Dr Arvind Kohli
Coronavirus disease 2019 (COVID-19) is a extremely challenging health issue that has provoked all the healthcare providers to contemplate various measures to take on the situation A type of coronavirus called SARS-CoV-2 causes COVID-19, an illness infamous for its effects on the lungs and airways.however emerging data has revealed its association with additional extrapulmonary manifestations and complications.that has significant implications for the cardiovascular care of patients.
Overall, it is still too early to judge the impact of COVID-19 on heart health. However, the emerging review outlines some fairly strong evidence that existing cardiovascular disease might increase the chance of developing COVID-19, the mortality risk, or both. Factors associated with mortality include male sex, advanced age, and presence of comorbidities including hypertension and diabetes mellitus
Covid19 infection has been associated with serious cardiovascular outcomes, including heart failure and heart attacks, as well as blood clots. Heart attacks called acute myocardial injury is determined by elevated high-sensitivity troponin levels(Trop T) which may occur in 7-17% of patients hospitalized with COVID-19 and 22-31% of those admitted to the intensive care unit.
Myocarditis The myocardium is the muscular tissue of the heart. Myocarditis is an inflammation of this tissue, and it can cause a rapid or abnormal heart rhythm. Recently some evidence has emerged that SARS-CoV-2 can cause myocarditis. They explain that autopsy reports suggest that inflammatory cells invade the myocardium which is a hallmark of inflammation.and it can lead to heart failures or arrythmias which can be potentially lethal
COVID-19 have “an increased risk” of venous thromboembolism orblood clots forming inside blood vessels, an important risk factor for brain strokes and clots in the lungs called Pulmonary embolism which are challenging to manage potentially and fatal conditions. Drug Therapies in some COVID-19 patients, are also a challenge It has been found that one of the drugs hydroxychloroquine HCQ may cause direct myocardial toxicity and worsen cardiomyopathy, a problem that can lead to heart failure,
Another drug which is now being used for manangement of Covid patients Remdesivir, could lead to abnormal heart rhythms, called arrhythmias, and low blood pressure, known as hypotension. And it should be administered with utmost caution to people with COVID-19
To add on to the challenges faced by medical professionals, like the response to COVID-19 can compromise the rapid triage and treatment of non-COVID-19 heart patients.
HCW Risks: Providing the cardiovascular care to the needy patients may place health care workers in a position of vulnerability as they become hosts or vectors of virus transmission.
Cardiovascular Surgery in Covid 19 Pandemic :
There are two main critical issues of cardiovascular surgery in this pandemic. First, to delay the elective surgeries is essential to sustain the healthcare service but decision to defer a procedure should be made keeping in view the capacity of the healthcare system, and severity of ailment Availability of surgical/anesthesia staff, intensive care unit beds, ventilators, and, extracorporeal membrane oxygenator(ECMO) which may be on standby for patients in pandemic of Covid is very important Hence a Level of priority of cases coming with cardiovascular ailments has to be made by the heart team that which patient needs urgent Cardiovascular surgery during this difficult situation
The second one is Personal protection equipment (PPE) which is the most crucial measure during the pandemic. . More measures should be taken into consideration for sterile operating room environment for such Cardiovascular surgical procedures The surgical team that scrubbed in must wear extra equipment such as a surgical coat and double gloves and N95 mask Some added measures such as face shield may be recommended for surgical procedures It is obvious that this kind of working environment with all this equipment is challenging for the team
The novel coronavirus pandemic is putting a lot of pressure in our health systems. As Surgeons, we are called for optimizing our activity in order to spare resources and to stop spreading the infection. On the other hand, the population who is at risk of severe COVID-19 cases has about 15% of cardiovascular comorbidities level of priority has to be established for helping the needy patients needing urgent cardiac surgical intervention making use of the properly sanitized operating room and ICU and providing adequate Protection equipment to Heart team.
(The author is Consultant Cardiac Surgeon GMC Jammu)
Dr Arvind Kohli