The coronavirus disease (COVID-19) is potentially fatal for vulnerable populations like seniors who over 60 years old, and those with underlying medical conditions, like heart disease, diabetes, and lung disease. Reports show that patients are suffering from heart impairment caused by COVID-19. A new study sheds light on the effect of the novel coronavirus on the heart, causing cardiovascular problems, even in those without underlying heart conditions.
The team of cardiologists from Beijing, China, have found that COVID-19 patients are at risk of cardiovascular impairment, requiring cardiovascular protective treatments to improve outcomes and hasten their recovery. The team recommends the use of proven and approved cardiovascular anti-inflammatory therapies on patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19 disease.
Trigger heart problems
Published in the journal Frontiers in Cardiovascular Medicine, the study provides an insight into the effects of the SARS-CoV-2 on the heart, which may explain why many patients suffer from sudden cardiac arrest or heart failure. The team has described the various ways the coronavirus triggers serious inflammatory-related cardiovascular problems. From there, they hope to provide doctors with guidance in treating heart problems as complications of the disease.
"We are the first to comprehensively discuss the application of cardiovascular, anti-inflammatory treatments for patients severely affected by COVID-19. Our study sets out guidance for the selection of specific cardiovascular anti-inflammatory therapies for COVID-19 patients, depending on the severity of disease and a patient's response to therapy. In addition, we highlight the known risks to the cardiovascular system of treatments currently being tested on patients with COVID-19," Professor Shuyang Zhang, lead author of this research, based at the Department of Cardiology, Peking Union Medical College Hospital Beijing, China, said.
What happens to the heart?
Amid the coronavirus pandemic, many scientists, doctors, and health experts race to understand the virus's behavior and how it affects major organs in the body. Since the virus first affects the respiratory tract, the initial symptoms include a sore throat, cough, and fever. The patient can develop pneumonia and later, acute respiratory distress syndrome (ARDS).
However, many patients with COVID-19 develop complications affecting the heart. The researchers explained that inflammation plays a key role in the development of cardiovascular disease. Patients who develop any signs of the inflammatory response to the virus are more likely to suffer serious cardiovascular events and are at a higher risk of death.
The team has identified a multitude of ways the SARS-CoV-2 can trigger cardiovascular diseases or problems. Firstly, the virus can directly cause inflammation of the tissues of the heart. This can worsen existing heart problems. Secondly, the virus can cause the immune system of the body to overreact to the infection, causing a cytokine storm. This phenomenon happens when the body's immune system starts attacking healthy tissues in the body.
For instance, many doctors working in the frontlines observed injuries to the heart of COVID-19 patients. Some patients develop heart attack, heart muscle inflammation, and even fatal heart arrhythmias.
Managing heart problems
COVID-19 disease has no cure or vaccine, and most of the treatment options available today focus on relieving symptoms. The researchers recommend that doctors and clinicians examine current and promising COVID-19 treatments, including cardiovascular anti-inflammatory therapies. To aid in the recovery of patients, the team highlights using potentially effective treatments, even those that can help reduce the inflammation in heart tissues.
"Many clinical trials have been conducted over the past decade to directly test the feasibility of using different anti-inflammatory agents for cardiovascular protection under various conditions, Accumulating evidence supports their ability to improve cardiovascular outcomes," Zhang said.
"Using current knowledge of cardiovascular anti-inflammatory therapies might be of great value in the management of COVID-19, and we recommend referring to this knowledge and experience in clinical practice and conduct related COVID-19 clinical trials," he added.
However, the team also cautions about using new treatments that are still undergoing trials. These drugs have not yet been approved for use on COVID-19 patients and may have issues on efficacy and safety. Since there are no treatments available for the disease, many countries resorted to using antiviral drugs. The team issues concern about their use and recommend that the doctors should use them with caution since these medicines have been linked to an increased risk of cardiovascular impairment.
Some of the drugs include ribavirin, azithromycin, lopinavir/ritonavir, and hydroxychloroquine.
"Considering that these drugs may be essential in the clinical management of COVID-19 patients, especially the antiviral agents, cardiovascular protective strategies are urgently needed to improve the overall prognosis," Zhang added.
Wang, L., Zhang, Y., and Zhang, S. (2020). Cardiovascular impairment in COVID-19: learning from current options for cardiovascular anti-inflammatory therapy. Frontiers in Cardiovascular Medicine. https://www.frontiersin.org/articles/10.3389/fcvm.2020.00078/full