The world is currently gripped in the midst of a pandemic of a novel coronavirus COVID-19. This has led to an unprecedented number of hospital admissions and increased demands for intensive care beds on a scale never before known in the history of modern medical science. COVID-19 is well known for its effects on the respiratory system leading to a varied clinical presentation. Some people experience mild symptoms of an upper respiratory tract infection that is self-limiting within a few days. In a small number of cases the infection leads to a viral pneumonia manifested as breathing difficulties and the needed for artificial ventilation.
What is less well known is that COVID-19 can also have a potentially significant effect on the heart. An early study conducted in a hospital in Wuhan, China revealed that nearly 1 in 5 (20%) of patients admitted COVID-19 illness had some form of involvement in their heart. Patients are more likely to have cardiac involvement (effects on their heart) if they are older (generally over the age of 70) and had pre-existing heart conditions such as hypertension (high blood pressure), previous heart attack or stent or heart failure.
The Coronavirus can typically cause myocarditis which is acute inflammation of the heart. The virus itself does not appear to affect the heart directly but in some people it can induce an immune response called a ‘cytokine storm’. This is thought to cause inflammation within the heart leading to myocarditis. In some cases the myocarditis can progress to weakness of the heart muscle – a condition known as heart failure. We are still in the early stages in our understanding of this condition and the heart effects it may have. The symptoms that a patient may experience could be chest pain, breathlessness and ankle swelling. The chest pain may indicate symptoms of pericarditis and/or myocarditis. Pericarditis is inflammation of the lining of the heart whilst myocarditis is inflammation of the heart muscle. The chest pain a patient might complain of is typically worse upon lying flat or breathing in and eased by leaning forward.
Further investigations may prove useful in making a diagnosis. An ECG may show abnormalities and is a very helpful baseline investigations. Blood tests such as a inflammatory markers, Troponin and BNP levels might be raised pointing to involvement in the heart. An echocardiogram is a helpful test to determine if there is weakness of the heart muscle and contraction. A cardiac MRI scan provides information about potential areas of inflammation within the heart muscle as well as accurately measuring the extent of heart muscle weakness.
If you have had symptoms suggestive of COVID 19 or have a confirmed diagnosis through a positive swab and are experiencing chest pain or breathlessness you may have had some cardiac involvement. If this is the case then you would need to see a cardiologist to arrange further investigations. If the chest pain is severe and ongoing it is always sensible to call 111 or 999 and it may be necessary to attend Accident and Emergency. However for less severe symptoms we can provide an appointment at short notice and arrange any further tests that may be required such as and ECG or echocardiogram.
In conclusion our understanding of COVID 19 is improving all the time. There are undoubtedly notable effects on the heart from this viral infection and if this is the case further investigations with a private cardiologist may be required to confirm a diagnosis.
Whilst there is no specific treatment for myocarditis there is some potential treatment for pericarditis in the form of a NSAID (such as ibuprofen) or a drug called Colchicine. Colchicine is usually used to treat gout but it is also extremely useful in the treatment of pericarditis. It will help reduce symptoms very quickly and reduce the likelihood of complications from pericarditis or recurrent pericarditis.
For heart failure resulting from myocarditis the treatment remains the same as that of standard heart failure treatment from other causes. This will be a combination of drugs including an ACE-inhibitor or ARB, beta-blocker and Spironolactone. Repeat tests such as ECG and echocardiograms may be required to assess the response to treatment.
