Your heart may need extra care as long Covid is ‘the new epidemic’

(This story originally appeared in on Feb 22, 2022)

NEW DELHI: People at a higher risk of developing heart diseases, including those with diabetes and hypertension, or those with a history of heart ailments should undergo thorough screening 8-12 weeks after recovering from Covid-19, according to experts.

If there is any abnormality, such persons may also require additional testing, top medical researchers from University of Oxford, University of Zurich and University of Wisconsin School of Medicine and Public Health have advised.

The advice comes in the backdrop of a surge in cases of long Covid, a condition characterised by the persistence of symptoms beyond three months, which is estimated to have affected nearly 22% of people who have recovered from the disease in India.

Long Covid is emerging as a new epidemic, the researchers have pointed out in a new study published in European Heart Journal (EHJ) which describes the mechanism of acute and chronic injury caused to the heart by Covid. This includes direct damage to the cells, formation of clot and inflammation in blood vessels and triggering of an autoimmune response.

While it is not yet known how many Covid patients end up developing cardiac complications, doctors say it may be prudent to increase awareness about the risks and develop guidelines for screening of high-risk individuals, which can help in timely diagnosis and management of immediate and long-term complications.

“Proactive screening and investigation, where appropriate, could allay fears and anxiety among patients,” the EHJ study states.

Dr Brahma Nand Sharma, senior cardiologist at University of Pittsburgh, said those who have recovered from Covid should resume physical activity gradually over six to eight weeks and self-monitor their blood pressure, heart rate and other vital parameters.

Last year, Delhi’s G B Pant hospital conducted a study wherein 134 patients who had fully recovered from Covid underwent imaging test – speckle tracking echocardiography – to assess heart function. The results revealed that nearly one in three patients had a subclinical left ventricle dysfunction while 11% had right ventricle dysfunction. The left and right ventricles of the heart, which has four chambers, are responsible for pumping oxygenated blood to tissues all over the body and for pumping oxygen-depleted blood to the lungs, respectively.

Dr Mohit Gupta, professor of cardiology at G B Pant hospital, told TOI dysfunction in the left ventricle was seen even in patients who had recovered after asymptomatic (8%) or mild (13%) Covid-19.

“The long-term effects of Covid-19 on the cardiovascular system are still not known. However, it is very clear that there is a subclinical effect on heart muscle. It would be pertinent to follow up these patients over three months and six months to see how this damage evolves,” Dr Gupta said.

He added that a long-term follow-up may translate into timely prediction of the impact of Covid on the cardiac function as well as the need for possible therapeutic interventions in order to prevent cardiovascular complications.

The EHJ study listed strategies for screening of Covid-recovered patients for cardiac complications. This includes a thorough history, clinical examination, blood test panel (C-reactive protein, troponin, B-type natriuretic peptide/NT-proBNP, glycated haemoglobin, lipids), ECG and transthoracic echocardiography at least 8-12 weeks from infection in high-risk individuals.

For patients with clinically significant abnormalities after the screening, additional testing is recommended, the study said. Given the strong association between obesity and long Covid, the researchers say measures to reduce weight through caloric restriction, diet, tailored exercise, stress reduction and good sleep hygiene could be beneficial in the long run.

Dr Ambuj Roy, professor of cardiology at AIIMS, said cardiovascular diseases are known to cause 27% of mortality in India. “If preventive steps aren’t taken, this percentage may go up further,” he said. He added that insights suggest the risk of cardiac complications after Covid is the highest in the first year after the infection, after which it flattens out. “Also, the risk of late heart involvement is more in those who have severe Covid pneumonia,” he added.

Dr Upendra Kaul, chairman of Batra Heart Centre, said there should be a low threshold for doing a coronary angiogram. “If it is abnormal, treatment needs to be started. Heart attacks have been reported and I have personally seen three cases in patients without previous cardiac involvement. They need to be treated as per the evidence-based management,” said Dr Kaul.

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