Before COVID-19 shut down the world in the Spring of 2020, the thought was that this latest virus was primarily a disease of the respiratory system. As the virus became widespread, hospitals started to fill up with COVID-positive patients whose symptoms manifested in many physiological forms. Over a year into the pandemic, it’s clear now that the novel coronavirus—COVID-19—affects much more than the lungs. Its reach extends to the cardiovascular system as well as the brain and other organs, making care of severe patients a complex process.
Even now, scientists’ understanding of the disease continues to change, and as the long-term ramifications of the COVID disease are discovered, its lasting effects on the cardiovascular system cannot be overlooked. It’s common for patients with comorbidities to require hospitalization for severe systems, but what may be less known are the statistics regarding patients with a pre-existing cardiovascular concern. In cases where the COVID-19 patient has experienced cardiovascular concerns, the mortality rate is highest. The disease is now known to cause myocarditis, shock, heart failure, and thromboembolism—ailments compounded by some of the drugs used to treat the virus.
Lindita Coku, MD, a respected cardiothoracic surgeon, describes the evolution of COVID cases in hospital settings. “Physicians of very specialty were at a disadvantage when COVID entered our areas of care. Each of us was forced to learn as we went, and the ultimate lesson is how little we knew at the beginning. With arduous research and observation,” Dr. Coku says, “We became better equipped to bring about positive outcomes for patients whose cardiovascular systems were turning against them because of this disease. Now, we educate the public to raise awareness and continue improving the treatment and outcomes for COVID patients.”
Cardiac Implications of COVID-19
According to the American College of Cardiology, the outcomes for COVID-19 patients are concerning and something physicians and patients should be aware of. The ACC asserts that 40% of COVID-19 patients now suffer from cerebrovascular or cardiovascular disease. Patients with pre-existing conditions have a higher risk of mortality or complications from contracting the virus. The concern for myocarditis is present, and over 16% of COVID-19 patients developed an arrhythmia. The novel coronavirus is responsible for destabilizing conditions with underlying cardiovascular diseases such as heart failure and coronary disease.
Covid-Positive ICU Patients
The frequent outcome for COVID patients requiring cardiology support was general admittance to the hospital, followed by worsening hypoxia and a move to the ICU. While ventilators were the standard in the first push to treat COVID-19 patients, treatment continues to evolve, but the general path leads to acute respiratory distress and the beginning of cytokine storm—a severe immune reaction where the body releases high amounts of cytokines at an alarming rate, leading to organ failure. Cytokine storms could incite ischemic stroke and shock as well.
As D-dimer levels increase in COVID-19 patients, the concern for thrombotic complications grows as well. The acute respiratory syndrome is not solely responsible for driving respiratory failure but is, instead, a greater risk when coupled with microvascular thrombotic processes. Venous imaging studies in COVID-19 patients consistently show a likely association between increased D-dimer levels and severe cardiovascular and respiratory disease. As the body reacts to severe inflammatory responses, hypercoagulability becomes another concern.
In some instances, the treatment for COVID is exacerbating or causing other life-threatening conditions. When myocarditis meets common drug therapies used in COVID treatment, patients can experience dangerous arrhythmias. Abnormal heart rhythms can also be related to infection.
Heart failure results from system inflammatory responses to infection or high lung pressures that come from lung damage. Determining which symptom has caused heart failure during COVID-19 infection is difficult at best. In older patients who present with hypertension or existing coronary artery disease, heart failure most likely stems from increased labor to the heart. Younger patients experiencing heart failure during a COVID-19 infection most likely contracted myocarditis from the virus.
The data points to the long-term consequences of COVID-19, which lasts far beyond the acute infections experienced during the virus. Patients experiencing long-term symptoms often report cardiopulmonary and neurological distress such as chest pain, dysautonomia, dyspnea, and chronic fatigue. Of particular concern is the correlation between COVID long-haul symptoms and Postural Orthostatic Tachycardia Syndrome, commonly known as POTS. With the long-term ramifications negatively impacting lifestyle and ultimate recovery, it’s important to continue learning about how COVID ultimately affects the cardiovascular system.
The COVID-19 pandemic has required new and innovative responses from medical professionals throughout the world. The novel coronavirus has shown its ability to bring short-term illness and long-term, devastating effects. The understanding of both acute and chronic cardiovascular consequences of the infection continues to evolve, and as the pandemic continues, scientists will seek to improve medical responses and new cardiothoracic techniques to battle this virus. One thing’s for sure, as with COVID symptoms themselves, fully understanding the effects of COVID-19 is a long-term effort.