COVID-19 can also cause cardiovascular disorders such as myocardial injury, arrhythmias, acute coronary syndrome and thromboembolic complications
The COVID-19 pandemic is changing our lives in unprecedented ways. Given the lack of safe and effective vaccines or proven treatments for COVID-19, our main strategy to combat the pandemic is adhering to basic prevention formula of social distancing, wearing face masks, avoiding crowds and repeated hand -washing with soap. The capacity of health-care systems globally has been severely tested (and in some countries completely overwhelmed), and the effect of this pandemic on social interactions, health-care delivery and the global economy continues to mount.
Although the predominant clinical manifestation of COVID-19 is viral pneumonia, clinical studies have also reported an association between COVID-19 and cardiovascular diseases. COVID-19 can also cause cardiovascular disorders such as myocardial injury, arrhythmias, acute coronary syndrome and thromboembolic complications. Some patients who present without the typical symptoms of fever or cough have cardiac symptoms as the first clinical manifestation of COVID-19.
Myocardial injury during the course of COVID-19 is independently associated with high mortality. Potential drug–disease interactions affecting patients with COVID-19 and comorbid cardiovascular diseases are also becoming a serious concern. Cardiovascular comorbidities such as hypertension and coronary artery disease are associated with high mortality in patients with COVID-19. Finally, medications that have been proposed as treatments for COVID-19 (though there is no absolute treatment yet available) such as hydroxychloroquine and azithromycin have pro-arrhythmic effects - atrial fibrillation; ventricular fibrillation; ventricular tachycardia.
While patients being admitted to hospital emergency units with an acute heart attack have decreased, there is a marked increase in deaths from cardiac arrest at home. This can be probably due to the postponement and delay in seeking medical attention. Therefore, it is important to emphasize that heart patients must not ignore any symptoms and/or delay medical attention as it will further deteriorate their health. As per research, the risk of dying of a heart attack is much greater than that of dying of COVID-19. Moreover, cardiac death is largely preventable if patients with a heart attack come to hospital in time to get treatment. Even if a heart attack doesn’t kill a patient immediately, experts say that delaying treatment could lead to life-altering ramifications, including heart conditions like cardiomyopathy and congestive heart failure. That is why swift action is necessary.
What’s worse is that shelter-in-place orders can make people fall into unhealthy routines, which could increase the risks of a heart attack. These include eating poorly, exercising less, or leaning more heavily on substances such as alcohol, smoking and drug abuse. Not being able to see our friends and loved ones, including disruptions in our routine, can be bad for our hearts. Research has shown that the inflammation caused by depression can increase a person’s risk for a heart attack.
When to Seek Emergency Care for COVID-19 and Heart Problems
The U.S. Center for Disease Control and Prevention (CDC) says to watch out for:
▪ Dry cough.
▪ Fever or chills.
▪ Shortness of breath or trouble breathing.
▪ Muscle pain.
▪ Loss of taste or smell.
▪ Gastrointestinal symptoms like nausea, vomiting, or diarrhoea.
You may be born with certain risk factors that cannot be changed. The more of these risk factors you have, the greater is your chance of developing coronary heart disease.
The majority of people who die of coronary heart disease are 65 or older. While heart attacks can strike people of both sexes in old age, women are at greater risk of dying (within a few weeks).
Men have a greater risk of heart attack than women do, and men have attacks earlier in life.
Heredity (including race)
Children of parents with heart disease are more likely to develop heart disease themselves. Most people with a significant family history of heart disease have one or more other risk factors. Just as you can’t control your age, sex and race, you can’t control your family history. So, it’s even more important to treat and control any other modifiable risk factors you have.
Modifiable Risk Factors
Tobacco / smoking
The risk that smokers will develop coronary heart disease is much higher than that for non-smokers. Cigarette smoking is a powerful independent risk factor for sudden cardiac death in patients with coronary heart disease. Cigarette smoking also interacts with other risk factors to greatly increase the risk for coronary heart disease. Exposure to other people’s smoke increases the risk of heart disease even for non-smokers.
High blood cholesterol
As your blood cholesterol rises, so does your risk of coronary heart disease. When other risk factors (such as high blood pressure and tobacco smoke) are also present, this risk increases even more.
High blood pressure
High blood pressure increases the heart’s workload, causing the heart muscle to thicken and become stiffer. It also increases your risk of stroke, heart attack, kidney failure and congestive heart failure. When high blood pressure is present alongside obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or stroke increases even more.
An inactive lifestyle is a risk factor for coronary heart disease. Regular, moderate to vigorous physical activity helps reduce the risk of cardiovascular disease. Physical activity can help control blood cholesterol, diabetes and obesity. It can also help to lower blood pressure in some people.
People who have excess body fat are more likely to develop heart disease and stroke, even if those same people have no other risk factors. Overweight and obese adults with risk factors for cardiovascular disease such as high blood pressure, high cholesterol or high blood sugar can make lifestyle changes to lose weight and significantly manage other modifiable risk factors.
Diabetes seriously increases your risk of developing cardiovascular disease. The risks are even greater if blood sugar is not well-controlled. If you have diabetes, be sure to work with your doctor to manage it, and control any other risk factors that you can. To help manage blood sugar, people with diabetes who are obese or overweight should make lifestyle changes, such as eating better or getting regular physical activity.
Individual response to stress may be a contributing factor for heart attacks. Some scientists have noted a relationship between coronary heart disease risk and stress in a person’s life, along with their health behaviors and socioeconomic status. These factors may affect established risk factors. For example, people under stress may overeat, start smoking or smoke more than they otherwise would.
Drinking too much alcohol can raise blood pressure, and increase your risk for cardiomyopathy, stroke, cancer and other diseases. It can also contribute to high triglycerides, and produce irregular heartbeats. Additionally, excessive alcohol consumption contributes to obesity, alcoholism, suicide and accidents. All that said, there is a protective benefit to completely avoid alcohol consumption.
Diet and nutrition
A healthy diet is one of the best weapons you have to fight cardiovascular disease. Choose nutrient-rich foods, which have vitamins, minerals, fiber and other nutrients, but are lower in calories than nutrient-poor foods. Choose a diet that emphasizes vegetables, fruits and whole grains. A heart-healthy diet also includes low-fat dairy products, poultry, fish, legumes, nuts and nontropical vegetable oils. Be sure to limit your intake of sweets, sugar-sweetened beverages and red meats. To maintain a healthy weight, coordinate your diet with your physical activity level so you’re using up as many calories as you take in.
If you think you’re having a heart attack or some other heart issue, don't ride it out at home because you're worried about COVID. It's really important to come in and get evaluated so that you can get the problem taken care of early. There are many helpful ways to help prevent a heart attack from occurring. These include controlling your blood pressure, maintaining a healthy weight, eating a healthy diet, exercising regularly, and monitoring your cholesterol and triglyceride levels and keeping them under control. In addition, control your social lifestyle choices, such as limiting your alcohol consumption and avoiding smoking cigarettes. Vaccine development is expected to take several months. To meet the urgent need for effective treatment and preventative strategies, a concerted effort must be made by researchers globally to investigate and integrate biological and clinical findings related to COVID-19.
(Author works at Narayana Hospital Jammu)