COVID-19 AND HEART FAILURE

Dr Suresh Rao K G, Co-Director, Institute of Heart and Lung Transplant & Mechanical Circulatory Support, MGM Healthcare

The COVID-19 pandemic is on everyone’s mind right now. It’s the infection caused by the SARS-CoV-2 virus that enters the body through the mouth, nose or eyes. 80% of the infected population has mild symptoms such as fever, dry cough, sore throat and some exhibit atypical symptoms such as loss of taste/smell, mild headache, abdominal pain and diarrhoea. A majority of them recover from the disease. 20% of the patients may require hospitalisation, especially when there are complaints of breathlessness. If they have coexisting conditions like chronic renal disease, cardiac disease, respiratory disease, cerebrovascular diseases, uncontrolled diabetes or hypertension, they carry a higher risk of mortality. Mortality in COVID-19 positive cases ranges from 2% to 8% worldwide. 

When we talk about COVID-19 infections and heart diseases, we face four scenarios:

 

FOR KNOWN CARDIAC PATIENTS

This is a tough time. The most important thing to remember is to continue taking your medication if you have a known cardiac condition. You must also take the following precautions:  

Remember this: Even if you don’t catch the infection, stressing about the situation can worsen your heart condition. So, it’s important to be alert and not anxious. 

 

FOR CARDIAC PATIENTS WHO DEVELOP AN INFECTION

Maybe you’ve come to the hospital with chest pain. You may not have COVID-19 but the hospital may have to test you for it. This is for everyone’s safety. If you test positive, you and anyone you have come in recent contact with should be quarantined for two weeks. 

There’s some evidence that shows a fever may actually be beneficial to your immune system in fighting the infection. So, for mild infections, fever can be treated with antipyretics. Antibiotics may be prescribed to you to treat secondary bacterial infections, if the symptoms are worse. Remember to consult your physician and not self-medicate! 

If you develop breathlessness or other serious respiratory symptoms, you may be admitted to the ICU. Any kind of infections may worsen cardiac failure or cardiac disease as it can produce inflammatory reactions that include vascular and myocardial inflammation. 

COVID-19 positive patients who develop cardiac complications are conservatively managed. For example, a patient with Triple Vessel Disease who is a candidate for coronary bypass surgery may instead be managed by angioplasty or medically managed with plaque stabilising drugs such as statins and antiplatelet agents. 

 

WHAT ABOUT END-STAGE HEART FAILURE PATIENTS?

The Institute of Heart and Lung Transplant & Mechanical Circulatory Support at MGM Healthcare manages both end-stage heart failure patients waiting for heart transplantation and more than 350 patients who have undergone heart transplantation earlier. End-stage heart failure patients are medically managed at present as the pandemic is making the logistics of transplantation difficult. 

Patients who have already had heart transplantation are at a much higher risk for infection as they are on immunosuppressive drugs. Our strategy is to prevent the infection among such patients by advising them to stay at home, use personal protective devices and maintain social distancing. We have a video consultation facility that patients can access.  

It’s normal to get worried about the ongoing pandemic given all the free time you have now and the exposure to several myths and misinformation. But worrying is not good for your health. Let the healthcare workers do their job and you focus on following the necessary precautions. Remember – stay alert, not anxious.