How Coronavirus (COVID-19) can affect heart patients
Patients with a history of cardiovascular disease may suffer from complications if they contract the new coronavirus SARS-CoV-2 (COVID-19). This may include plaque destabilization, infarction or exacerbation of heart failure. Due to this fact, the American College of Cardiology (ACC) has published new recommendations to help to protect patients with a risk for cardiac disease.
Patients with pre-existing diseases suffer more severely from infections with the new coronavirus than previously healthy individuals. Approximately 40 % of hospitalized COVID-19 patients suffer from chronic cardio- or cerebrovascular disease. Virus infections often lead to general destabilization in cardiac risk patients. Virus infections that affect the respiratory tract, such as influenza, SARS, MERS or the new COVID-19 pose a particular challenge to the cardiovascular system.
Previous pandemics such as influenza, SARS or MERS often led to exacerbations of the underlying cardiovascular disease and acute heart failure, especially if the patients had developed pneumonia. In patients with chronic coronary syndrome (CCS) it could lead to plaque destabilization and subsequently result in myocardial infarction. Finally, comorbidities common in heart patients such as diabetes mellitus, obesity, COPD or chronic kidney disease further increased the risk for cardiovascular complications.
In a recently published case study1, 19.6 % of hospitalized COVID-19 patients developed acute respiratory distress syndrome, 16.7 % developed arrhythmias and 7.2 % suffered acute cardiac injuries. In addition, 8.7 % of patients suffered from shock and 3.6 % acute kidney damage. An expert panel of the American College of Cardiology (ACC) has published a list of clinical recommendations for patients with cardiac risk with regards to COVID-19. It also includes clinical guidance, given the fact that there is still widespread uncertainty regarding the new coronavirus.
Among the recommendations:
- Make plans for quickly identifying and isolating cardiovascular patients with COVID-19 symptoms from other patients in the ambulatory setting.
- As part of a triage of COVID-19 patients, those with underlying chronic diseases of the heart,respiratory system, kidneys or other organs should be treated with priority.
- Older patients with COVID-19 often do not have a fever. In older patients, symptoms such as coughing, and shortness of breath must be given greater weight when examining on the suspicion of COVID-19.
- The symptoms of a COVID-19 infection can overlay the classic symptoms and typical clinical pictures of acute myocardial infarction (AMI) so there remains a risk of underdiagnosis.
- Advise all cardiovascular patients of the potential increased risk and encourage additional, reasonable precautions.
- It is important for patients with cardiovascular disease to remain current with vaccinations, including pneumococcal vaccine given the increased risk of secondary bacterial infection with COVID-19. Cardiovascular disease patients should be vaccinated against influenza in accordance with current ACC & American Health Association (AHA) guidelines
- In regions with active COVID-19 outbreaks, it may be reasonable to substitute in-person routine visits with telephonic of telehealth visits for stable cardiovascular disease patients.
- Planning for emergency telehealth protocols should begin now.
- General immunological health remains important for both providers and patients, including eating well, sleeping and managing stress.
- The COVID-19 epidemic is spreading rapidly and has an unclear clinical profile. Medical professionals should therefore be prepared for new information that may change the recommendations at any time.
A mobile ECG can help to effectively implement telehealth and give the patient swift feedback on their heart health without them having to leave their home. The medical professional can receive for instance a 15-lead ECG reading wirelessly to identify cardiovascular pathologies like infarctions and take the necessary steps. In time-critical situations the advantage of sophisticated ECG data cannot be underestimated. This is both true on the ground as well as in aircrafts.
1 Fei Zhou, Ting Yu et al. „Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan; China: a retrospective cohort study”. The Lancet. Published March 9, 2020. www.thelancet.com/pb-assets/Lancet/pdfs/S014067362305663.pdf