Dr Arvind Kohli
World Heart Day is celebrated every year on 29th September. It is aimed at creating Awareness amongst people regarding heart ailments and the range of associated health issues. The day is commemorated to promote different preventable steps and changes in lifestyle to avoid any cardiovascular diseases, like heart attack, stroke,and heart failure So this years theme is asking the world to Use Heart to beat CVD (cardiovascular diseases)
At present we are living in unprecedented times. The COVID-19 pandemic has taken the world by storm and has cast spotlight on the healthcare profession, as well national healthcare systems and we don’t know what course the pandemic will take in the future but we do know that taking care of our hearts right now is more important than ever. People with heart disease and its risk factors are more vulnerable to severe forms of COVID-19, and up to 1 in 5 patients hospitalised by COVID-19 have evidence of heart muscle injury.
So we stress for this years additional and most important aim is to UseYour Heart to fight COVID-19 because COVID-19 can wreck your heart, Even if one hasn’t had any symptoms beyond its scientific backing, the notion that a COVID-19 patient might wind up with long-term lung scarring or breathing issues has the ring of truth but over the past few weeks, the evidence has strengthened that cardiac damage can happen even among people who had coronavirus infection but never displayed cardiac symptoms
Patients with CardioVascular risk factors including male sex, advanced age, diabetes, hypertension and obesity as well as patients with established CV and cerebrovascular disease have been identified as particularly vulnerable populations with increased morbidity and mortality when suffering from COVID-19.
Though it often resolves without incident, myocarditis (Inflammation of heart musculature) can lead to severe complications such as abnormal heart rhythms, chronic heart failure and even sudden death. Myocarditis appears to result from the direct infection of the virus attacking the heart, or possibly as a consequence of the inflammation triggered by the body’s overly aggressive immune response. and it is not age-specific: This is an incredibly tricky diagnosis.
Patients with myocarditis often experience symptoms like shortness of breath, chest pain, fever and fatigue-while some have no symptoms at all. According to some reports, as many as 7 percent of deaths from COVID-19 may result from myocarditis.
The Ventricular arrhythmia that sometimes accompanies it is also worrisome, and it has been found to be fairly common among COVID-19 patients
Heart Failure is another very important presentation of heart ailments and can be compounded by ARDS,covid lung injuries,and myocardites
Patients who developed coronavirus infection and recovered,subsequently it was found that about 10 weeks after their initial symptoms, 37 percent of them were diagnosed with myocarditis or myopericarditis-and fewer than half of those had showed symptoms at the time of their scans done during the illness Any such cardiac sequelae lingering weeks to months after the fact is clearly concerning,
Acute Coronary Syndromes COVID-19 patients might abruptly develop acute cardiac complications (such as ACS or pulmonary embolism [PE]Patients present with acute chest pain shortness of breath features of shock called cardiogenic shock and need Emergent hospitalization and management in coronary care unit
Diagnostic Consideration of Covid19 Cardiac patients
ECG : This basic investigation is very important for assessment of myoCardial Injury acute coronary syndromes and arrhythmias
Biomarkers Cardiomyocyte injury, as quantified by cardiac troponin (Trop T) concentrations, and haemodynamic stress, as quantified by B-type natriuretic peptide (BNP) may occur in COVID-19 infections and there elevation above a particular range is important for assessment
D-Dimers D-dimers are generated by cleavage of fibrin monomers by prothrombin and indicate the presence of thrombin formation or reflect an unspecific acute phase response from infection or inflammation. D Dimers also may indicate the presence of disseminated intravascular coagulation associated with shock
Markers of haemostasis including activated partial thromboplastin time, prothrombin time, fibrin degradation products and D-Dimers should be monitored routinely. In particular, elevations of D-Dimers have been associated with poor outcome
Non-Invasive Imaging Echocardiography can be performed bedside to screen for CardioVascular complications and guide treatment. , FoCUS( Focussed Cardiac Ultrasound Study) and critical care echocardiography are probably the preferred modalities to image patients with COVID-19. Limited evidence exists for the use of lung ultrasound to differentiate ARDS (single and/or confluent vertical artefacts, small white lung regions) from Heart failure
Cardiac CT should be performed when there is a potential impact on clinical management, including evaluation of symptomatic suspected CAD, acute symptomatic heart valve dysfunction, left ventricular assist device (LVAD) dysfunction, Pulmonary Embolism which warrants an, urgent structural intervention. Cardiac CT is preferred to TEE to rule out the presence of intracardiac thrombus. In patients with acute chest pain and suspected obstructive CAD, CCTAngiography is the preferred non-invasive imaging modality since it is accurate, fast and minimizes the exposure of patients.
Cardiac Magnetic Resonance CMR is preferred investigation for diagnosis of acute myocarditis.especially in patients having typical symptoms like elevated troponins, ventricular dysfunction and/or severe arrhythmias that cannot be explained by other diagnostics and imaging methods.
Take home advice Patients with cardiovascular (CV) risk factors and established cardiovascular disease (CVD) represent a vulnerable population when suffering from COVID-19. They have high potential of having cardiac injury and increased risk of morbidity and mortality and hence prompt and early diagnosis of these heart ailments is extremely important for management there are well set protocols for usage of various drugs like anticoagulants anti arrhythmic drugs and heart failure directed medical therapy, like beta blockers, ACEInhibitors, ARBs. Further where ever required the coronary intervention for acute coronary syndrome and devices like Extracorporeal Membrane Oxygenerator (ECMO) support for ARDS and failing heart should be established
Its very important to follow the theme “Use your heart to fight Covid-19 but still be careful. Just don’t get the virus in the beginning. As of today, it’s still the best defense we’ve got.”
(The author is Consultant CTV Surgeon SSH GMC Jammu)
Dr Arvind Kohli