Need to scrutinise Covid’s cardiac impact

Heart attack has become a buzzword owing to several recent deaths of young and middle-aged people. The increasing number of deaths due to heart attack in the country is concerning and point towards lack of proper understanding of the issue. A few cases may be due to pre-existing heart-related issues leading to untimely death, but there are cases which may also be linked with Covid-19. However, due to lack of proper examination and study there is no clear evidence.

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These unfortunate deaths, nonetheless, have caught people’s attention. Many people died either dancing, singing, playing cricket or performing their duty like driving a bus. A sudden surge in deaths due to heart attack during the Covid pandemic and later has, however, baffled clinicians, policymakers and the common man equally. The experts are still not sure if and how these deaths are correlated with Covid. Researchers do agree that Covid has affected our organ system in such ways that it is difficult to comprehend it without planned studies.

According to a study based on the US Department of Veterans’ Affairs data, people who had contracted Covid face a substantially high risk of cardiovascular issues, including heart attack and stroke. These problems may also happen in people who had relatively mild Covid and have fully recovered from it. The researchers are worried that after the main shock of the pandemic, which affected billions of people globally, cardiovascular-related issues may turn out to be an aftershock. Besides, how long these aftershocks are going to be felt by the people is unclear.

In a recent study published in a journal, Nature, it was reported that people who recovered from severe Covid had extremely high risk of developing cardiac issues till a year later, including heart swelling and lung thromboembolism, which were up to 20-time higher than those in uninfected. Further, those who had mild infection and recovered at home without hospitalisation also had risk of heart attack (8 per cent higher) and heart inflammation (2.5-fold higher). Other studies conducted in the UK also point out that people hospitalised with Covid-19 have two-and-a-half to three-fold more risk of heart-related issues than those uninfected.

However, other non-Covid factors may also have affected people indirectly, including irregular or missed health check-ups, sedentary lifestyle without much physical activities, high-energy diet and stress during the pandemic.

Interestingly, a study at Yale University reported the presence of excessive number of auto antibodies in the people hospitalised with severe Covid. Most of these antibodies are against one’s own tissues and cells and can inadvertently attack the body tissues, including the heart, and weaken their architecture. These damages do not bother unless they accumulate over a period of time and result into acute events like heart attack and sudden death.

The coronavirus enters through the ACE2 receptor found in organs and tissues such as the lungs, neurons, liver, kidney, intestine and also the heart and blood vessels. The damages caused to these organs and tissues are wide-ranging and long-lasting even after the Covid recovery. This is called ‘long-Covid’ that lasts for months to a year or more. Healthy endothelium, the innermost lining of blood vessels made up of endothelial cells, is crucial for the overall vascular health. These cells are prone to damage either by pathogens like viruses and bacteria or their toxic products, which linger on for longer duration and induce thrombosis or blood clotting. The clots may block the blood supply to vital organs like the heart or brain and cause heart attack or stroke, respectively. This may be a possibility in Covid-recovered people with damaged or weakened endothelial cells.

Furthermore, studies also found the presence of virus or its remnants in cardiomyocytes, the heart muscles, which indicate that it could cause cardiac inflammation, resulting in arrhythmia and heart failure in the long run. Affected with these conditions, a person doing strenuous workout would put excessive load on the vasculature and cardiac tissue, which may result in heart-related fatality.

These premature deaths are alarming and raise a pertinent question — Is Covid-19 infection or the vaccine is responsible? A study published in Nature says that the cases of stroke have increased among the youth in the post-Covid period. Also, the possibility of blood clotting in Covid-recovered patients has increased, which may result in heart attack. Similarly, there are cases of cardiovascular complications, thrombosis and arrhythmia among Covid patients. Is vaccination responsible for these deaths? Studies to answer this question have not been done sufficiently, but vaccination-related cases of clotting, ischemia and stroke have been reported in many countries.

Even though they may sound similar, not all heart-related problems are the same. One needs to understand the different terminologies associated with the heart. Heart attack is a condition when the heart does not receive the blood supply, and thereby nutrition and oxygen, due to blockage caused by atherosclerotic plaque or entrapped blood clot in a coronary artery. As a result, heart undergoes myocardial infarction in which a portion of the heart does not get the blood and malfunctions or dies, resulting in fatality. Heart failure is a condition where the heart is not capable of meeting the demand of the body, especially during strenuous exercises, due to the weakening of the heart architecture. Cardiac arrest is related to electrical signal that is generated in the sino-auricular (SA) node that causes and maintains the heart’s rhythmic contraction. When the electric signal is not generated or transmitted, it leads to arrhythmia or fibrillation and may result in sudden stopping of the heart.

The causes of the recent heart-related deaths need to be examined carefully so that preventive and therapeutic strategies can be aptly designed. It needs to be understood that death in different individuals may be due to different factors, which should be examined by doctors and proper postmortem studies should be performed to understand the cause. The best way to tackle this is to have timely and proper health checkups and rule out any precondition. One should maintain a healthy lifestyle, consume fresh fruits and vegetables, do meditation and yoga and include walk and exercise in our daily routine. If comorbid, one should take the prescribed medicine and maintain good health parameters, including glucose level, heart rate, blood pressure etc. We also need to train the youth in giving CPR (cardiopulmonary resuscitation) to tackle this kind of public emergency.