COVID-19 Heart-Stopping Alert

Electron microscope image COVID-19. CP/NIAID-RML via AP

"[It is clear that COVID-19] is a disease that affects multiple organ systems. Everyone thinks of the lungs first and foremost, but we know there are quite a few patients who have involvement of the heart." "What is really scary about this infection is its unpredictability. You have the occasional story of the 25-year-old marathon runner in perfect shape who dies from COVID. That can happen. That freaks everybody out."                                                              "We know that COVID and heart disease don't marry very well. You don't want to bring the two together."                                                                                              "I think we are going to have to manage both threats for a long time -- the COVID threat, but also the heart disease threat, and make sure people don't forget to seek medical attention when they need it."                                                                    Dr.Marc Ruel, head, cardiac surgery, Heart Institute, Ottawa

Doctors and nurses inspect a patient’s scans in Istanbul. Concern is growing that the lungs and other organs can struggle to heal after infection. Chris McGrath/Getty Images

Specialists at the University of Ottawa Heart Institute are on alert in recognition of medical experts now acknowledging that COVID-19 constitutes an especial threat to the heart-health of those who contract the virus. Though once it was felt people with heart disease were likelier to become infected with COVID-19 now evidence has shown that those with heart disease, though not likelier to contract COVID-19, are nonetheless likelier to have a severe form of the disease.

An even stronger link between COVID-19 and the heart has been revealed by new research. Research that leads to the belief that COVID-19 could result in long-term detrimental impacts on the state of heart health of some patients with no prior heart disease condition. Dr. Ruel of the Ottawa Hospital Heart Institute estimates that the number of patients with heart involvement resulting from COVID could be as high as 20 percent.

Because COVID-19 stresses the body in a number of ways, it specifically does so to the cardiovascular system. In that it can both reveal the presence of previously unknown heart disease and on the other hand, become the catalyst to produce new issues in some patients, though its frequency is not yet clear. According to Dr. Ruel, COVID-19 ultimately will have a profound effect on the heart health of some patients once recovered from the disease.

A recent study from Germany, published in JAMA Cardiology discovered troubling cardiac signs in patients recovered from COVID-19 in comparison to people who were similar but never infected. Comparing cardiac MRIs of 100 relatively healthy previously infected patients and 100 non-infected patients, the study found those who had COVID-19 likelier to come out of the experience with signs of heart disease, including structural changes to the heart in 78 percent of recovered patients. 

Yet another study found elevated levels of the virus in the hearts of patients who had died as a result of having contracted COVID-19 early in the appearance of the pandemic. Some characteristics of COVID-19 clearly have direct influence on the heart. Unusual blood clotting issues in a significant number of patients, along with widespread inflammation which can damage cells and affect the function of the heart, included. 

There have been instances of relatively young and healthy people suffering serious outcomes, even death, while many other people who contract COVID-19 recover completely. No cases of COVID-19 have occurred among open-heart surgery patients at the Heart Institute, but the potential of such an occurrence must be contemplated, with the continuation of the global pandemic.

Another issue is raised in the presence of the pandemic, one of persuading people reluctant to enter a  hospital for fear of contracting COVID-19 there. Evidence exists globally of patients deliberately avoiding entering hospital for any reason, for fear of contracting the virus there, leading to more severe illness of various types; in some cases death.

"These are two studies that both suggest that being infected with Covid-19 carries a high likelihood of having some involvement of the heart. If not answering questions, [they] prompt important questions about what the cardiac aftermath is."  "The question now is how long these changes persist. Are these going to become chronic effects upon the heart or are these — we hope —  temporary effects on cardiac function that will gradually improve over time?" 
Matthew Tomey, cardiologist, assistant professor of medicine, Icahn School of Medicine, Mount Sinai Health System, New York

1 Brain fog Difficulty thinking can occur after acute COVID-19infection. The virus may damage brain cells, and inflammation in the brain or body may also cause neurologic complications.Other viral infections can also lead to brain fog. 

2 Shortness of breath Doctors are eyeing lung and heart complications including scarring.Patients who become critically ill with COVID-19 seem more likely to have lingering shortness of breath, but those with mild cases are also at risk. 

3 Heart arrhythmia The virus can harm the heart, and doctors are concerned about long-term damage. How the heart heals after COVID-19 could help determine whether a patient develops an irregular heartbeat. 

4 Hypertension Some patients have high blood pressure after an acute infection,even when cases were relatively mild and people were previously healthy, possibly because the virus targets blood vessels and heart cells.   V. Altounian/Science