COVID-19 and The Heart

The heart and its related blood vessels can be affected by COVID-19 infection. This can sometimes be seen as the detection of elevated levels of certain cardiac biomarkers in the bloodstream. There is some prognostic value of these biomarkers, especially in those who continue to show an upward trend in these markers. Inflammation in the blood vessel system can potentially lead to thrombosis (blood clot) in these vessels.

Inflammation affecting the heart and its blood vessels may result in:

  1. Heart muscle inflammation (Myocarditis) which sometimes can lead to dangerous compression of heart muscle sac by excess fluid production and accumulation as a result of the inflammation (Cardiac Tamponade)
  2. Heart muscle weakening and heart failure (Cardiomyopathy)
  3. Cardiogenic shock
  4. Abnormal heart rhythm which can be life-threatening (Cardiac Arrhythmias)
  5. Heart muscle damage (Acute Coronary Syndrome), +/- ECG changes with heart attack mimic
  6. Rapid deterioration and sudden death

Patients can have a wide range of clinical outcomes, but in the elderly population or those with pre-existing cardiovascular (CV) risk factors like hypertension/diabetes, or related conditions are predisposed to a disproportionately worse outcome like multi-organ failure and death.

Currently, there remain no vaccine nor evidence-based medications that can treat COVID-19 infection, although there have been positive signals coming out from multiple countries and pharmaceutical companies who are all actively working on a viable vaccine. Management is supportive based on early prognostic indicators with expectant management. Appropriate treatment for heart failure, arrhythmias, acute coronary syndrome, and thrombosis remain the cornerstone of any treatment for patients with COVID-19 infection with cardiac involvement.


AUTHOR: Dr. Ang Teck Kee, Consultant & Interventional Cardiologist, Livingstone Cardiology

References
1. Acute pulmonary embolism and COVID-19 pneumonia: a random association?
Eur Heart J. 2020 Mar 30. pii: ehaa254. doi: 10.1093/eurheartj/ehaa254
2. The Science Underlying COVID-19: Implications for the Cardiovascular System
Liu et al. Circulation 10.1161/CIRCULATIONAHA.120.047549
3. Association of Coronavirus Disease 2019 (COVID-19) With Myocardial Injury and Mortality. JAMA Cardiol. 2020 Mar 27, doi:10.1001/jamacardio.2020.1105.
4. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020 Mar 27. Doi: 10.1001/jamacardio.2020.1096
5. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020 Mar 27. Doi: 10.1001/jamacardio.2020.1017
6. Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis. Prog Cardiovasc Dis. 2020 Mar 10. Doi: 10.1016/j.pcad.2020.03.001
7. High-Sensitivity Cardiac Troponin Can Be An Ally in the Fight Against COVID-19. Circ. 2020 Apr 6. Doi: 10.1161/CIRCULATIONAHA.120.047008
8. Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease. Circ. 2020 Mar 21. Doi: 10.1161/CIRCULATIONAHA.120.046941
9. ST-Elevation Myocardial Infarction in Patients With COVID-19: Clinical and Angiographic Outcomes. Circulation 2020; Apr 30:[Epub ahead of print]

*Information is accurate at the time of publication: 20th May 2020