The world has went into a spiral, with the unprecedented emergence of the novel corona virus. It has put many developed countries to shame, and made the world realize, that more than equipment of mass destruction, we need instruments of healing. The need for doctors, healthcare workers, volunteers has never been higher, throughout the world.
Now there a lot of rumors that surround this virus, that it was man-made, so on and so forth. I am here to discuss facts- hard facts.
Corona Virus, the primary illness is that of a respiratory one, but there are instances and case series, where the heart has been involved. In fact, Corona virus disease can be seen as a disease involving multi-systems within the body, in it’s most severe form.
I’m here to talk about the cardiovascular implication of the novel corona virus. The corona virus can involve the heart by a variety of mechanisms-
- The respiratory distress that the disease causes, can lead to increased metabolic demand of the body, including the heart, that may lead to a substrate demand-supply mismatch, leading to myocardial infarction, or heart attack in simpler terms. Patients with a pre-existing heart ailment, like the presence of a pre-existing coronary artery disease, are particularly more vulnerable, because this pre-existing ailment, causes a decreased ability of the heart to increase it’s own blood supply, during stress, of any cause, this again leads to a demand and supply mismatch of the substrates (that travel via the blood) and lead to heart attack (Myocardial infarction; MI)
- Myocarditis– The virus can directly attack the myocytes (tissues of the heart) and cause inflammation of the heart, this can lead to various rhythm disturbances, that can precipitate sudden cardiac death.
- Arrhythmias- corona virus, can lead to myocarditis, as we already discussed in brief, this can lead to various rhythm disorders- including fast rhythms (tachy-arrhythmias) and slow abnormal rhythms (bradyarrhythmias)- these can lead to sudden cardiac death.
- Electrolyte disturbances- any illness can lead to electrolyte disturbances and that can lead to arrhythmias again, and also lead to sudden cardiac death.
- Heart failure- patients can have heart failure, de novo (new onset) or may have precipitation or decompensation of heart failure in patients with pre-existing heart ailment.
- Long term sequelae- the long term sequelae of the novel corona virus on the heart is still to be studied and investigated and we need to keep recovered patients in follow-up to best judge the situation.
There have been several case reports and series, where raised cardiac enzymes, particularly trop-i, has been associated with a worse outcome, when compared with patients with normal cardiac enzyme levels and/or mildly elevated levels. This highlights the importance and gravity of the situation if one develops cardiac manifestation with a covid-19 infection.
The effect of proposed drugs is not to be taken lightly as well- drugs like hydroxychloroquine can lead to QT prolongation (also, azithromycin and many other anti-virals) that can lead to sudden cardiac death. This is why I recommend a baseline ECG to look for a pre-existing QT prolongation to assess the risk of such medication and then follow it up with daily ECGs/EKGs.
These are tough times, where the best we can do, till a definitive cure comes, is to stay at home and try and do something productive. Work from home, if you can. Wash your hands frequently. Don’t touch your face. Maintain social distancing of about 2 meters at all times. Only go out, if it is absolutely necessary. Remember, prevention shall always be better than cure.
If you have any serious inquiries, and want me to clear any doubts, or just want to connect or collaborate- email me.