Since clusters of coronavirus occurred in China in 2019 and WHO declared it a pandemic in March 2020, we have travelled a long distance in terms of diagnosis, management, and prevention of covid19 disease.
Initially thought to be a respiratory illness and later on found to have multisystem involvement our disease perspective has changed and still evolving.
Mild to moderate symptoms are most common and occurs in approximately 81% of patients, severe symptoms in 14% and only around 5% are critical.
The cardiovascular system is usually also affected in severe to critical cases with complications including myocardial injury, myocarditis (inflammation of heart muscles), acute myocardial infarction, heart failure, rhythm abnormalities and venous thromboembolic events.
Diagnosis of myocarditis in recovered covid patients should be reserved for those who have clinical symptoms like chest pain, breathlessness and exercise intolerance with objective evidence of myocardial injury like increase troponin level, heart rhythm abnormalities, wall motion abnormalities on echo or chronic inflammatory findings on CMR.
Due to concern for myocarditis related heart rhythm abnormalities that may occur in the setting of ongoing inflammation, it is recommended that athletic patients should avoid competition for 3 to 6 months. Cardiovascular risk assessment (treadmill test, ECHO and 24 hr. Holter) is recommended for mild symptoms lasting longer than 10 days, for moderate or severe symptoms including hospitalization, advanced cardiac testing is recommended depending upon symptoms and abnormal findings in baseline testing.
Post-acute covid19 syndrome:
Long covid or sequelae of covid can occur in recovering patients. Fatigue or muscle weakness, breathlessness, joint pain and chest pain sleep difficulties, anxiety or depression and worsening quality of life are the most common symptoms reported. Greater illness severity during hospitalization was associated with more impaired lung function and abnormal chest imaging.
It is still unclear what is a cardiac contribution in this syndrome and how it affects long term outcomes. Palpitations may be a presenting symptom in many patients. A range of abnormal heart rate or rhythm have been encountered in patients with covid19 infection. Most frequent is sinus tachycardia or inappropriate sinus tachycardia where even minimal exertion results in a very high heart rate. It can result from multiple causes like fever, low oxygen, anxiety, myocarditis or residual pulmonary embolism. Other less common variants of high heart rate are rhythm abnormalities like atrial fibrillation, supraventricular tachycardia and the most dangerous one like ventricular tachycardia or fibrillation arising due to Qtc prolongation (caused by some drugs) or severe myocarditis or hypoxia.
It may take 3 to 6 months for myocarditis or heart inflammation to resolve completely. Everyone recovering from covid19 should be careful.
Consult your physician immediately in case of any symptoms but not panic.
Dr. Amrendra Kumar Pandey, Consultant – Cardiology, Dharamshila Narayana Superspeciality Hospital, Delhi.