COVID-19 and cardiovascular manifestation.

Dr. Manoj Kumar
DM, FACC
Director cardiology
Max Hospital, Delhi

COVID-19 is a novel disease, caused by SARS-Cov2 virus originated from the city of Wuhan, China. Common symptoms are fever, cough, shortness of breath, headache & myalgia. Covid19 is a spectrum of disease ranging from a mild flu-like syndrome to critical illnesses requiring mechanical ventilation. It is primarily respiratory illness-primarily lungs are involved.patients with pre-existing comorbidities like heart disease, diabetes, high blood pressure, asthma, emphysema, malignancy & prior stroke are more prone to develop a critical illness.

55% of patients only develop mild symptoms & 15% of patients develop a critical illness. The case mortality rate varies depending on patient age, 18% mortality in the elderly.

Once the patients develop an acute cardiac injury, they have a very high mortality rate. Typical CT findings are diagnostic even PCR test is negative.

Cardiovascular manifestation

  • Type-1 Heart attack
  • Type-2 MI
  • Myocarditis
  • Stress cardiomyopathy
  • Coronary micro vascular dysfunction
  • Stress cardiomyopathy

The exact mechanism of cardiac injury is not clear. Immunopathology (cytokines storm) may precipitate myocarditis & sudden cardiac death. Direct viral injury can also cause myocarditis.

There is controversy regarding the high Troponin levels related to myocardial damage. But it is certain that patients with high Troponin levels have a high mortality rate. Elderly patients, diabetics, hypertensive & COPD patients have a higher incidence of critical illness. Patients with elevated cardiac biomarkers have adverse outcomes.

There can be true myocarditis or takotsubo cardiomyopathies ( stress cardiomyopathy). Acidosis, low oxygen saturation & cytokines storm can cause myocardial dysfunction ( poor functioning heart)
In a recent report, 16.7% of patients admitted in hospital & 44.7% admitted in the ICU of COVID-19 had arrhythmia.

Drugs like hydroxychloroquine & azithromycin can induce prolongation of interval & can induce polymorphic ventricular tachycardia.

ACE inhibitors/ ARB controversy
SARS-cov2 virus spikes bind to ACE2 receptors present in lung tissues.
Theoretically ACE inhibitors/ARB (BP medicine) may upregulate ACE2 receptors & May aggravate lung injury. But no clinical data suggest that these medications increase the risk of Covid19. So at this time continuation, of ARB/ACE inhibitors is recommended.

Dr. Manoj Kumar
DM, FACC
Director cardiology
Max Hospital, Delhi

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