that they remain at home unless they have any medical emergencies,” adds Dr Jain.

In addition, in an advanced stage, COVID-19 affects the heart and other organs. “The cardiac manifestations can be varied and include precipitating strokes in susceptible patients (diabetic and hypertensive), worsening of heart failure, and irregular heartbeats,” says Dr Rajasekar.  

Novel Coronavirus infection can also cause changes in ECG, 2D Echo and blood test readings (high troponin levels) mimicking heart attacks or heart failure, and it is important to identify and treat these as manifestations.

“Patients who suffer cardiac strokes are managed with specific injections (clot busters) or emergency stenting/surgical procedures. Heart failure is managed by oxygen and supportive drugs. People with high blood pressure should continue to take their medications under supervision. Medications taken by those with stents or who are in the post-bypass surgery stage should not be stopped. A minority of patients require advanced ventilator care and specialised treatment in dedicated intensive care units,” adds Dr Rajasekar.

Dr Jain points out that, “From the start of this pandemic, there have been some conflicting theories about blood pressure medication making patients susceptible to the Novel Coronavirus. Be assured that common blood-pressure medicines don’t raise patients’ risk of infection. It is advised not to stop the blood pressure medication, as hypertension is a major risk factor and can lead to more complications in case of infection.”