Name:
Heart Injury Caused by COVID-19
Description:
Heart Injury Caused by COVID-19
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Duration:
T00H05M46S
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Upload Date:
2022-02-28T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
>> Practice Impact Extra podcasts are derived from Hurst's The Heart Board Review and other online resources available only through accesscardiology.com. >> As you're all aware, the coronavirus-19 is associated with a significant mortality, and that's so disappointing. And in the hospitals, we certainly began seeing a lot of cardiac arrests, and this was certainly associated with the well-documented mortality numbers. And so, the question is, "Can COVID-19 damage your heart?" Hi, Dr. Bernie, and welcome to Practice Impact Extra.
COVID-19, the disease caused by the new SARS-CoV-2 coronavirus, has sickened millions and continues to kill large numbers of people worldwide. Primarily, it was considered to be life-threatening for its effect on the lungs. However, two studies from academic hospitals in Wuhan, China, published in March 2020 in JAMA Cardiology Journal finds COVID-19 can also cause heart injury, even in people without underlying heart issues.
One study included 187 hospitalized patients with laboratory confirmed COVID-19, and 28% of these patients had myocardial injury that was determined by elevated troponin levels that were associated with an in-hospital mortality of 60%. That was compared to 9% mortality in those individuals with normal troponin levels. Of note, the mortality was 70% if a patient had underlying cardiovascular disease, but mortality rates of only 38% were noted in those with elevated troponin levels, but who did not have underlying cardiovascular disease.
Interesting that the researchers noted that there were significantly elevated C-reactive protein levels and BNP levels linking it to myocardial injury. And as one would expect and what they found was the severity of inflammation was associated with LV dysfunction. A second Chinese study used data from 416 hospitalized adults with confirmed COVID-19. They observed 20% of patients had evidence of myocardial injury manifested by elevated troponin levels.
This group had a 51% mortality. That was compared to 4.5% of patients who did not have myocardial injury. The more elevated the troponin levels, the more likely these patients would lead to ventilation, being on a ventilator, and again, associated with a significantly higher mortality. A third study published in the New England Journal in April 2020 from NYU Langone Medical Center here in New York reported on 18 patients with severe COVID who had classic EKG signs of STEMI, ST elevation myocardial infarction, on either admission EKG or an EKG during hospitalization.
Ten of the 18 patients were found to have non-coronary myocardial injury. This was documented on echocardiogram and/or cardiac catheterization. Nine patients underwent cardiac catheterization, six of whom had obstructive disease, and five of those had PCI. All of these patients had elevated D-dimer levels. Disturbingly, the mortality was 72% in those patients with non-obstructive myocardial disease, non-obstructive coronary artery myocardial disease.
So, what could be the possible mechanisms for the different clinical manifestations? One, demand injury, hypoxia, plaque disruption, intense inflammatory stimulating related to the release of multiple cytokines and chemokines, the so-called cytokine storm, direct viral infections of the myocardium of the myocardium leading to myocarditis, direct viral vascular injury, coronary artery spasm, the so-called broken heart syndrome, which is thought to be related to the damaging effects of stress hormones on the heart, and the pro-thrombotic state with multiple sites of clotting.
Since the initial presentation in China in late of December 2019, we were aware that COVID-19 is a severe respiratory illness. We've come to learn that cardiac involvement is common and is associated with a worse acute prognosis, particularly in those with prior heart disease. However, I want to leave you with one more thought, and there is a critical unknown. For those recovering from COVID-19, what would be the long-term effects, the cardiac effects, on heart damage and the effects of potential heart failure and cardiac arrhythmia?
These are certainly unknown. We still have really so much more to learn from this novel virus. Thanks again for joining me, and see you next time on Practice Impact Extra. >> We hope you enjoyed this podcast from McGraw-Hill. Subscribers to AccessCardiology have instant access to over 25,000 pages of rich medical content, receive medical updates from trusted experts, and have access to other special features. To subscribe or learn more, please visit accesscardiology.com.
