World Heart Day special 2022: While the end of the Covid-19 pandemic may be in sight, its effects on our health linger on. Heart issues in Covid survivors especially have become a cause of worry for many people who continue to struggle with cardiovascular problems long after their recovery. Even a mild Covid infection can increase a person’s risk of cardiovascular issues for at least a year after diagnosis, a new study showed. There are many types of heart damages that Covid-19 survivors suffer and not all of them had pre-existing heart conditions before contracting the disease. In case of people who had pre-existing heart problems, Covid has exacerbated their trouble even further. (Also read: World Heart Day 2022: What is broken heart syndrome and can it cause heart attack? Experts answer)
“People who have never experienced heart problems before may develop them as a result of Covid-19. But your risk of developing heart issues is highest if you earlier had cardiovascular disease. You carry an increased risk of significant problems if you have heart disease risk factors such high blood pressure, diabetes, obesity, or high cholesterol,” says Dr. Bimal Chhajer, a former consultant at AIIMS and the founder of SAAOL (Science and Art of Living). (Also read: World Heart Day 2022: Best and worst foods for heart health)
Experts in a conversation with HT Digital reveal all the ways Covid has impacted our heart health:
* Covid increases risk of heart attack significantly
“It is becoming clear that the coronavirus can cause a significant increase in blood clots throughout the body. Few studies show Covid-19 affected patients had clot formation in heart vessel leading to Heart attack. The clot formation in lung vessels can lead to Pulmonary embolism,” says Dr Naresh Kumar Goyal – Director & HOD – Cardiology & Heart Failure Programme, Fortis Hospital Shalimar Bagh. (Also read: 4 simple lifestyle rules to prevent heart attack in young)
“Heart attacks, which happen when a blood clot forms in a weak heart artery and prevents oxygen from reaching the heart muscle, are the most common cause of heart damage. Inflammation brought on by COVID-19 increases the risk of this kind of heart attack,” says Dr Chhajer.
* Covid causes inflammation of heart muscles
“Firstly, inflammation is the main culprit. The lining of your blood vessels (the endothelium) can become inflamed. When this happens, there is greater risk of heart attack by forming clots in the artery supplying the heart muscle. Secondly, the body responds to the coronavirus by creating inflammation (a means to fight against infection). This includes inflammation of muscle of heart, also referred as myocarditis,” says Dr. Vikrant Khese, Consultant Cardiologist, Apollo Clinic.
Dr Chhajer says myocarditis usually affects only patients with advanced Covid-19 illness.
“Myocarditis can be caused by a virus directly invading the heart or, more frequently, by inflammation brought on by a cytokine storm. This can cause the heart to expand and weaken, which can cause low blood pressure and fluid buildup in the lungs,” says Dr Chhajer.
* Irregular heart beat
Covid also manifested in causing irregular heartbeat or rapid heartbeat, a condition which is medically referred to as Arrythmia. This combined with low oxygen levels led to a collapse in the lungs and a heart attack or cardiac arrest, says Dr. Tejas V Patel, MD, DM Cardiology (CMC Vellore), Gold Medalist, Consultant Interventional Cardiologist, Marengo CIMS Hospital.
* Pulse rate fluctuations
“Pulse rate fluctuation is impacted by Covid-19 infection, many patients are presenting with syncope sinus bradycardia or low pulse rate especially after the second wave are. For such patients we do electrocardiogram (ECG) to know that heart rate is around 40/45/50. If the patient is having sinus bradycardia, we do Holter monitoring to see patient has a complete heart block or second-degree heart block or first-degree heart block. Nowadays, people use pulse oximetry to know the spike in oxygen saturation and at the same goal they are seeing that their pulse rate is around 110 120. So, for that reason, they are visiting their physicians for an ECG or echocardiography or even Holter monitoring to know about inappropriate sinus tachycardia or atrial fibrillation condition, if they have been suffering from COVID 19 infection,” says Dr. Sumanta Chatterjee, Consultant Cardiologist, AMRI Hospitals, Dhakuria.
* Covid leads to clot formation
“Coronavirus is known to affect the blood coagulation system by stimulating various inflammatory factors thereby leading to clot formation in various organs including the heart leading to heart attacks,” says Dr Charan Reddy, Consultant, Interventional Cardiology, Apollo Hospitals, Navi Mumbai.
* Covid can cause cardiomyopathy
Dr Chhajer says this is a condition of the heart muscle that impairs the heart’s ability to adequately pump blood which can be caused by viral infections, like Covid-19. The stress caused by these viral infection causes the body to release an excess of catecholamines, which can stop the heart, he adds.
* Covid 19 worsens existing heart disease
“Less oxygen can reach the bloodstream as the virus causes inflammation and fluid to fill the air sacs in the lungs. To pump blood through the body, the heart must work harder, which can be dangerous in people with heart disease. Hearts that are overworked can fail, and a lack of oxygen can cause cell death and tissue damage in the heart and other organs,” says Dr Naresh Kumar Goyal.
* Covid-19 causes heart failure
Cardiomyopathy, a heart muscle disorder that affects the heart’s ability to pump blood effectively, can be caused by viral infections.
“When the body is attacked by a virus, it experiences stress and produces a surge of chemicals (ie. Cytokinines, catecholamines), which can damage the heart to decrease the contractility leading to heart failure. When the infection is gone, the stressor is gone, and usually the heart reverts back to normal,” says Dr Goyal.
* Covid- 19 causes arrhythmias
“Covid also manifested in causing irregular heartbeat or rapid heartbeat, a condition which is medically referred to as Arrythmia. This combined with low oxygen levels led to a collapse in the lungs and a heart attack or cardiac arrest,” says Dr. Tejas V Patel.
“Coronavirus can affect the conduction system of heart, leads to different rate or rhythm disorder, commonly Tachycardia, bradycardia, occasionally premature beats and rarely dangerous arrythmias leading to death,” says Dr Goyal.
* Covid-19 delays the diagnosis
Heart disease patients usually present with symptoms of chest pain or breathing difficulty, which can be mistaken as the manifestation of Covid-19 infection. It delays the diagnosis of heart disease and treatment which can be dangerous, says Dr Goyal.
* Covid-19 can lead to fluctuation in blood pressure
“Covid-19 also leads to fluctuation in blood pressure which causes hypertension, orthostatic, hypotension, autonomic dysfunction, postural hypotension (a dizzy spell or even syncope whenever somebody is trying to stand from a sitting or lying down position which causes blackout).
Even the blood pressure medications that are prescribed to the patients are causing fluctuation in blood pressure parameters. Earlier patients were getting medications and now blood pressure is hovering around 140 /150 or 160 and they are prescribed by another medicine to control blood pressure. This is also happening in patients with Covid-19 infection in the form of autonomic dysfunction,” says
Dr. Sumanta Chatterjee, Consultant Cardiologist, AMRI Hospitals, Dhakuria.
* Impact of steroids on heart during Covid treatment
“During Covid-19, people have increased doses of steroids which are producing QT prolongation (a measure of delayed ventricular repolarisation). The QT prolongation can be diagnosed with a simple ECG and that can lead to Ventricular Tachycardia (VT) and Ventricular Fibrillation (VF). So, patients should be very cautious whenever they are having those vital antivirals. They should go for regular ECG. The cardiologist needs to monitor whether there is a QT prolongation or other aesthetic changes in the heart,” says Dr Chatterjee.