How COVID-19 can damage your heart

NEW DELHI: Covid-19 is known to damage the lungs. But there is emerging concern over the effect of this viral infection on the heart. According to the Cardiological Society of India (CSI), some studies have shown 20-30% of patients hospitalised due to Covid-19 have cardiac injury, which is defined by elevated levels of cardiac troponin — a protein released in the body by the injured heart muscle — and new abnormalities seen in ECG.

Cardiac complications have also been found to contribute to 40% of deaths related to Covid-19, studies showed.

The CSI, in its statement guideline published in the Indian Heart Journal, cited multiple studies to explain the mechanism of cardiac injury. It stated that majority of cardiovascular events in patients with Covid-19 are the result of severe immune over-reaction by the body called cytokine storm.



Simply put, when a person is infected by the novel coronavirus his or her immune system tries to fight back. Too many cytokines — small proteins important in cell signalling — are released into the blood too quickly, thus leading to a cytokine reform. This has been linked to many complications, including heart attack in patients with Covid-19.

Respiratory failure and lack of oxygen in blood – other known effects of Covid-19 – can also impair the heart’s functioning. Heightened inflammation due to Covid-19 can cause clotting of blood which can cause heart attack, experts said.

Many researchers have linked Covid-19 with myocarditis or heart muscle damage. According to CSI guideline, this can happen due to direct infiltration of the novel coronavirus into the heart muscle but mainly it is attributed to the cytokine storm occurring in response to the systemic inflammation.

“Cardiac injury usually becomes evident in the second week of the illness and manifests as ECG changes, troponin elevation, ventricular dysfunction or arrhythmias. Any of the above mechanisms which causes cardiac injury can potentially lead to heart failure. Also, the hemodynamic stress and inflammatory milieu can worsen pre-existing heart failure,” CSI said.

Several studies conducted in China and Europe suggested death rate among persons with pre-existing heart disease, who get Covid-19, is much higher compared to others.

Case fatality rates reported are 6% for hypertensives, 7.3% for diabetics and 10.5% among those with cardio-vascular disease, while the overall case fatality rate was only 2.3%, studies suggested.

Dr Ambuj Roy, professor of cardiology at AIIMS, who coauthored the CSI guidelines, said that people with heart diseases should practice isolation meticulously, frequent hand washing and social distancing.

“Due to travel restrictions, many patients with pre-existing heart disease, for example heart failure, are not able to visit doctors. My advice is they shouldn’t discontinue medications. They can contact their doctor on phone and, based on their opinion, continue with medications,” he said.

Dr Aparna Jaswal, additional director, cardiology and electrophysiology at Fortis Escorts Heart Institute, said heart patient who get Covid-19 should be monitored regularly. “Some of the medicines used for management of Covid-19, for example hydroxychloroquine, have known sideeffects on heart function. Therefore, special care is needed in administering drugs as well,” she said.