Covid-19 haunts survivors with cardiac problems

On Thursday, a 27-year-old woman was rushed to the ICU of Manipal Hospital, Bengaluru, after she developed cardiac problems.

The woman had contracted and recovered from Covid-19 but had returned to the hospital with myocarditis and breathing difficulties, revealing a deadly facet of the virus.

Dr Ranjan Shetty, Chief of Cardiology at Manipal Hospitals, said that the woman had tested positive in the third week of August when she was subjected to a routine test shortly before a caesarean.

“She was asymptomatic. The baby did not have Covid-19. She was subsequently clear of Covid-19 after two weeks,” Dr Shetty said.

The case has once again highlighted the issue of the long-term effects of the contagious disease, with several hospitals confirming that they are increasingly seeing a large number of Covid survivors with “cardiac manifestations”.

Dr Shetty said her heart ejection fraction, which indicates how much blood is pumped per beat, had dropped from 60% to 25%. In normal people, this ranges between 50% and 75%.

“Importantly, her medical history shows that she had no previous heart conditions before contacting Covid-19,” Dr Shetty said, adding that physicians also had to employ a diuretic to remove fluid from her lungs.

This interplay between a healthy heart and breathing ability was underscored by several doctors who said that “lung functions will be affected if the heart is affected.”

One-in-five face problems

According to a recent paper by Eric Topol of the Scripps Research Translational Institute, as many as one-in-five hospitalised patients could face cardiac issues.

An unofficial survey conducted at Fortis Hospital found "cardiac manifestations" in 30% of 400-odd Covid-19 patients, according to senior cardiologist Dr Rajpal Singh.

These manifestations range from limited necrosis of heart cells to myocarditis and thrombosis, and what was noticed in the 27-year-old patient: cardiogenic shock or an often fatal inability to pump sufficient blood.

“While these are mild in most, in 10% there was an acute reaction with some suffering heart attacks,” Dr Singh said.

A committee sanctioned by the Minister for Medical Education Dr K Sudhakar to look into the long-term effects of Covid-19 may shed more light, but preliminary results were unavailable.

“The report is expected soon and this will help to make necessary modifications in our treatment protocol and post-Covid care. We have already introduced cardiac manifestation prevention drugs in the treatment prophylactically as per guidelines,” Dr Sudhakar said.

According to Dr C N Manjunath, Director of the Jayadeva Institute of Cardiovascular Sciences and Research, this “treatment protocol includes blood thinners which are introduced if d-dimers tests show thrombosis (clotting) in patients.”