COVID-19 HEART damage. Effect of COVID-19 on HEART

The virus which can have heavy effect on your LUNGS can also damage your HEART heavily !!
COVID-19 virus, which has caused the recent pandemic, leads to MULTIPLE ORGAN FAILURE. Meaning, it not only has effects your lungs, but also your heart, kidney, intestines and other organs.
Among all these organs, the one that is highly affected after your lungs, is HEART.
So let’s see what is the damage caused by COVID-19 on HEART.
At the end of this we will also discuss the possible reasons why COVID-19 causes damage to heart. So make sure you read till the end!

CHIEF COMPLAINS-

COVID-19 HEART damage. Effect of COVID-19 on HEART
It has been seen that many patients, who presented with complaint of breathlessness along with chest pain, not only turned out to be COVID POSITIVE but also had some or other effect on the heart as well.
According to a research data from China, where the pandemic originated, heart injury occured in 20%-30% of the hospitalised patients who were admitted to the hospital. Many patients had cardiac injury from the very first day of admission.

BLOOD REPORTS TO DETERMINE HEART DAMAGE-

Any COVID-19 positive/suspected patient is advised to undergo a series of investigation and reports to determine the severity of the disease and the organs affected by the disease.
One of those tests include, TROPONINE I (TROP I).
This report shows the damage present in he heart muscles. The patients who have myocardial infarction or ischaemia (aka heart attack), have raised level of TROP-I in their blood.
Apart from TROPONINE-I there are other blood reports also which deteect heart damage. These are less specific for heart damage. These include- 
CK‐MB, myoglobin, lactate dehydrogenase, ultra‐TnI, NT‐proBNP
Many patients who tested positive for COVID-19 also tested positive for TROPONINE-I.
This indicates that there is damage caused to heart. Even other blood reports which are less specific for heart such as- CK‐MB, myoglobin, lactate dehydrogenase, ultra‐TnI, NT‐proBNP are found to be raised in COVID positive patients.
Most of these patients were usually in age range of 40-60 years and also had other risk factors such as diabetes and hypertension.
COVID-19 HEART damage. Effect of COVID-19 on HEART

COMPLICATIONS of HEART DAMAGE in COVID-19-

Patients who came in with cardiac injury required ICU admission. Moreover, these patients either had poor lung function or had so severe heart damage that they required the help of VETILATOR MACHINES.

Talking about other complications, it was found in one study that patients with cardiac injury also had higher complications such as electrolyte imbalance, acute kidney injury, hypoproteinemia and coagulation disorders.

EFFECT OF COVID-19 on HEART PATIENTS?

For patients who were long standing heart patient or had any heart procedure conducted in the past, it was found that these had a POOR PROGNOSIS if they got COVID infection.
This is quite similar to the scenario discusses above. Meaning they will be considered in category of high risk.
They might have poor recoveries with longer ICU stays and higher death rates (approx 40%).

MECHANISM OF THIS EFFECT

Well, the precise reason of this damage is still under research, but there have been certain findings and theories pointing out towards probable mechanism.

Direct effect-

schemetic diagram
showing receptor action
COVID-19 virus is known to attach to the lungs through a specific receptor known a ACE-2 receptor. These receptors are found plenty in lungs. Some of the recent study findings show that these receptors are also present in other tissues of the body such as HEART, KIDNEY and INTESTINES in large to small numbers.
Hence COVID-19 virus attaches not only to the lungs and damages them but also attaches to other organs of the body including the heart. Thus, CORONA virus might directly attack the heart.

INDIRECT EFFECT-

COVID-19 virus primarily affects the lungs and thereby the breathing capacity of the lungs. The lungs are in direct connection with the heart. So any problem in the lungs leads to effect on the heart.
In Covid, lungs undergo fibrosis, this leads to cardiac stress thereby damaging the heart.
Covid leads to systemic inflammation of the multiple organs in the body. This leads to increase in inflammatory markers in the body. This amplified inflammatory response results in damage to multiple organs of the body including heart. This is clinically known as MULTIPLE ORGAN FAILURE.   

CONCLUSION-

Populations with age more than 40 years at increased risk of HEART DISEASE during COVID-19. 
It is always smart to get your blood reports done at regular intervals during course of COVID-19.
Hence, it’s not just the lungs that are affected !!

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SOURCES-

  1. COVID-19 and the Heart by Akbarshakh Akhmerov and Eduardo Marbán
  2. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus by Wenhui Li and others Nature volume 426, pages450–454(2003
  3. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China by ProfChaolinHuangMDa and others
  4. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China by Shaobo Shi and others
  5. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19) by Tao Guo, and others;JAMA Cardiol. 2020;5(7):811-818.
  6. The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2 by Liang Chen, Xiangjie Li, Mingquan Chen, Yi Feng, Chenglong Xiong
  7. Cardiovascular Research, Volume 116, Issue 6, 1 May 2020, Pages 1097–1100, 
  8. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection by Xin Zou1and others
  9. End-stage Heart Failure with COVID-19: Strong Evidence of Myocardial Injury by 2019-nCoV by Nianguo Dong, Jie Cai, Ying Zhou, Junwei Liu, Fei Li
  10. Heart and Lung Multimodality Imaging in COVID-19 by Eustachio Agricola and others; JACC: Cardiovascular Imaging Volume 13, Issue 8, August 2020
  11. Case Report: Clinical Case- COVID-19 Complicated by Acute Pulmonary Embolism and Right-Sided Heart Failure by WaqasUllah and others
  12. The expression level of angiotensin-converting enzyme 2 determines the severity of COVID-19: lung and heart tissue as targets by Mohammad Mahdi Nejadi Babadaei and others.
  13. Patterns of heart injury in COVID‐19 and relation to outcome by Ajay Kumar Mishra and others

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