The vaccine is here but till it takes effect in the population, we cannot drop our guard on the often devastating effects of the virus in cases so far even after recovery. Covid-19 was originally thought to be a respiratory infection. However, as the pandemic progressed, it became clear that this infection threatens other organs of the body as well, including the heart, brain and kidneys.
The effect of Covid-19 on the heart was initially thought to occur in patients with pre-existing heart diseases, old age, obesity, diabetes or any long-term medical condition. But as the disease spread, many patients with no previous medical history showed features of cardiac damage. As many as one in four hospitalised patients showed signs of myocardial injury or injury to the heart tissue related to Covid-19.
Covid-19 damages the heart both directly and indirectly. Direct cardiac injury occurs due to viral invasion of heart cells leading to cell inflammation called myocarditis. This inflammation may vary from a mild form to a severe fulminant type which can result in decreased heart function, abnormal rhythms and risk of sudden cardiac death. Indirectly, Covid-19 infection is seen to increase clots in arteries supplying the heart, inflammation of blood vessels and a mismatch between oxygen supply and demand by heart cells. All these reactions can result in features of acute heart attack and heart failure. With treatment and timely intervention, these conditions can be controlled. What has recently been identified is that many patients who had mild disease or did not require hospitalisation are now presenting with cardiac symptoms.
Anticipating, that the cardiac sequelae may be as debilitating as the rest of the Covid-19, a Covid Cardiac Care task force was formed at our facility. We found a growing population of individuals who recovered from this infection came with a wide range of symptoms like palpitations, heart racing, shortness of breath, fatigue on exertion and dizziness. A pilot study is underway where we are evaluating and following up patients who are experiencing persistent or new cardiac symptoms after weeks of testing negative for Covid-19.
Out of the current 100 patients, 40% have no past medical risk factor such as diabetes, hypertension or obesity. Patients now presenting with cardiac symptoms are in all age groups, from 29 to 70 years. Once all alternative causes for these symptoms are ruled out such as lung consolidation or lung fibrosis, patients undergo a concise and focused cardiac work-up.
They undergo blood tests for cardiac biomarkers, an electrocardiogram and echocardiography with strain study to look for evidence of cardiac damage or dysfunction. This cardiac work-up has shown that many such patients have developed cardiac injury due to Covid-19 illness. Even patients after testing negative for the virus have underlying cardiac injury, which is now producing symptoms much after recovery. The extent of cardiac injury is seen to be independent of the individual’s past medical history and health and more dependent on viral inoculum and virulence. There is currently no way to predict who is at risk of developing these cardiac abnormalities.
Once a patient is detected to have Covid-19-related cardiac injury, he or she is started on cardio-protective medications to maintain a steady healthy heart rate and minimise inflammation. The role of blood thinners is still not clear.
Managing such patients requires careful examination, ruling out all alternative diagnosis and planning rehabilitation. Patients who have recovered from acute Covid illness are advised to eat a healthy balanced diet rich in vitamins, minerals and antioxidants.
It would seem that the recovery process from Covid-19 exists on a continuum early in the course of acute Covid-19. Management is focused on detecting and treating acute Covid-19 related complications while after recovery from the acute phase, people require management and evaluation of persistent or new symptoms.
RR Kasliwal is adjunct professor of cardiology, Medanta Heart Institute
The views expressed are personal