7 June 2020
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Coronavirus, you’re breaking my heart

Dr Ross Walker
11 May 2020

Despite only hitting the world scene since the start of the year, COVID-19 has had a profound effect on the lives of almost every individual on the planet.

I’d like to present 5 simple facts on how this very contagious virus may affect the cardiovascular system.

1. Patients with a history of heart disease or cardiovascular risk factors are at much higher risk for the severe complications and even death from COVID-19. For example, the death rates for COVID-19 in people with conditions such as established cardiovascular disease, hypertension, obesity and diabetes are somewhere between 6 to 10%, which is much higher than the mortality rates of COVID-19 in people without these conditions. Interestingly, these are somewhat higher rates than seen in people with chronic lung disease, cancer and smokers.

2. Commonly used BP drugs known as ACE inhibitors & ARBs are involved in the metabolism of ACE-2 receptors, which are allegedly the entry point for COVID-19 into the cells. There has been no evidence to date that taking these drugs increases the susceptibility to the COVID-19. There are even some studies that suggest that these drugs may reduce the overall severity of COVID-19. So, if you are on one of these medications, the message is simple - DON’T STOP!

3. COVID-19, in serious cases, may have significant consequences on the clotting system leading to a severe disorder known as disseminated intravascular coagulation. There is also a much higher rate of pulmonary embolus, which is where a clot travels into the lungs, damaging lung tissue. It also appears that stroke rates are higher in COVID-19.

4. Direct effects on the heart – COVID-19 may induce a heart attack, inflame the heart with a condition known as myocarditis and potentially lead to heart failure. A significant proportion of patients, especially those with cardiac risk factors, also develop atrial fibrillation and ventricular rhythm disturbances. Although the primary effects of COVID-19 are on the lungs leading to a serious pneumonia or adult respiratory distress syndrome, often requiring a ventilator, the cardiac manifestations can still be very serious.

5. Finally, there are many new treatments being trialled for COVID-19. Many of these therapies are available for other conditions. Much publicity has been given to hydroxychloroquine, which is used for the treatment of malaria and for autoimmune diseases such as rheumatoid arthritis and lupus. It is important to note, however, that (especially in predisposed individuals, such as those with cardiovascular risk factors) there is a risk of serious heart arrhythmias in patient given this drug. It should only be used under cardiac monitoring when people are very sick in hospital. It should not be taken as a preventative. Many of the other anti-viral drugs proposed may also induce this serious side-effect.

In many ways, COVID-19 has seriously changed the way the world functions and also how many people are now practising medicine. It will be very interesting to see how we all cope in the post COVID world but one thing is for certain; we will never go back to life as it was before.

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