CARDIOVASCULAR EFFECTS OF COVID-19

COVID-19 Pandemic has infected almost 77.6 million people in the United States with more than 900,000 deaths. COVID-19 virus leads to acute and long-term cardiovascular complications among the infected patients. Multiple studies have been done to investigate the impact of COVID-19 on the heart.

Acute or immediate cardiovascular complications among the hospitalized patients range from heart attack, irregular heart rhythm (atrial fibrillation) and weakness of the heart muscles (heart failure) with variable rate of occurrence reported in various studies.

There has been a recent study published by authors in the Epidemiology department of VA at St. Louis, MO. They compared the incidence of cardiovascular complications among COVID-19 and without COVID-19 individuals for one year. This study involves cohort of 153,760 individuals with COVID-19, as well as two sets of control cohorts with 5,637,647 (contemporary controls) and 5,859,411 (historical controls) individuals to estimate risks and 1-year burden of a set of predefined incidents of cardiovascular outcomes.

Study results have shown quite alarming numbers of cardiovascular complications with various manifestations across a wide spectrum including stroke, arrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thrombo-embolic disease.

These groups were followed for almost 12 months to assess the burden of cardiovascular complications in various settings including both hospitalized and non hospitalized patients.

1. Incidence of Cerebrovascular Disease (Stroke): In a cohort with patients who survived the first 30 days of COVID-19 has shown 1.52 times higher risk of stroke.

2. Incidence of Electrical Disturbances in the Heart (Arrhythmia): There is an increased risk of overall electrical disturbances in heart leading to episodes of fluttering, pounding heart beats. There was a 1.71 times increased risk of atrial fibrillation, 1.84 times increased risk of sinus tachycardia, 1.53 times increased risk of sinus bradycardia and 1.84 times increased risk of ventricular arrhythmia.

3. Incidence of Heart Attack and Weak Heart Muscles: Post COVID-19, there is an increased risk of heart attack and chest tightness episodes. Ischemic heart disease included risk of heart attack increase by 1.63 times, weak heart muscles with shortness of breath (ischemic cardiomyopathy) by 1.75 times and chest tightness (angina) by 1.52 times.

Another study published has shown that patients admitted to the hospital with COVID-19 and blood test showing high blood marker (troponin) has 3 to 6 times higher likelihood of having narrowed in heart arteries (coronary artery disease) and risk of heart attack.

4. Incidence of Sudden Heart Arrest and Heart Failure: Post COVID-19 there is increased risk of heart failure and heart arrest as well. Risk of heart failure increases by 1.72 times, cardiac arrest by 2.45 times and cardiogenic shock increases by 2.43.

5. Incidence of Blood Clots in Lungs and Legs: Thrombo-embolic disorders included pulmonary embolism (blood clot in lung) by 2.93 times, deep vein thrombosis (blood clot in vein) by 2.09 times and superficial vein thrombosis (blood clot in superficial vein) by 1.95 times.

Initial imaging studies had reported higher incidence of myocarditis (inflammation of heart muscles) withCOVID-19, however recent autopsy studies have documented that myocarditis rate is less than 5%.

Few studies have reported that almost 60-80% of patients report at least one residual symptom of chronic fatigue, shortness of breath and chest pain after 50 days from initial diagnosis of COVID-19. So, it is strongly encouraged to seek a medical opinion from your physician if you are having symptoms of chest pain, shortness of breath, heart palpitation, lightheadedness and passing out spellsafter COVID-19.

Author: Dr Bharat Marwaha, MD Cardiology

References:

1. https://www.nature.com/articles/s41591-022-01689-3

2. https://www.sciencedirect.com/science/article/pii/S2666602221000239#bb0305