By Dr. Smriti Shakya, Cardiologist.
The emergence of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) which causes corona virus disease 2019 (COVID-19) has been a nightmare for humankind ever since it has rapidly grown into a pandemic creating a wreaking havoc in human lives. The experiences from different parts of the world has revealed that this virus may infect anybody without preconception but the more severely affected are preferentially elderly, diabetics and with cardiovascular comorbidities such as hypertension or coronary artery disease. Till date more than 20 lakh people are infected in around more than 200 countries and more than 1.2 lakh patients have lost their lives among which badly hit were those who had some sort of preexisting cardiovascular diseases.
Now the question arises, does the preexisting cardiac illness have dreadful effects in infected patients or the virus independently causes cardiac problems? Whether infection increases the severity of underlying cardiac illness or the preexisting risk factors increase the severity of infection?
COVID-19 is well known for its cardinal symptoms of fever, cough, and difficulty breathing. It may cause mild symptoms like sore throat to severe pneumonia like any other corona viruses that had outbreaks in the past such as SARS (severe acute respiratory syndrome) in 2002 and MERS (Middle East respiratory syndrome) in 2012. Though SARS and MERS have had significantly higher case fatality rates that is, there were more critical patients or deaths of infected patients than COVID-19, the most terrifying part about COVID-19 compared to the previous ones is that it is more infectious that spreads more easily among people, leading to larger case numbers. And the clinical factors that lead to the fatality or mortality in COVID-19 are older age (>65 years), underlying medical conditions including diabetes mellitus, cardiovascular diseases, hypertension and immunocompromised conditions.
The previous corona virus and influenza epidemics have taught us that viral infections can trigger acute coronary syndromes (heart attack), arrhythmias (irregular heart rate), myocarditis (inflammation of heart muscle) and development of exacerbation of heart failure. The most common COVID-19–related complications seen till now are Acute Respiratory Distress Syndrome (ARDS), acute cardiac injury and secondary infection.
Covid-19 may either induce new cardiac pathologies and/or exacerbate underlying cardiovascular diseases. The cardiac injury may occur as a result of direct viral invasion into myocardial cells or cytokine storm induced by the virus which may have toxic effects on the myocardium (heart muscles) leading to weakening of heart muscles disturbing the pumping activity of the heart. The body by its natural healing process in order to eradicate the virus, may mobilize a storm of immune cells (the policemen of the body that comes in frontline to fight when the body finds a foreign material unknown to it) which releases molecules called cytokines into the bloodstream which when excessive, in turn may attack patient’s own organs including heart, the phenomenon termed as cytokine storm. However in some conditions like immunocompromised states and diabetes mellitus, body’s ability to fight against the virus becomes ineffective, thus flaring up the infection.
So primarily the lungs get attacked which loses its functional capability and when the patient already having comorbidities gets infected, it will altogether put the heart into strain which will not be able to cope with this inadequacy of oxygen. The infection in itself may decrease blood pressure and increase heart rate. Thus myocarditis, worsening of heart failure, arrhythmias and shock (hypotension) are the menace in COVID-19 that would require hospitalization and specific treatment.
But this is preventable if we take necessary precautions. Since there is no concrete treatment or vaccine proven till date, prevention is the best remedy. So there are few safety measures that can be pursued on daily basis.
- Those people who have chronic illnesses like Diabetes Mellitus, High blood pressure, coronary artery disease should continue their medications as prescribed by their physicians. If any new symptom arises one should never hesitate to contact the local physician. They need to keep blood pressure and blood sugar levels under control.
- Elderly people at home should be taken extra care of to prevent potential transmission of the virus to them.
- Diet should focus on nutritious food like properly washed and cooked vegetables, properly cleaned fruits especially citrus fruits, nuts, legumes, cereals, no excess oil, salt and sugar.
- The body should be kept in condition with some household works, exercise, simply walking around the house as per the individual capability, yoga at home to keep mind and body positive and healthy.
- General measures like avoiding family gatherings, frequent hand washing with soaps, social distancing should strictly be followed to break the chain of transmission.
Thus the rise of COVID-19 doesn’t undermine concern of other chronic cardiac illnesses, rather extra care is required but not to a level of anxiety. Eventually when all are safe individually, it will reflect upon our family, community and entire world, each contribution at personal level does matter.
( By Dr. Smriti Shakya Cardiologist Lecturer Manmohan Cardiothoracic Vascular and Transplant center, IOM, Maharajgunj )