Covid-19 can cause full spectrum of heart disease, cardiologist says

COVID-19 affects the heart, because studies have shown, and patients with pre-existing heart conditions also have a higher incidence of severe disease, making it a double-edged sword, said Sameer Gupta, an interventional cardiologist at Metro Hospitals and Heart Institute in Delhi.

Recovered COVID-19 patients come back with stress cardiomyopathy — a temporary weakening of the heart muscle — and myocarditis (weakness of the heart muscle due to inflammation), Gupta says in this interview, explaining that it’s an effect of the huge infection or inflammation, not the virus itself.

Gupta specializes in cardiovascular and peripheral interventional procedures. He completed his medical residency at Penn State University, his fellowship at the University of South Florida, and his interventional cardiology fellowship at the University of Chicago. Gupta has recovered from COVID-19 himself.

Edited excerpts:

As a cardiologist, what are you seeing today in terms of symptoms or progression of COVID-19?

COVID affects the heart, and patients who have heart disease also have a higher incidence of bad problems with COVID. So it’s kind of a double-edged sword.

We have seen patients with heart failure (meaning the heart muscle is weak to begin with), blockages, and coronary artery disease have a higher incidence of poor prognosis (or death) with COVID. Additionally, some of the risk factors that cause these problems, such as diabetes and hypertension, also increase the risk of serious problems with COVID.

On the other hand, COVID – in someone who doesn’t have heart disease – also causes the full spectrum of heart disease. It increases the risk of arrhythmias (abnormal heart rhythms). We have seen that there is a higher incidence of [heart] muscle weakness and heart attacks in patients with COVID.

What are the trends among the patients you have treated? Did they come back later with heart-related issues?

I’m an interventional cardiologist, so I don’t treat COVID patients directly. But we receive consultations. We are seeing patients who have either had COVID in the past or patients with heart disease who now have COVID and are going to another facility. The prognosis was not very good in some of these patients. I remember one patient very well. He had a massive heart attack. We treated him and he went home. Then he developed COVID after a few weeks and had a poor prognosis, and he eventually died.

So we’ve seen people come back with COVID. We’ve also seen COVID patients come with other heart issues.

These are people who technically recovered from COVID, but later showed heart problems. Is it correct?

Heart problems with COVID come in many forms. We see patients who have recovered from COVID come back with heart failure, and then we see they have cardiomyopathy (heart muscle weakness). There is some evidence that sometimes muscle weakness is temporary (stress cardiomyopathy), and that it can be treated with medication. We don’t have long-term studies yet, because the virus is only nine months old.

Are there any demographic similarities – in terms of age or sex – among COVID-19 patients who showed certain symptoms of heart disease after recovery?

No, this incidence is currently very low. It is therefore difficult to quantify and categorize. But on the other hand, people who have heart problems like myocardial damage and heart failure when they have COVID are usually old people. These are people who have risk factors like hypertension, diabetes, or pre-existing heart disease, and who develop heart complications from COVID. There is also myocarditis, which is weakness of the heart muscle due to inflammation.

The question is: does the virus cause myocarditis and heart muscle damage? Or does inflammation and everything going on in the body make the heart an innocent bystander? From studies and autopsy data, we find that the heart is the innocent bystander. Our whole body lives in a sort of balance: everything is codependent on each other. So if there is a massive infection or massive inflammation occurring in the body, it also affects the heart.

Is there anything to say that the heart is more affected than the other organs?

The lungs, heart and coagulation system are mainly affected. In COVID patients, we see that the blood becomes thick as there are various changes in the clotting pathway. And there’s a higher incidence of blood clots, which then get into the lungs – and we’ve seen a lot of massive blood clots in the lungs, which are also a cause of death. These blood clots can occur in the brain, arms, legs…we have seen many.

If I already have heart disease, how can I be more careful? You said that people who came with a heart problem later developed COVID.

These people are certainly more at risk. I live in Delhi, and when I go out on the street, I see that Delhi is back to about 75-80% pre-COVID traffic. The streets are flooded. The good thing is that everyone wears at least one mask. Even if it’s on the chin, at least they’re aware enough to wear a mask.

I see that there is a lot of caution fatigue: people were very cautious at the beginning in March, April and a small part of May. Now, over time, people get tired. I would like to remind everyone that even though we have 700 to 800 cases every day, you don’t want to be one of those 700 cases. Please be vigilant. Do not go out for unnecessary meetings; don’t go out and socialize just because you’re bored. You cannot fall into caution fatigue.

Also, take your medications. In the first part of the lockdown, we saw that some patients were unable to get medicine for some reason. Medicines were available, but they got lazy. They came back with complications – not COVID, but heart complications from not adhering to medication. So please take your medicine. If you are diabetic, please take your diabetes medication. I cannot stress this enough.

And it’s very important to keep exercising, to keep training, because that’s also something we’ve seen – that people aren’t training.

Please train and stay healthy. Its very important.

And that keeps the heart alive and active as well, in a metaphorical way.

Yes definitely. Cardiovascular fitness is extremely important. Another thing I would like to point out is that in the first part of the lockdown – and in some cases even today – people are reluctant to come to the hospital. I received a few calls from emergency patients, reluctant to come to the hospital for fear of being exposed.

Heart disease has not gone away. Even today, heart disease is among the leading causes of death in India. Yes you can have [or could be at risk for] COVID, but you can still have a heart attack. So please don’t ignore your symptoms.

You mentioned 700 cases. And you were also one of those 700 and you suffered. So tell us about your experience.

It was a Monday and I woke up in the morning with a tickle in my throat and a bit of body pain. COVID is not the first thing [you think about], although I was exposed to a few COVID patients working in the hospital. People come in with a heart attack, and you don’t know who has COVID and who doesn’t.

So I got up with a tickle, worked all day. I started having back pain. And I thought it was the way I slept, or the leash I wore during procedures. [to block radiation]. I was very tired, I fell asleep. I woke up at 4am with a fever and realized it must be COVID. I woke up my wife and told her I had a fever, and immediately practiced physical distancing. A few hours later, even she had a fever. So we both had COVID.

Fortunately, it was the soft version. I just had a fever for a few days. My oxygen saturation and everything else was good. And I recovered, I did my whole two-three weeks of quarantine. I went beyond the recommendations because if I want to get back into the workforce, I have to make sure I’m not even 1% infected. So I did two negative tests, just for my own satisfaction, and then I went back to work. I even donated my plasma.

I assume you and your spouse recovered at the same time?

Yes. It varied. I had symptoms for about three to four days. She had a very mild fever for five or six days. But we ended our quarantine together. We observed physical distancing.

You may not realize it, but many healthcare professionals around the world are observing physical distancing with their loved ones. When the cases started to increase and I knew there were people coming into the hospital with other symptoms who later turned out to have COVID, I started to walk away physically from my parents who live in the same building as me. I started interacting with them only by wearing a mask. This is the reality of what many medical professionals around the world do. I know people who haven’t kissed their child for six months. They just can’t take the risk.

Looking to the future and considering your own personal experience and the experience you have gained treating patients, how do you feel? Do we have some control over this disease? Would you say, for example, that our sense of control is at least 50% now, as opposed to nothing maybe four or five months ago? Or do you think we still have a long way to go?

that’s a great question. And the problem with this disease is that every day we learn something. It is also very interesting to see how the whole medical community and some of the best scientific minds in the world have come together to try to help and contribute to [fighting] the pandemic. If you go back and see the timeline, it was originally said that masks weren’t useful. Then they came and said the masks were helpful. They said hydroxychloroquine is good, then they said it’s not good. Now new treatments are coming.

We know a lot more than six months ago, and six months later we will know a lot more than today. So I think it’s very gratifying as a scientist, a cardiologist, and a physician to see how everyone has come together.

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