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Coranovirus infection can cause a number of complications. Although the most common complications are the functioning of the respiratory system and lungs, the circulatory system and the heart are also at risk. We are dealing here with a wide spectrum of ailments, ranging from publicized thromboembolic complications, to more rare – heart rhythm disturbances, pressure fluctuations, myocarditis, and even unusual symptoms resembling a heart attack. Fortunately, we can all diagnose and treat them, as told by Dr. Jacek Piegza, MD, a specialist in internal medicine and cardiologist from the Silesian Center for Heart Diseases in Zabrze.
- Coronavirus has many side effects. Some of them concern the circulatory system
- One of the most common are thromboembolic complications
- SARS-CoV-2 virus infection can also cause a heart attack. On the other hand, the symptoms of COVID-19 infection may only mimic the symptoms of this ailment
- If someone who has contracted COVID-19 suddenly experiences shortness of breath or chest pain, they should not take it lightly – says Dr. Jacek Piegza, MD, a cardiologist
- You can find more such stories on the TvoiLokony home page
Monika Zieleniewska, MedTvoiLokony: The side effects of COVID-19 may manifest itself in cardiovascular ailments. Do we already have systematic knowledge on this subject?
Jacek Piegza, MD, PhD: At the beginning, it should be emphasized that coexisting diseases of the heart and circulatory system cause a more severe course of COVID-19. Conversely, the SARS-CoV-2 virus infection itself can exacerbate some cardiovascular diseases or trigger them for the first time. For example, heart failure may be the first symptom of COVID-19, and we don’t always know whether it is the result of a viral infection or whether the infection exacerbated the course of heart disease. Just getting COVID-19 can reveal certain heart conditions that have been undiagnosed and unaware of the patient.
But the coronavirus infection itself also causes specific cardiovascular diseases.
Quite often in the course of this infection there are thromboembolic complications, about which we hear a lot in the media recently. They can manifest themselves differently. One of the clinical manifestations is pulmonary embolism. This is a disease where blood clots close the pulmonary artery or its branches. If left untreated or undiagnosed, it is very dangerous and life-threatening. Symptoms can be very similar to those of COVID-19, with sudden, severe shortness of breath, chest pain, or a dry cough. It is believed that up to 1/3 of patients with a severe course of COVID-19 treated in intensive care units may develop various types of thromboembolic complications, including pulmonary embolism.
How do doctors distinguish a viral attack on the lungs from a pulmonary embolism?
The basic diagnostic test that confirms or excludes embolism is computed tomography with contrast. We give the patient a contrast, we visualize the pulmonary arteries and their branches, confirming whether any of them are blocked.
How often is it a pulmonary embolism?
It is quite common in the group of the most severely ill. A specific form of thrombosis seen in COVID-19 is the so-called pulmonary microembolism. Blood clots occur in the tiny vessels of the microcirculation. Their presence impairs perfusion, i.e. blood flow, through already inflamed lungs, deepening the body’s hypoxia. The presence of microembolism worsens the prognosis.
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Are there any other less publicized complications of COVOD-19?
Thromboembolic complications may also manifest themselves in other ways, e.g. deep vein inflammation of the lower extremities. Then the manifestation of thrombosis is different. The patient feels pain in the calf accompanied by visible swelling. Blood clots that form in the venous system of the extremities can travel downstream and obstruct the pulmonary arteries. The aforementioned pulmonary embolism may be a consequence of deep vein thrombosis. Embolic complications can occur in virtually any area of the circulatory system. For example, if there is a sudden closure of an intracerebral artery, this results in an ischemic stroke. Fortunately, such complications are rare in the course of getting COVID-19, but if they do occur, they can cause permanent disability. It is estimated that various types of thrombotic complications occur in about 10-25% of patients. sick.
The heart also does not save the coronavirus infection?
It can cause myocarditis, but fortunately it is rarely found. The SARS-CoV-2 virus can attack cardiomyocytes, or heart muscle cells, but this is not as common as with lung cells. The symptoms of myocarditis can vary greatly. In mild cases, the patient does not experience any heart symptoms, and only after blood tests it turns out that they indicate increased rates of myocardial damage. In other cases, we observe various types of heart rhythm or conduction disturbances. The most serious consequences of the disease may be damage to the heart leading to circulatory failure or dangerous arrhythmias.
- Heart disease. What symptoms are worrying?
How are they diagnosed?
The most useful imaging tests in the diagnosis of myocarditis are echocardiography and magnetic resonance imaging. In special circumstances, a heart biopsy may be necessary.
How soon after the infection starts can we expect such complications?
They most often appear in the second or third week of infection, but may also appear later, especially when the so-called cytokine storm. We also recognize the so-called long COVID, and we know that various complications, including those from the heart, can go on for a long time.
What about heart attacks?
In cardiology departments, we encounter heart attacks in the course of COVID-19, I would add that it happens often now. The course of the heart attack itself is then more severe. It is believed that infection with SARS-CoV-2 virus may initiate a heart attack. The symptoms of COVID-19 infection can also mimic the symptoms of a heart attack. The patient complains of typical retrosternal pain, ECG changes similar to infarction, elevated blood counts indicative of myocardial damage, while coronary angiography does not show changes in the coronary vessels. In a typical heart attack, one of the coronary arteries is closed or narrowed. With such unusual symptoms, the heart muscle is damaged by a different mechanism. Hypotheses as to why this is so vary. One says that the cause is a disturbance in the microcirculation of the capillaries within the heart muscle, and this can happen early in an infection, as can thromboembolic complications.
- A heart attack, more so than a stroke caused by genes
How should such covid heart attacks be dealt with?
In pharmacotherapy, we focus on treating the symptoms of SARS-CoV-2 infection. In part, pharmacological treatment is similar to that typical for a heart attack, of course, the artery is not opened, because there is no such need.
It took a while.
The frequently observed heart rhythm and conduction disturbances should also be mentioned. They can occur both in the early stages of the disease as well as later. It happens that patients present in the third week of COVID-19 disease with sinus tachycardia, i.e. increased heart rate, atrial fibrillation or other cardiac arrhythmias. Certain cardiac arrhythmias, such as ventricular tachycardia, can be life-threatening. The treatment regimens of arrhythmias in the course of SARS-CoV-2 infection do not differ from the accepted standards of management.
Should we pay attention to something in the group of patients with cardiac symptoms?
In some patients pressure fluctuations are observed. Hypotension, i.e. low blood pressure, may be a sign of a severe course of SARS-CoV-2 infection. Interestingly, it can also occur in patients treated for arterial hypertension. In such cases, it is necessary to consult a doctor and modify the doses of anti-hypertensive drugs.
How large is the group of convalescents due to cardiological complications?
We see only those patients who come to us, but there is no doubt that there are definitely fewer cardiological complications than pulmonary complications. It all depends on the course of the infection. The more severe it is, the more complications, and the more varied. The spectrum of symptoms can also be very, very different.
What would a cardiologist do for convalescents?
If someone who has recently contracted COVID-19 suddenly experiences shortness of breath or chest pain, this should not be taken lightly. These are symptoms that require urgent internal or cardiological consultation. If the patient has heart rhythm disturbances, he should also consult his doctor. We will be able to tell more about the permanent impact of the coronavirus infection on the circulatory system after some time.
Considering how many people are now suffering from COVID-19, I am convinced that in the near future, internal medicine and cardiology offices will be full of patients with postovid complications.
Read also:
- Nine arguments to convince skeptics to vaccinate
- The four chronic diseases that are most dangerous in COVID-19
- Biodegradable face masks now available
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