Is there a link between coronavirus and heart failure?

During the coronavirus pandemic, symptoms such as breathlessness, fever, and, in more severe cases, pneumonia, have been the primary focus. However, recent evidence from cardiac specialists in China, Italy and the USA shows that the respiratory illness can also infect the heart muscle and potentially lead to heart damage.

We look at whether there is a possible link between the heart being affected by COVID-19 in patients with no previous history of heart disease and what it might mean for those who already have pre-existing heart conditions.

What are we discovering about the link between the heart and coronavirus?

Doctors on the frontline of managing cases of coronavirus are questioning whether the patient’s heart is being affected by the virus and whether there is something that they can do about it.


Determining how the virus affects the heart is difficult because severe illness alone can influence heart health. In a condition such as pneumonia, there is widespread inflammation in the body. This can lead to plaque in the arteries becoming unstable, causing heart attacks. Inflammation can also lead to a condition known as myocarditis where the heart weakens and ultimately, fails.

Research suggests that coronavirus attaches to certain receptors in the legs and those same receptors are found in the heart muscle too.
 

What evidence is surfacing?

The first evidence of cardiac problems in patients with COVID-19 was published in March 2020 in two studies in China. The larger study analysed 416 patients who were hospitalised with the virus and found that 19% of patients showed signs of heart damage. It also showed that in 51% of those who were significantly more likely to die, they did so with heart damage.

According to WebMD, who discuss the same case: ‘Patients who had heart disease before their coronavirus infections were much more likely to show heart damage afterwards. But some patients with no previous heart disease also showed signs of cardiac damage. In fact, patients with no preexisting heart conditions who incurred heart damage during their infection were more likely to die than patients with previous heart disease but no COVID-19-induced cardiac damage.’

More research needs to be conducted so that medical professionals can understand why some patients experience more cardiac effects than others. This might prove difficult, however, as patients with COVID-19 are often so sick that it is difficult for them to undergo an invasive procedure. Testing with electrocardiograms, for example, may also expose more healthcare workers to the virus.
 

If someone has a heart condition already, are they at risk of coronavirus?

According to the British Heart Foundation (BHF): ‘Having a heart and circulatory condition probably doesn’t make you any more likely to catch coronavirus than anyone else. But if you have a heart condition, it may mean that you could get more ill if you catch it, which is why it’s really important to protect yourself.’

You are considered to be at high risk of more severe complications of coronavirus if you have a heart condition.

You would fall into the extremely vulnerable category if:

• You have had a heart transplant
• You are pregnant and have significant heart diseases, such as coronary heart disease, hypertrophic cardiomyopathy, thickening of the heart muscle caused by high blood pressure, pulmonary arterial hypertension, a narrow or leaking heart valve, which is moderate to severe, heart failure that affects your left ventricular function or significant congenital heart disease.

People who fall into either of these categories should stay at home for 12-weeks, which is a strategy known as ‘shielding’. You should have already been contacted directly by your local GP clinic or doctor with further advice.

 

Are others with a heart condition still considered high risk?

You may still be particularly at high risk if:

• You have heart disease and are over age 70
• You have heart disease and lung disease or chronic kidney disease
• You live with angina that restricts your normal daily activities
• You have been treated for heart failure in the last year
• You have severe heart valve disease
• You have had open-heart surgery in the last three months

• You live with cardiomyopathy and the symptoms limit your daily life
• You have any type of congenital heart disease with lung disease, pulmonary hypertension, heart failure or pregnancy.

If you have coronary heart disease and have experienced a heart attack previously, have a stent, or have had bypass surgery at any time, you should also stay at home and consider yourself to be in the vulnerable group. This also applies to those with high blood pressure.

For those with Brugada syndrome or long QT syndrome who are experiencing symptoms of COIVD-19, you should call 111 and tell the operator about your heart condition and let your cardiologist know. You might need extra ECGs to monitor your heart.

In cases of atrial fibrillation, the BHF says: ‘there’s isn’t enough information at the moment to tell whether it or other abnormal heart rhythm problems put you at high risk from coronavirus. It seems likely if you have well-controlled atrial fibrillation, that your risk is lower than the groups mentioned above.’

For patients who live with a pacemaker, whether or not this raises your risk depends on the reason why the pacemaker was implanted. The BHF says: ’There is no evidence that the virus itself infects pacemakers or ICDs, or that it causes endocarditis.’