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Heart & Covid

The emergence of novel coronavirus, officially known as Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has presented an unprecedented challenge for the healthcare community across the world. Covid manifest as respiratory involvement, presenting as mild flulike illness to potentially lethal acute respiratory distress syndrome or fulminant pneumonia or as various cardiovascular manifestation including chest pain due to myocardial infarction (Heart attack), arrhythmia (pulse irregularity) and heart failure and so forth with many other system. So patient presenting in emergency in present pandemic with chest painalways poses a possible risk of having underlying covid which mandates to take precautions to manage such patients to protect health care providers and fellow patients from contracting the covid and simultaneously to give optimum care to patient.


There are ways how we can tackle this problems, one should undergo a nasopharyngeal swab immediately after admission, waiting for swab result, patients must be isolated in a dedicated and monitored ED, hospitals must have separate facilities in place for dealing with COVID-19 cardiac patients and non COVID-19 cardiac patients. Triaging such patients to low risk, intermediate risk and high risk based on their clinical presentation, ECG findings, blood biomarkers.The COVID-19 pandemic should not compromise timely reperfusion of high risk STEMI (major heart attack) patients, concurrently the safety of HCP (health care provider) should be ensured. To that purpose, and in the absence of previous SARS-Co-V2 testing, all STEMI patients should be managed as if they are COVID-19 positive. As per international guidelines emergency angioplasty may be delayed during the pandemic (up to 60 minutes) due to delays in the delivery of care and the implementation of protective measures. If the target time cannot be met or no facility to do emergency angioplasty then clot busting agents should then become first line therapy. The level of protection of HCP depends on patient risk status, setting and procedure performed, from disposable surgical cap, surgical mask, latex gloves, goggles, work uniform to N95 mask to full face respiratory protective devices. HCP should be well-versed in proper techniques for donning and removing PPE including eye protection a terminal cleaning and sanitization of catheterization laboratory should be performed after each procedure.

Low risk patients might be managed with a primarily conservative approach. Non-invasive imaging using HRCT and CT coronary angiography may speed-up risk stratification, avoid an invasive approach allowing early discharge. Use of plaque stabilizing agents (aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors) has often been used as a therapeutic strategy.

Finally it is noticed that sheer due to fear of contracting the COVID, patient of chronic cardiac condition not seeking timely medical care, doing self medication, non compliance with medicines, neglecting the symptoms like chest pain making out of hospital cardiac arrest due to non covid reason more commonly than before which means the safest place to be if you're having a heart attack is in the hospital. We are there to help you out, so stay safe and stay protected.

 

Heart Disease Complications

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has demonstrated a broad spectrum of presentations ranging from asymptomatic disease to severe respiratory failure, myocardial injury, and death. Up to 20%–30% of patients hospitalized with COVID-19 have evidence of myocardial involvement manifested by elevated troponin levels. The prevalent cardiac expression of angiotensin I–converting enzyme 2 (ACE2),the target for SARSCoV-2’s spike protein, is implicated in the pathophysiology of the associated myocardial injury. There are multiple pathways to myocardial injury (Figure 1), including type 1 or 2 myocardial infarction (MI), myocarditis, vasculitis, or other mechanisms related to inflammation, thrombosis, and/or stress. Depending on the type of myocardial injury, there may be important sequelae if residual inflammation or fibrosis exists.

ACUTE COMPLICATIONS

1. Vasculitis
The spectrum ranges from urticarial vasculitis, to Kawasaki disease, pediatric multisystem inflammatory syndrome, and adult kawasakis disease

2. Myocardialischaemia
Severe systemic inflammation increases the risk of atherosclerotic plaque disruption and AMI. Due to extensive inflammation and hypercoagulability, the risk of AMI is likely present in patients with COVID-19. These patients may need fibrinolysis or PTCA along with medical management

3. Myocarditis
Myocarditis is a disease marked by the inflammation of the heart muscle, most often due to viral infection. This inflammation interferes with the electrical system and compromises the pumping capacity of the heart and results in arrhythmia and cardiac arrest.

4. Myocardial arrhythmias
Palpitations may be a presenting symptom in over 7% of patients with COVID-19 . A range of dysrhythmias have been encountered in patients with COVID-19 infection. Most frequently, sinus tachycardia is seen in such patients, resulting from multiple, simultaneous causes (hypoperfusion, fever, hypoxia, anxiety, etc). Dysrhythmias may occur in the setting of viral illness due to hypoxia, inflammatory stress, and abnormal metabolism.

5. Coagulation abnormalities and Thromboembolic events
COVID-19 infection has been associated with cerebrovascular accidents and venous thromboembolism. The incidence of acute ischemic stroke in patients with COVID-19 is approximately 1%–3%.

LONG TERM COMPLICATIONS

      1. Arrhythmias : Atrial fibrillation/ premature ventricular complexes and ventricular tachycardia has been observed
      2. Cardiomyopathy: Both ischemic and non ischemic cardiomyopathy can evolve due to acute cardiac complications of covid
      3. Subclinical abnormalities: systolic and diastolic abnormalities in cardiac function can be seen
      4. Long covid: Lingering cardiopulmonary and neurologic symptoms, namely chronic fatigue, dyspnea, chest pain, and dysautonomia – colloquially known as "long COVID".
      5. POTS : Postural Orthostatic Tachycardia Syndrome (POTS)-like syndrome emerging among COVID-19 survivors Screening for residual cardiac involvement in the convalescent phase is needed to establish the population burden of long-term cardiac disease contributed by COVID-19. If a significant burden of disease is identified, trials of prophylactic therapies to prevent long-term complications may be appropriate.