COVID-19 Prognosis & Cardiac Complications

The COVID-19 epidemic rocked the world from 2019-2022 and even today we are still dealing with the repercussions of COVID-19. As the world recovers from this deadly endemic plenty of COVID patients are still dealing with long-term cardiac issues. COVID was initially recognized as a respiratory disease but has been found to affect the cardiovascular system leading to myocardial damage and cardiac and endothelial dysfunction. At Atallah Heart Center cardiac care is of the utmost importance and we strive for early detection of cardiac ailments. Roughly 80% of patients will get a mild case of COVID, 15% of patients will get a severe case, and about 5% of patients require intensive care. The major cause of death in COVID-19 patients (2-5%) stems from Acute Respiratory Distress (ARDS) and other vital organ involvement including the cardiovascular system. [1]

Cardiac Symptoms from COVID-19

Patients with underlying heart disease are among the highest risk individuals for developing severe forms of COVID-19. Complications include myocarditis, myocardial injury, elevated cardiac enzymes, and heart failure.

Myocarditis, Myocardial Injury, & Elevated Cardiac Enzymes

Myocarditis is the inflammation of the myocardium, a heart muscle, which can reduce the heart’s ability to pump blood and can cause chest pain, shortness of breath, lower extremity swelling, fatigue, and heart arrhythmias. [2] In cases of severe myocarditis, the heart weakens, and the rest of the body doesn’t get proper blood flow potentially leading to stroke or heart attack. The damage to the heart muscle cells causes troponin and creatine kinase to seep out of the heart and into the blood. The elevated enzymes point to a heart in distress. [3]

Heart Failure

A new onset of heart failure was observed in as much as a quarter of hospitalized COVID-19 patients; and in as much as one-third of those admitted to the intensive care unit, despite not having a history of heart failure. [4, 5] These hospitalizations could be due directly to the virus or as an effect of systematic heart inflammation, hypoxia, cytokine release, renal failure, or stress. [1] Patients with an underlying cardiovascular disease may experience exacerbated symptoms of heart disease due to COVID-19 which can result in heart failure or worsening preexisting conditions. Injury to the heart muscle can affect its ability to pump blood and the blood that collects can lead to blood clots that can cause heart attack or stroke. A heart attack occurs if a blood clot blocks one of the coronary arteries and a stroke is the result of a blood clot in the heart that travels to an artery leading to the brain. A damaged heart muscle can also change how the heart beats called an arrhythmia, which can also increase the risk of stroke. Certain serious arrhythmias can cause the heart to stop beating and if not treated immediately can result in sudden cardiac death. [2]

Contact Atallah Heart Center

When it comes to your cardiac health it is imperative to be proactive. If you or someone you know is encountering symptoms such as fatigue, chest pain, shortness of breath, swelling of the legs, ankles, and feet, light-headedness, or flu-like symptoms that could potentially be linked to COVID-19, it’s crucial to prioritize your cardiac well-being. Take proactive steps and contact Atallah Heart Center at 248-656-3100 to schedule an
appointment today!

References
1. Basu-Ray I, Soos MP. Cardiac Manifestations Of Coronavirus (COVID-19) [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556152/

2. Mayo Clinic. Myocarditis – Symptoms and causes [Internet]. Mayo Clinic. 2019. Available from: https://www.mayoclinic.org/diseases-conditions/myocarditis/symptoms-causes/syc-20352539

3. Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D. Elevated Troponin in Patients With Coronavirus Disease 2019: Possible Mechanisms. Journal of Cardiac Failure [Internet]. 2020 Apr 18;0(0). Available from: https://www.onlinejcf.com/article/S1071-9164(20)30357-2/fulltext

4. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 395(10229):1054–1062. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext

5. Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, Lee M (2020) Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA 323(16):1612–1614