Chronic Heart Diseases and COVID-19
Disclaimer: Not medical or professional advice. Always seek the advice of your physician.
Any viral infection worsens the course of existing chronic diseases and contributes to the development of acute complications. The coronavirus is no exception. Cardiac complications are the main problem that doctors face today in the treatment of COVID-19. Cardiovascular disease remains the leading cause of death in the world, even against the background of the COVID 19 pandemic. The presence of such diseases significantly worsens the prognosis for coronavirus infection. According to WHO statistics, 65% of all people who died from COVID‑19 suffered from heart and blood vessel diseases.
Impact of COVID-19 on the Cardiovascular System
Thanks to special receptors, the virus enters cells and attaches to angiotensin-converting enzyme 2. This protein is found in the cells of blood vessels, lungs, and heart. Therefore, the infection affects these particular organs. The disease poses the greatest danger to people with pathologies of the cardiovascular system. However, it was found that cardiac complications often occurred in patients who had never previously encountered this problem. Scientists are just beginning to gather information about how the virus affects the cardiovascular system.
There are two main theories of the effect.
- Inflammation caused by a strong immune response of the body. The immune response can indirectly damage the heart tissue, decreasing blood supply to the heart and increasing the risk of inflammation.
- Direct attachment of the SARS-CoV-2 spike protein to the receptors in the heart.
A study of the hearts of patients who died from COVID-19 at the beginning of the pandemic revealed problems with blood clotting (microvascular thrombosis) and death of heart cells (necrosis). Scientists found blood clots in small blood vessels and heart tissue. Further research is needed to fully reveal the mechanisms underlying the influence of the coronavirus infection on the heart.
Cardiovascular Complications Associated with COVID-19
Myocarditis and Arrhythmia
During the hard course of the infection, myocarditis may develop. Its symptoms.
- Short breathing.
- Chest pains.
- Increased sweating.
- Tachycardia.
If your heart hurts or there is discomfort in the chest, these signs are no less dangerous than the appearance of a dry cough and fever. It is arrhythmia or tachycardia that are often the first signs of myocarditis. Against their background, cardiac insufficiency can occur, which poses a threat to life.
Cytokine Storm
The body's immune response to inflammation appears to be too strong. Many cytokine molecules are released that stimulate the production of immune cells. In patients with COVID-19 with the cytokine storm, peracute myocarditis occurs, with which acute heart failure, cardiogenic shock rapidly develops. This course of the disease requires immediate resuscitation measures.
Atypical Myocardial Infarction
Several studies suggest that patients with COVID-19 may have an atypical myocardial infarction. Usually, a heart attack is caused by a blockage in a coronary artery - blood stops flowing to a specific area of the myocardium where the tissues die. In the same case, the signs of myocardial infarction can be seen on the ECG, while on coronary angiography and in laboratory studies, blockage of the artery is not detected.
Studies show that people with even a mild course of the disease may be at risk for cardiovascular complications. In patients with COVID-19 and concomitant cardiovascular pathologies, the disease exacerbated their heart problems. This increased the risk of intubation in the medical intensive care unit.
Keeping Your Heart Strong Through the COVID-19 Pandemic
- Monitor your blood pressure (target values - no higher than 130/80 mm Hg).
- Try not to gain excess weight.
- Stick to a healthy diet. Watch the size of your food portions, limit your intake of salt, sugar, and fat, eat more foods that contain fiber.
- Drink plenty of fluids.
- Avoid drinking alcohol.
- Stay physically active. Heart and vascular health require at least 150 minutes of moderate physical activity per week (just over 20 minutes of light workouts daily). You can achieve this level of activity without even leaving your home.
- If you smoke, quit this habit. Nicotine damages the vascular wall, causing spasms and blood clots in the arteries. Therefore, the risk of cardiovascular disease in smokers is two times higher than in non-smokers.
- Take your medicines following the prescription.
- Make sure you have at least a 30-day supply of heart medicines, including cholesterol and pressure-lowering drugs.
- Call your doctor if you are worried about your health or feel unwell.
Arterial Hypertension and COVID-19
High blood pressure (arterial hypertension) is a serious medical condition. If left untreated, it can lead to many other health problems. Health risks associated with high blood pressure include heart disease, stroke, and disabilities affecting cognitive ability.
The latest data suggests that people with uncontrolled or untreated high blood pressure may be at risk for a serious course of COVID-19. It's also important to note that people with untreated high blood pressure are more at risk of complications from COVID-19 than those with high blood pressure treated with medication.
If you have high blood pressure, the most important thing you can do is control it. Follow the treatment plan that you and your doctor have made up together. Protecting yourself from serious health problems that high blood pressure can cause is especially important when a person suffers from COVID-19. Here's a reminder of lifestyle choices that can help control high blood pressure.
- Choose foods that are healthy for the heart. Eat fruits, vegetables, whole grains, poultry, fish, and low-fat dairy products.
- Reduce the amount of salt in your diet. Aim to limit your sodium intake to less than 2,300 mg per day or less.
- Decrease your weight. Even a little weight loss can lower your blood pressure.
- Be active. Regular exercise lowers blood pressure and helps to fight stress and achieve weight loss.
- Deal with stress. Try to manage stress in healthy ways, such as deep breathing and meditation.
- Avoid or limit alcohol consumption. Alcohol can raise blood pressure.
- Quit smoking. Tobacco causes high blood pressure and rapid lesions formation in the arteries.
Lifestyle changes, drug intake, daily blood pressure control — whatever you do to control your blood pressure, stick to it. Don't change anything you are used to doing without first talking to your doctor. If you are taking blood pressure medications, make sure you have at least two weeks of their supply.
I Have Heart Disease. Should I Get the COVID-19 Vaccine?
There are no contraindications for vaccination for patients with chronic heart disease. Exceptions are acute conditions such as myocardial infarction or cerebrovascular disturbance. The period when vaccination in these cases is contraindicated lasts about four weeks. At the same time, it is possible to vaccinate during the rehabilitation stage.
It is necessary to be vaccinated since cardiovascular disease is a risk factor for a more severe course of coronavirus infection and, accordingly, its outcomes. Vaccination increases the chance of avoiding illness or more severe course of the disease. After operations, patients with a cardiological profile should consult a doctor before vaccination.
What Conclusions can be Drawn?
- Hospitalized patients with underlying heart disease and COVID-19 have an extremely poor prognosis compared to patients without heart disease in history. They have a higher risk of death, thromboembolism, and septic shock.
- Regardless of the treatment regimen used, patients with the preexisting cardiovascular disease remain in the intensive care unit longer than patients without underlying heart problems.
- Data on cardiovascular disease following viral epidemics are limited. The current outbreak of COVID-19 highlights the need to raise awareness of the immediate and long-term effects of viral infection on the cardiovascular system. There are also significant knowledge gaps that need to be addressed in future research.