The SARS-CoV-2 virus has caused a significant increase in mortality worldwide. In most cases, it is associated with acute respiratory distress syndrome (ARDS). In their reports, clinicians also point out that heart problems may occur more and more among convalescent. Prof. dr hab. n. med. Krzysztof J. Filipiak in an interview with Poradnik Zdrowie.

At the onset of the pandemic, cardiovascular complications, according to the report "COVID-19 disease characteristics, symptoms and he alth effects. Recommendations and experiences of Polish clinicians ”(the so-called“ White Book ”), prepared by recognized experts from the initiatives“ Science against pandemic ”, were perceived through the prism of infarction, myocarditis, exacerbation of heart failure, arrhythmias and cardio-embolic complications. Despite the passage of time , the ultimate incidence of cardiovascular complications has not yet been established . According to the latest reviews, a large percentage of people suffering from SARS-CoV-2 infection struggle with them.

Here are the types of cardiovascular complications that can occur:

  • myocardial ischemia(about 20% of convalescents) - increased protein concentration may indicate overload of the heart muscle, and elevated troponin levels do not necessarily result, as experts in "Biała Book ", from ischemic damage to cardiomyocytes.
  • heart rhythm disturbances(about 15% of convalescents) - may occur in the acute phase of COVID-19 and in the post-COVID state. The most common symptoms of this ailment include: increased heart rate (so-called tachycardia), paroxysmal palpitations, attacks of atrial fibrillation. Polish clinicians indicated in the "White Book" that "in the course of COVID-19, other proarrhythmic factors (contributing to uneven heart beat) are also activated, so it seems justified to actively search for atrial fibrillation in people who have had COVID-19".
  • heart failure(approx. 14% of convalescents) - recognition of new features of heart failure in patients with SARS-CoV-2 infection or exacerbation of heart failure may be indirectly related to the phenomenaCOVID-19. These are, for example: hypoxemia, acidosis, respiratory failure, changes in lung tissue, cytokine storm.
  • acute coronary syndrome(about 1% of recoveries).

So the question is, should healers worry about their heart? We askedprof. dr hab. Krzysztof J. Filipiak, MD , FESC. In his opinion, "people who have had SARS-CoV-2 infection, even those who have had it poorly or asymptomatically, may also develop post-COVID syndromes and experience various he alth problems." Today they are classified as cardiological diseases for the so-called chronic COVID (long-COVID, chronic-COVID).These may be: arrhythmias, inadequate tachycardia (persistent elevated pulse), deteriorating blood pressure control or thromboembolic complications- said a cardiology specialist.

Read also: Coronary artery disease - symptoms. How to recognize ischemic heart disease?

COVID-19 and cardiovascular disease: follow-up treatment is important

People diagnosed with cardiovascular diseases can be classified as high risk of death in the course of SARS-CoV-2 infection. Why? - Patients with cardiovascular diseases are elderly. In the first year of the pandemic, when there were no vaccines, these people fell ill and most often died. Currently, this situation is changing dynamically.The dangerous variant of the SARS-CoV-2 delta virus (formerly known as the Indian variant) is spreading primarily among the unvaccinated , i.e. younger people. As prof. dr hab. n. med. Krzysztof J. Filipiak, "in the fourth wave of coronavirus, where>90% of seniors have already been vaccinated, we will recognize that cardiovascular diseases will no longer be associated with such a risk of death in the course of SARS infection - CoV-2 ".

In addition, people with diagnosed cardiovascular diseases must continue treatment during the pandemic. - People who suffered from COVID-19 more often, required hospitalization or, unfortunately, died during the epidemic are undoubtedly people with poor control: heart failure, hypertension, diabetes, chronic coronary syndrome - said Prof. dr hab. n. med. Krzysztof J. Filipiak. Optimal pharmacotherapy, adherence to the follow-up schedule and constant medication intake are important for these patients.

Read also: Tricuspid regurgitation: symptoms and treatment

Patients with congenital heart disease in the pandemic era

We cannot skip the related thread as wellif you are born with a heart disease or have had an organ transplant in the past. What are the risks of COVID-19 in their case?

Prof. dr hab. Krzysztof J. Filipiak, MD, emphasized that"SARS-CoV-2 infection can cause myocarditis,but it seems to be a rare phenomenon, or at least much more rare, than we thought at the beginning of the pandemic. "

- Dealing with this is routine. We act symptomatically. There is no specific treatment. The diagnosis is based on echocardiography and taking markers of myocardial damage. The correct diagnosis can be made on the basis of a myocardial biopsy (which, of course, we do not do during the vital process) or on the basis of a specific myocardial resonance examination, which is able to indicate areas of the heart that are inflamed. The description of such tests should be approached very carefully - explained the specialist in the field of cardiology, internal medicine, hypertensiology and clinical famacology.

He also pointed out that "these tests must be performed both on properly calibrated equipment and described by very experienced specialists". Therefore, whether such tests are necessary is decided by a specialist cardiologist who conducts diagnostics. As for patients after heart transplantation, Prof. dr hab. Krzysztof J. Filipiak, MD, in an interview with Poradnik Zdrowie, there is very little. - This is definitely a group of patients that needs special care and should have been fully vaccinated a long time ago - added the doctor, stating that"all people with heart defects are also people who should have been vaccinated. long ago " .

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Possible permanent cardiovascular complications

In the "White Book" prepared by well-known experts on the initiative "Science against the pandemic" it was noted that "late cardiac complications after COVID-19 are recognized as symptoms of post-COVID-19 syndrome."

In children and adolescents, they manifest themselves in the form of acute myocarditis and acute heart failure (the so-called PIMS-TS syndrome). More specifically, PIMS-TS is a childhood multi-system inflammatory syndrome temporarily associated with COVID-19.May reveal in the period of 2 to 6 weeks in the youngestwho have been asymptomatically or relatively infected with SARS-CoV-2 virus. It is possible that this multi-systemic inflammatory disease may also be acute. PIMS-TS is therefore the body's immune response to the past oneillness.

As indicated by Polish clinicians in the "White Book", adults more and more often struggle with cardiopulmonary disorders referred to as post-COVID syndrome. Symptoms occur several weeks after the illness, including: dyspnoea , exercise shortness of breath, increased concentration of D-dimers, arrhythmia, myocarditis . Some of them require further diagnosis with the participation of a pneumonologist and a cardiologist for further lung examinations.

From the cardiological point of view, convalescents require, as pointed out by experts in the "White Book", optimal therapy and treatment of comorbidities.

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COVID 19