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Cardiovascular Complications of COVID-19 Infection

Updated: Apr 29

8 APR 2020




How often?

Damage to the heart is found in 1 in 5 patients admitted to hospital with COVID-19 infection. In one study those with signs of heart damage had an 11-fold higher risk of death versus those without, 51% vs 4.5%.


Who are at risk?

Being elderly (aged 65 and over), pre-existing heart problems, medical conditions of high blood pressure and/or diabetes and/or kidney disease, and possibly male gender are additional risk factors of suffering heart damage from COVID-19 infection.


What happens to the heart?

COVID-19 infection increases the risk of;

  1. An acute heart attack by making cholesterol plaques in coronary arteries (blood vessels) unstable, or by spasming of the arteries, which in turn causes disruption of blood flow to heart muscles;

  2. Acute inflammation within and around heart muscle cells causing temporary or permanent damage to muscle cells.


How is heart damage diagnosed?

  1. A blood test showing a high level of Troponins, an enzyme inside heart muscle cells which leaks into the blood steam as muscles are injured;

  2. Cardiac ultrasound (echo) showing weakening of heart muscle function;

  3. Abnormal electrocardiogram (ECG).


What causes the heart damage?  

  1. Heart muscle damage could be from the virus directly infecting the heart muscle cells;

  2. The inflammation process mounted by our immune system fighting the virus “cross attacking” muscle cells and blood vessels (like the “friendly or crossfire” in a war).


What are the cardiovascular consequences?

  1. Heart failure, when heart muscle is unable to pump efficiently and eventually the whole-body organ system including kidneys shuts down from inadequate blood flow;

  2. Dangerous, erratic heart rhythm or arrhythmia resulting in cardiac arrest and/or ineffective pumping of heart muscles;

  3. Deep vein thrombosis or blood clots in the veins (DVT).


What are the symptoms to watch out for?

  1. Palpitation, dizziness, light-headedness and/or syncope may also be the presenting or accompanying symptoms of COVID-19 infection. In one report, 7% of patients admitted with COVID-19 had symptom of palpitation;

  2. Chest discomfort and breathlessness. Symptoms of COVID-19 infection can even mimic an acute heart attack. There have been cases of patients being taken directly from the Emergency Department to the Cardiac Laboratory for an urgent coronary angiogram, only to find out an erroneous diagnosis had been made.


More common symptoms are fever, cough and breathlessness, wheezing, muscle and joint aches, fatigue, and diarrhea.


Reference:

Driggin E et al. JACC Apr 2020.

DOI: https://doi.org/10.1016/j.jacc.2020.03.031

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