COVID – 19 and the State of Heart

As the world slowly tries to move away from the clutches of the ongoing pandemic, we uncover how COVID -19 impacted the heart, directly and indirectly. Although severe COVID-19 disease is characterized by acute hypoxic respiratory failure, there have been diverse manifestations within the cardiovascular system that each pose unique therapeutic challenges. Of these manifestations, myocardial injury and right ventricular dysfunction are the most common, however, heart failure, circulatory shock, cardiomyopathy, arrhythmia, and vascular thrombosis have been noted as well.

Many studies have been published recently that have tried answer how SARS-CoV-2 can cause myocardial injury. The proposed mechanisms of myocardial injury are direct damage to the cardiomyocytes, systemic inflammation, myocardial interstitial fibrosis, interferon mediated immune response, exaggerated cytokine response by Type 1 and 2 helper T cells, in addition to coronary plaque destabilization, and hypoxia (1). Some of the suggestive cellular and molecular mechanisms whereby SARS-CoV-2 may lead to detrimental consequences to the cardiovascular system are aging, cytokine storm, NLRP3/inflammasome, hypoxemia, and air pollution (2).

Also, the impact of lockdown and change in routine lives has had it ill- effects on the heart. Firstly, the ongoing health emergency in the country meant many of the routine visits and evaluation of existing heart patients were put on hold. The pandemic significantly impacted the approach of patients to visit a healthcare facility for heart ailments. Moreover, the restrictions meant less exercise (unable to go out to exercise/ play a sport in the open), spending more time in front of computer screens and having an increasing sedentary lifestyle. All of which again is detrimental to a healthy heart and more so for an ailing one.

With the onset of 2021 that brings with it hope, we can once again look forward to a world where cardiac care takes its rightful place in the healthcare system. But as I post this article the country is on the verge of entering potential partial lockdown/s because of an unprecedented rise in the number of cases. Delhi govt. announced that 14 super specialty hospitals will function as full COVID hospitals. Although one understands the need of diverting most of our resources in tackling & fighting the pandemic, it also leaves many existing cardiac (and other critical specialties like oncology, trauma etc.) patients in a limbo. As much as the govts. and medical community are fighting the pandemic at a war footing, the onus also lies on us as individuals to follow the rules and stick to COVID appropriate behavior. This is a battle that can only be won when the entire country acts as one & with one single goal in mind of defeating the pandemic.

References

1.       Babapoor-Farrokhran S, Gill D, Walker J, Rasekhi RT, Bozorgnia B, Amanullah A. Myocardial injury and COVID-19: Possible mechanisms. Life Sci. 2020;253.

2.       Moccia F, Gerbino A, Lionetti V, Miragoli M, Munaron L.M, Pagliaro P etall. COVID-19-associated cardiovascular morbidity in older adults: a position paper from the Italian Society of Cardiovascular Researches. GeroScience Aug 2020, 42 (4):1021–1049.