Coronavirus can cause heart injury in patients even without underlying heart conditions, says study

Coronavirus can cause heart injury in patients even without underlying heart conditions, says study

COVID-19 can be fatal not just for people with underlying heart diseases, it can cause cardiac injury even in patients without heart conditions, according to a review by experts at The University of Texas Health Science Center at Houston (UTHealth).

Experts have known that viral illnesses such as COVID-19 can cause respiratory infections that may lead to lung damage and even death in many cases. However, less is known about its effects on the cardiovascular system.

The researchers of the current study found that the new coronavirus disease is associated with a high “inflammatory burden that can induce vascular inflammation, myocarditis (inflammation of the heart muscle), and cardiac arrhythmias (abnormal heart rate or rhythm).” 

“It is likely that even in the absence of previous heart disease, the heart muscle can be affected by coronavirus disease. Overall, injury to the heart muscle can happen in any patient with or without heart disease, but the risk is higher in those who already have heart disease,” says lead author of the study Dr Mohammad Madjid in the analysis published in JAMA Cardiology. He is an assistant professor of cardiology at McGovern Medical School at UTHealth.

Cardiac injury, also referred to as myocardial injury, occurs when there is damage to the heart muscle. Such damage can occur when blood flow to the heart is reduced -- which is what causes a heart attack.

A medical worker looks out onto a line of patients waiting for COVID-19 testing outside Elmhurst Hospital Center in New York (AP Photo/John Minchillo)

The authors of the study explained that research from previous coronavirus and influenza epidemics suggests that viral infections can cause acute coronary syndromes, arrhythmias, and the development of, or exacerbation of, heart failure. “Given the high inflammatory burden of COVID-19,50 and based on early clinical reports, significant cardiovascular complications with COVID-19 infections are expected,” says the analysis.

The experts say that it is reasonable to expect that severe and critical cases have more severe effects on the cardiovascular system. Critical cases are defined as having respiratory failure, septic shock, and/or multiple organ dysfunction or failure. 

Experts have said that people with heart disease, diabetes have worst outcomes. According to a study, the death rate was highest among people who had cardiovascular disease (CVD) as a preexisting medical condition at 10.5%. This is followed by those with diabetes 7.3%, 6.3% for chronic respiratory disease, 6.0% for hypertension, and 5.6% for cancer, say researchers in their findings.

A previous study had also said that heart injury could be a common condition in patients hospitalized with COVID-19 and that it is associated with a higher risk of death among those patients.

The observational study of 416 hospitalized patients in China with COVID-19, published in JAMA Cardiology, found that 19.7% suffered a cardiac injury, which was found to be a risk factor for dying in the hospital. This complication increased the in-hospital mortality risk for the patients: Half of those with heart damage died (42 of 82 or 51.2%) compared with only 4.5% (15 of 335) of the other hospitalized COVID-19 patients as of February 10, the study finds.

“The study demonstrates the statistically significant association between cardiac injury and mortality in patients with COVID-19. Cardiac injury, as a common complication (19.7%), was associated with an unexpected high risk of mortality during hospitalization,” say the experts.

They add, “Although the exact mechanism of cardiac injury needs to be further explored, the findings presented here highlight the need to consider this complication in COVID-19 management.”

An editorial in JAMA Cardiology says that whether the data linking myocardial injury and high mortality risk in patients with COVID-19 can be generalized to other countries, including the US, is yet to be determined. “But the wake-up call has been delivered,” they emphasize. 

Coffins arriving from the Bergamo area, where the coronavirus infections caused many victims, are being unloaded from a military truck that transported them in the cemetery of Cinisello Balsamo, near Milan in Northern Italy (Claudio Furlan/LaPresse via AP)

Another study from China also has similar conclusions, which suggests the myocardial injury is significantly associated with fatal outcome of COVID-19. The study examined 187 patients with confirmed COVID-19, of which 144 patients (77%) were discharged and 43 patients (23%) died.

“In the current study, among 187 patients with COVID-19, 52 (27.8%) exhibited myocardial injury as demonstrated by elevation of TnT levels, and the mortality was markedly higher in patients with elevated TnT levels than in patients with normal TnT levels (59.6% vs 8.9%),” says the study published in JAMA Cardiology.

“Patients with underlying cardiovascular disease (CVD) and escalation of TnT levels had the highest mortality (69.44%) and the shortest survival term. However, patients with underlying CVD but with normal TnT levels during the course of disease experienced a more favorable prognosis, compared with patients with elevated TnT levels but without underlying CVD (mortality, 13.3% vs 37.5%),” it says. The researchers recommend that “aggressive treatment” may be considered for patients with myocardial injury.

Yet another report, which examined 21 cases in the US, found that 33% of the COVID-19 patients developed cardiomyopathy -- a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of your body.

“This study represents the first description of critically ill patients infected with COVID-19 in the US. Cardiomyopathy developed in 7 patients (33%). It is unclear whether the high rate of cardiomyopathy in this case series reflects a direct cardiac complication of COVID-19 infection or resulted from overwhelming critical illness. Others have described cardiomyopathy in COVID-19, and further research may better characterize this risk,” says the study published in JAMA. 

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