Dr. Ajay Sharma, Cardiologist, Lahey Hospital and Medical Center; Southern New Hampshire Medical Center
World has indeed become a global village. There is ready access to international travel and the consequent human mobility sets the stage for increased microbial transmission around the world, which make the possibility of global pandemic a persistent threat. In the last two decades, we have experienced epidemics of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and H1N1 influenza, and it is now recognized that their overall impact on health burden may be under-estimated since the manifestations are beyond pulmonary involvement alone and have been usually overlooked.
It is now understood that acute and chronic cardiovascular complications of pneumonia are common and are a sequelae of various mechanisms, including relative ischemia (decreased blood supply), systemic inflammation, and direct pathogen-mediated damage. Ongoing Coronavirus induced COVID-19 pandemic has raised its Hydra head wreaking havoc the world over. From our understanding of Influenza infection and cardiovascular complications, myocarditis (inflammation of heart muscle), acute myocardial infarction (heart attack) and exacerbation of heart failure are well established. Electrocardiographic changes and cardiac enzyme elevation may signal acute coronary event or myocarditis. In the setting of chronic cardiovascular conditions with a reduced baseline cardiac reserve, as a consequence of imbalance between infection induced increase in metabolic demand, instability may set in. At a molecular level (down regulation of ACE-II pathways and upregulation of pro-inflammatory cytokines), may lead to cardiac muscle inflammation, pulmonary edema and consequently acute respiratory failure. This can lead to hypotension (low blood pressure), arrhythmias and even sudden cardiac death.
Patients with established coronary artery disease and heart failure, in a response to systemic inflammation induced by viral infection, may be at a particular risk to develop coronary plaque rupture, increased likelihood of in-stent thrombosis and hence an acute coronary event. It is of paramount importance to be compliant to medications including antiplatelet agents (Aspirin, Clopidogrel), and plaque stabilizing agents (statins), ACE/ ARB enzyme inhibitors (Lisinopril/ Valsartan etc.), and adrenergic receptor blockers (metoprolol etc.) COVID-19 is a rapidly evolving pandemic and being aware is the most important aspect. Please observe social distancing, keep physical contact to the minimum with strangers and stay home. To borrow my wife’s statement-“Find you inner peace and stay safe”. If you have been in contact with someone who is sick, stay vigilant, take your medications regularly. Healthy adults are requested to stay away from aged parents and grandparents particularly if they have cardiovascular disease or any co-morbid condition for that matter.
