By Thomas Cawthon, MD
February marks American Heart Month, a time people are encouraged to focus on their cardiovascular health in an effort to prevent heart disease, which accounts for one in four deaths in the U.S.
Heart disease affects all ages, genders and ethnicities, and although heart disease has been around for thousands of years, we do know that many aspects of modern life exacerbate risk factors and make people more prone to heart disease and heart failure. Among those risk factors include high cholesterol, high blood pressure, smoking, diabetes and excessive alcohol use.
Over the past year, a new variable has been added to the mix of risk factors for heart disease in the form of COVID-19. While not present in all COVID-19 patients, for those who recover with lasting adverse effects on the heart, the battle can be lengthy and, without proper medical care, may not end well. In particular in the South where there is such a high propensity of heart disease, this is not welcome news.
COVID-19 has many potential secondary conditions directly resulting from the infection. It has been found that people with cardiovascular disease are more than twice as likely to contract severe forms of COVID-19 and has also shown that asymptomatic heart inflammation was seen on MRI (magnetic resonance imaging) in up to three-quarters of patients who had recovered from severe COVID-19.
One of the most concerning of these secondary conditions is myocarditis, which is inflammation of the heart muscle. It has been determined that the virus damages the heart muscle whereas the body’s immune response causes inflammation of the heart muscle. This damage and long-term inflammation can cause a condition called cardiomyopathy. This is defined as the thickening or thinning of the heart muscle, which decrease the hearts ability to pump blood effectively. In both myocarditis and cardiomyopathy, the main signs and symptoms are chest pain and shortness of breath, as well as irregular heartbeat, swelling of the feet and fatigue.
The incidence of COVID-19-induced myocarditis is not well established. In late July, shocking findings from a study published in JAMA Cardiology suggested that after being screened via cardiac MRI, 60 percent of COVID-19 survivors (independent of the severity of the illness) had developed myocarditis. However, an article published by Johns Hopkins in October 2020 indicated the rate of myocarditis was between 1.4 percent and 7.2 percent.
No matter how likely a patient is to develop myocarditis, a history of pre-existing cardiovascular conditions − such as damaged heart muscles and blocked heart arteries − makes them more vulnerable to the stresses of COVID-19 on the body.
At Princeton Baptist Medical Center, our cardiology team is seeing both primary (arrhythmias, myocardial infarction, and myocarditis) and secondary (myocardial injury/biomarker elevation and heart failure) cardiac involvement, and in severe cases, profound circulatory failure can result in COVID-19 patients.
Our cardiology team uses an early intervention approach in treating patients. The focus being on early treatment with anticoagulants to prevent complications from blood clots and continuation of low dose anticoagulants after discharge. Steroids and Remdesivir are frontline treatments for decreasing the overall viral load and inflammatory response of patients.
For select critically ill patients they have had success with the use of ECMO or mechanical circulatory support. This allows the patient’s lungs and or heart to be rested or supported through the critical stages of the infection. They also use EKOS for the treatment of acute pulmonary embolism. This minimally invasive therapy decreases the clot treatment time and even allows for removal. The key to their success is a team approach with a dedicated interdisciplinary team.
While not every patient who recovers from COVID-19 will experience cardiovascular complications, it is important to pay close attention to whether or not these persons have any shortness of breath or are experiencing chest pains. It is possible these individuals may have already had a cardiac involvement during the infectious period and simply did not feel sick enough at that time to seek treatment at the hospital, but they may experience residual effects of COVID-19.
Not every patient requires a visit to the cardiologist, but those with ongoing symptoms who have either taken too long to recover from symptoms or have regression of symptoms need to seek medical care and see a cardiologist to determine if they have consequences of the infection in the form of fluid around the heart or congestive heart failure.
Thomas Cawthon, MD is a cardiology specialist at Princeton Baptist Medical Center.
For more visit: princetonbaptistmedicalcenter.com/services/cardiovascular