Why is Covid-19 causing cardiac complications? I would really begin by saying: this is not something new. Previous cases of flu have shown this. Post Spanish flu, we realised that a lot of the deaths happened because of the direct involvement of the flu itself, but it also leads to other reasons for mortality and morbidity. And heart was one of the important complications. Subsequently, we saw, after most flu outbreaks, the incidence of heart diseases goes up. And that is why people who are susceptible and who have heart disease are recommended to take flu shots. We want to prevent flu among individuals at high risk of heart disease. This is no different with Covid-19. And we are seeing that this virus is also causing cardiological complications, subsequent to recovery from acute Covid-19. For example, there is a large study from the United States that looks at a US veterans’ database of 1.54 lakh. The analysis showed that people who had Covid-19 had a higher risk of a range of cardiac problems a year later. Unfortunately, we know from serosurveys that a large majority of people in India have had Covid-19. So we are susceptible to these cardiac complications. Having said that, we have seen that people who had a severe form of Covid-19 are much more likely to have these complications, compared to those who had a mild form. We know if you are vaccinated, you usually have a milder infection. So vaccines will prevent those complications. So that is another reason, beyond Covid-19, to get vaccinated. What are the signs that indicate a patient might have developed heart complications after Covid-19? Let us look at what are the types of complications being reported. One complication is heart attack; they typically present with a lot of heaviness in the chest, sweating, acute breathlessness, or just a crushing pain around the upper chest. Besides, these people are known to have an arrhythmia. Patients present with palpitation, they develop very fast heartbeats, the heartbeat is irregular, fast, and the patient may feel giddy. The third complication being reported is that it affects heart muscles. It has been shown in autopsies that in people who succumbed to Covid-19, the heart muscles have the virus. In some people, it can trigger inflammation of the heart, and can lead to the weakening of the heart muscles. This basically means that the pumping capacity of the heart muscle goes down. The patient experiences breathlessness and accumulation of fluid in the body. Another complication is that Covid-19 makes you susceptible to clots. Your veins could develop clots and this could be potentially dangerous, because if these clots migrate to the lungs, it can lead to sudden choking of the blood supply to the body. Who is getting hit the hardest? We are hearing about young people reporting cardiac complications. If you look at the large study, people who have a more severe form of Covid-19 are most susceptible. Second, the elderly and patients with comorbidities are more susceptible. But given that India has a very large young population, even if your probability is small, we will see a lot of young people get hit. Even with a small increase in the risk in the younger population, there will be a lot of people with those complications. Why are people without a history of comorbidities reporting complications? I would first move away from this question. Because as South Asians, we are anyway prone to heart disease. This is now proven through multiple research done on Indian diaspora abroad, where they compared the risk of South Asians to that of the native population. The risk varies from study to study, but if I have to give a broad ballpark estimate, it is about two times higher among South Asians. Heart diseases typically develop a decade earlier in South Asia as compared to the West. Traditionally, there are five risk factors for developing cardiovascular disease: tobacco use, diabetes, hypertension, bad cholesterol, and family history. I would put Covid-19 as one of the risk factors now. So how do we detect this early, especially when many healthy, young, asymptomatic patients complaining of long Covid complications? We should focus on what can be done to prevent these complications. The focus should be on risk factors. Any which way, every person should have one preventive cardiac check. It is a very simple check: of your blood pressure, blood sugar, blood cholesterol levels, of your weight, and diet. We know that almost half of our people with hypertension are not aware of their condition because they have never measured it. High blood pressure is a silent killer — it won’t show symptoms most of the time. If you look at the population level, just 10% in rural and 20% in urban areas have their blood pressure under control. So everybody should go for a preventive check-up. Even more now. We are seeing people undergoing ECHO tests, and cardiac MRIs. Is that needed? Clearly, in an asymptomatic person, that is not needed. There is a guideline we developed for the Health Ministry on post-Covid cardiac management. We have very clearly said that besides the very basic tests you need to do, if you don't have symptoms — you are doing well, you are back to doing your usual activity like you can do a good walk for 20 minutes without getting breathless, or you can walk with a person of your age and fitness as much as he can — then you do not need to go for any further tests. But yes, if you have episodes of palpitations, breathlessness even when you walk a flight of stair, in those cases, we may need further tests. There is a study from Germany, which does a detailed analysis of people who have Covid-19 versus uninfected people. It showed that even cardiac MRIs were no different in people who had Covid-19 versus those who did not have Covid-19. There was no additive value in doing these high-end tests. So unless you have symptoms, you don't need to do anything more than the very basic tests. So, when does a patient need to consult a specialist? In your convalescent stage, if you continue to have one of these symptoms — breathlessness, palpitations, faster heartbeat with minimal activity, or if you feel your heartbeat is irregular, or if you notice swelling on your limbs, or when you walk you feel some heaviness in the chest — these are the symptoms when you definitely need to quickly consult a specialist. Other than that, if you are back to your usual physical activity, then there is nothing more needed than simple blood pressure, blood sugar, and blood cholesterol test — which are anyway mandated for anybody after 25 years of age. What are the preventive measures? This begins with very simple lifestyle measures. It includes absolute abstinence from tobacco. The second is maintaining optimum body weight. Third is having regular physical activity in your day-to-day life, which means a good, brisk walk of 20 to 30 minutes, at least 5-6 days in a week. Fourth is a prudent diet —lots of fruits and vegetables; avoiding too much sugar and salt and rich fried food in the diet. Additionally, you should have a routine preventive cardiac check of a very basic nature. If they are out of range, you must initiate therapy early. (Dr Roy spoke to Kaunain Sheriff M)
