Advice from a Consultant Cardiologist
This information is sourced from Dr Amit Bhan, Consultant Cardiologist
Q. What are the cardiac manifestations of Covid-19?
- It has become clear that patients with cardiovascular risk factors (male sex, advanced age, diabetes, hypertension and obesity), and those with established cardiovascular disease have heightened vulnerability to Covid-19 infection
- From the limited available evidence, the cardiovascular complications appear to be similar to those seen in Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS)
- Myocardial injury is common in Covid-19 and is usually defined as elevation of high sensitivity Troponin and/or new ECG or echocardiographic findings
- Myocardial injury can be secondary to acute coronary syndromes (arterial and venous thrombosis is seen frequently), myocarditis, stress cardiomyopathy or the so-called cytokine storm, as well as other causes
- Arrythmia may also occur, either secondary to ischaemia or as a result of any myocardial injury
- In addition, treatment sometimes used in Covid-19 (in particular hydroxychloroquine or certain antibiotics) may result in QT prolongation which increases the chance of ventricular arrythmia
Q. When in the course of the illness do these occur?
- Cardiac manifestations can occur anywhere in the course of the disease although it stands to reason that the risk is highest during the acute inflammatory phase
- It is not unusual for patients to present with a cardiovascular manifestation such as acute coronary syndromes and pulmonary embolism, but equally these can occur at varying times during, what can be a very lengthy inpatient stay
Q. Do cardiovascular manifestations occur in patients who have mild or severe Covid-19 illness?
- It appears that the severity of Covid-19 infections correlates with cardiovascular manifestations, so that those with milder disease are less likely to be affected in such a way
- Whether that is because those that have more severe disease tend to be those with higher baseline cardiovascular risk is unclear