Coronavirus and heart damage: how the virus affects patients’ hearts

We learn a little more about Covid-19 every day. It was known that the death rate among people with cardiovascular disease was 10.5% and that those over 65 with coronary heart disease or hypertension were at greater risk of contracting the disease and developing serious symptoms, likely to lead to hospitalization. In these people, the virus could cause heart damage resulting in death. It has recently been learned that Covid-19 could even cause heart damage even in patients without any heart problems. According to an article in the magazine Henry J. Kaiser, relayed by the American media WebMD on April 6, it could lead to heart failure and then death, even in people who had no symptoms of respiratory distress.

These new data could change the way doctors and hospitals treat patients, especially in the early stages of the disease. Ultimately, it also highlights the importance of new precautions in people with pre-existing heart conditions, raises the issue of medical equipment, and necessitates the development of new treatment strategies for survivors’ damaged hearts.

Currently, the biggest difficulty is whether heart problems are caused by the virus itself or are an effect of the body’s reaction to it. A serious illness can be enough to damage the heart muscle. For example, pneumonia can lead to widespread inflammation, which in turn can lead to myocarditis. This can cause weakening of the heart muscle and ultimately heart failure and arrest.

It is still unclear why some patients experience more cardiac effects

However, according to Robert Bonow, professor of cardiology at the Feinberg School of Medicine at Northwestern University (USA) and editor of the medical journal JAMA Cardiology, in patients with Covid-19, the damage observed could be due to the virus directly infecting the heart muscle. Doctor Ulrich Jorde, head of heart failure, heart transplantation and mechanical circulatory support for the Montefiore Health System in New York (USA) agrees. “We have to assume, perhaps, that the virus directly affects the heart”he explains.

Early research does indeed suggest that the coronavirus attaches to certain receptors in the lungs and that these same receptors are also found in the heart muscle. However, according to cardiologists, some patients could be affected by several routes at the same time.

In March, Chinese studies showed that 19% patients with Covid-19 showed signs of heart damage. These people were significantly more likely to die than others: 51% of people with heart damage died compared to 4.5% of others. While patients with pre-existing heart disease were more likely to have heart damage after coronavirus infection, some people who had never had heart disease also showed signs of damage. They were even more likely to die from Covid-19 than patients who already had heart disease but did not suffer heart damage from the virus.

Currently, researchers still do not know why some patients experience more cardiac effects than others. According to Robert Bonow, this could be due to a genetic predisposition or because they are exposed to a higher viral load. Either way, these uncertainties highlight the need for closer monitoring of cardiac markers in people with Covid-19. If doctors could understand how the virus affects the heart, they might be able to provide a risk score to help clinicians better manage patients, he says.

“It is extremely important to answer the question: ‘their heart (of patients, Editor’s note) is it affected by the virus and can we do something about it?’ This could ultimately save many lives”insists on Ulrich Jorde.

Establish a coordinated response

To better determine whether the heart muscle is indeed infected with the coronavirus, doctors should be able to take biopsies of the heart. The problem is that patients with Covid-19 are often so sick that they cannot undergo invasive procedures of this kind. What’s more, carrying out more tests could endanger healthcare professionals: many hospitals do not use electrocardiograms on patients in order to avoid involving additional staff.

However, in the United States, hospitals are making a concerted effort to coordinate the necessary tests and put the results in the medical records, says Dr. Sahil Parikh, interventional cardiologist at Columbia University’s Irving Medical Center in New York (United States). United). “We all recognize that because we are at the forefront, for better or for worse, we must try to compile information and use it to move the field forward”he explains.

In New York, New Jersey and Connecticut, cardiologists are sharing the latest information about the virus through a WhatsApp group. At the same time, doctors in New York are testing new drugs and treatments in clinical trials. Parikh and several of his colleagues notably recently compiled a compilation of knowledge on the cardiac complications of Covid-19. The article was immediately available online.

In particular, doctors discovered that the infection could mimic the effects of a heart attack. So while for years hospitals rushed suspected heart attack patients straight to the cath lab, now “we take a step back”, explains Parikh. “We are considering bringing patients to the ER for brief assessment, so that we can determine: Is this person really at high risk for Covid-19? Is this manifestation that we call a heart attack really a heart attack?”

New protocols to be put in place

From now on, the new protocols foresee the intervention of a cardiologist and the realization of an ECG or an ultrasound to confirm a blockage. “We do this largely to protect the patient from what would otherwise be an unnecessary procedure, but also to help us decide what kind of personal protective equipment we will use in the cath lab.”details Parikh.

Finally, in terms of the long term, once recovered, patients who have had Covid-19 could suffer the long-term effects of heart damage. However, there are treatments for various forms of heart damage that should be effective once the viral infection is gone, says Dr. Ulrich Jorde.

What is cardiovascular disease?

The cardiovascular illnesses are a collection of disorders affecting the heart and blood vessels. They include coronary heart disease (affecting the blood vessels supplying the heart muscle), cerebrovascular disease (blood vessels supplying the brain), peripheral arterial disease (blood vessels supplying the arms and legs), rheumatic heart disease (these affect muscle and heart valves and result from acute rheumatic fever, caused by streptococcal bacteria), congenital heart defects (malformations of the structure of the heart already present at birth), deep vein thrombosis and pulmonary embolism (obstruction leg veins by a blood clot, which can break free and migrate to the heart or lungs).

These diseases are the leading cause of death in the world. In France, they come just after cancer and cause around 140,000 deaths per year. Several risk factors are known such as hypertension, hyperglycemia, overweight, obesity or even stress. Avoiding tobacco, alcohol abuse, regular physical activity and a balanced diet have also been found to reduce risk.