Coronavirus can damage the heart as experts find 'abnormalities' in over half of patients' scans
Coronavirus can damage the heart, according to researchers who found that more than half of Covid-19 patients who received a heart scan in the hospital showed ‘abnormalities’ in heart function. According to the research team, around one in seven showed severe abnormalities, which are likely to have a major effect on their survival and recovery. The majority of the patients had never been diagnosed with a heart disease before, leading the researchers to conclude that Covid-19 itself may be responsible for causing heart problems.
"Damage to the heart is known to occur in severe flu, but we were surprised to see so many patients with damage to their heart with Covid-19 and so many patients with severe dysfunction. We now need to understand the exact mechanism of this damage, whether it is reversible and what the long-term consequences of Covid-19 infection are on the heart," writes Professor Marc Dweck, British Heart Foundation senior lecturer and consultant cardiologist at the University of Edinburgh, in the analysis published in European Heart Journal — Cardiovascular.
Early case reports suggest that Covid-19 can cause a wide range of cardiac conditions that include heart attack and inflammation of the heart muscle, among others. However, the incidence of these cardiac complications and the subsequent implications for treatment and resource allocation are unknown, say experts, adding that there is an urgent need to better understand the interactions between the new coronavirus and the heart.
Accordingly, researchers from the British Heart Foundation Centre of Research Excellence at the University of Edinburgh looked at echocardiogram results of 1,216 patients with Covid-19 from 69 countries across six continents. An echocardiogram is a type of ultrasound scan used to look at the heart in real-time at a patient’s bedside. The scan results were sourced from many Covid-19 hotspots around the world, allowing researchers to urgently understand the impact of Covid-19 on the heart while the pandemic was at its peak. Overall, 60% of scans were performed in a critical care setting (54% intensive care, 2% high dependency unit and coronary care unit, 5% emergency room and 1% cardiac catheter laboratory), with the remainder performed in general medicine, cardiology, respiratory and dedicated Covid-19 wards.
The authors found that 55% (667) of all patients, including those with pre-existing heart disease, showed abnormal changes to the way their heart was pumping, with around one in seven showing evidence of severe dysfunction. The majority or 901 had no known heart disease before the study and showed similar changes. In those without pre-existing cardiac disease, almost half (46%) and one in eight (13%) showed abnormal changes and severe dysfunction respectively. These changes were observed for the first time during the patients’ Covid-19 illness and the researchers believe they could be due to the effects of the virus.
Compared with patients with a normal echocardiogram, patients with an abnormal scan were older and had a higher prevalence of pre-existing heart disease, heart failure, or valvular heart disease, but a similar prevalence of hypertension or diabetes mellitus.
"Overall, 667 (55%) patients had an abnormal echocardiogram. Left and right ventricular abnormalities were reported in 479 (39%) and 397 (33%) patients, respectively, with evidence of new myocardial infarction (heart attack) in 36 (3%), myocarditis (inflammation of the heart muscle) in 35 (3%), and takotsubo cardiomyopathy in 19 (2%). Severe cardiac disease was observed in 182 (15%) patients. In those without pre-existing cardiac disease, the echocardiogram was abnormal in 46%, and 13% had severe disease,” the findings state.
It adds, “Right ventricular abnormalities were observed in a quarter of patients and were more common in patients with more severe symptoms of Covid-19. These are likely to reflect severe respiratory disease, including the viral pneumonia itself, as well as both clinical and subclinical pulmonary thromboembolism (blood clot). Left ventricular abnormalities were present in a third of patients and were predominantly non-specific in nature."
The team also found that one-third of patients (405, 33%) had their treatment changed as a result of the echocardiogram. This included being given medicines for heart failure or more careful control of fluids and therapy designed to support heart function – treatments that could help save lives. According to the authors, the findings suggest that heart scans could prove crucial for identifying patients who may benefit from additional treatments to improve their Covid-19 recovery and prevent potential long-term damage to their heart.
"Severe Covid-19 illness can result in damage to the heart and circulatory system. We urgently need to understand more about why this is happening so we can provide appropriate care – both short and long term. This global study, carried out at the height of the pandemic, shows that we must be on the lookout for heart complications in people with Covid-19 so that we can adapt their treatment if needed," says Dr Sonya Babu-Narayan, associate medical director at the British Heart Foundation and Consultant Cardiologist.
"Covid-19 is a complex, multisystem disease which can have profound effects on many parts of the body, including the heart. Many doctors have been hesitant to order echocardiograms for patients with Covid-19 because it’s an added procedure that involves close contact with patients. Our work shows that these scans are important – they improved the treatment for a third of patients who received them," says Dweck.