Advice from a Consultant Cardiologist
PLEASE NOTE: THIS IS NO LONGER RELEVANT AND IS NOT BEING UPDATED BUT HAS BEEN LEFT ON THE SITE FOR REFERENCE PURPOSES ONLY
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