Don’t neglect your heart after Covid

Scientists have long been aware that respiratory infections — such as influenza or certain types of coronaviruses — can trigger heart disease. This happens because respiratory infections cause inflammation, which plays a major role in aggravating cardiovascular conditions. Now, a new study reveals that Covid-19 infection appears to impact the risk of cardiovascular events up to 12 months post-infection, even among those who weren’t hospitalised or only suffered from a mild infection.

“Right now people think of cholesterol, blood pressure and diabetes as risk factors for heart disease, but we need to add Covid-19 to that list,” says Dr Debabratha Dash, Consultant Interventional Cardiology, Aster Hospital, Mankhool. “Different cardiovascular problems, including abnormal heart rhythms, heart muscle inflammation, blood clots, strokes, heart attack, and heart failure increased in the year after recovering from even mild Covid infection.”

Also, 85 per cent of those diagnosed with the disease were not hospitalised and that’s what adds to the public health problem. “Anyone who is experiencing a sudden onset of symptoms such as chest pain, intense muscle weakness, or shortness of breath, palpitation within 12 months of infection, should get a cardiovascular check-up,” says Dr Dash. “Early identification, diagnosis, and treatment of heart disease are essential to lessen the risk of adverse health impact.”

It’s no surprise that a pandemic of such historic impact has potential consequences on the cardiovascular health of millions who survived the infection worldwide, and the care pathway of these post-Covid patients includes vigilant attention to cardiovascular health. “People with diabetes, hypertension, obesity, lung issues, and cancer, as well as senior citizens, should be a little more careful,” advises Dr Srinivasan Ravindranath, Specialist Cardiologist, Aster Clinic, Al Muteena, Deira. “They should do a blood test like troponin T, NT-proBNP and D-Dimer, 2D Echocardiography, or cardiac MRI at an early phase. Besides, appropriate management is also advised, for instance starting blood thinner medication if there is elevated D-Dimer, for prevention of cardiovascular morbidity and mortality.”

Dr Ravindranath adds, “Preventive vaccines offer hope in reducing the severity of Covid-19 infection and its complications, including cardiovascular events, so healthcare providers should educate people and stress the importance of vaccination among patients.”

Doctors also believe that healthcare providers should evaluate all the common risk factors for heart disease, and treat and control them more aggressively among those diagnosed with Covid in the past. “The pre-existing medicines for cardiovascular or associated illnesses should be continued as per the guidelines,” says Dr Brajesh Mittal, Consultant Interventional Cardiologist, Head of Cardiology Department, Deputy Medical Director, Medcare Safa Hospital. “There should be a periodic evaluation of post-Covid patients. Any symptoms suggestive of heart-related conditions such as chest pain, shortness of breath, palpitations or easy fatigue, should prompt further testing.”

Covid-19 also primarily affects the lungs, explains Dr Sundar Kumar, Consultant Interventional Cardiologist, Prime Hospital, but cardiac involvement in the infection can be in the form of inflammation of the heart muscle, causing its weakness and irregular beats or due to involvement of the blood vessels causing blood clot formation and heart attack. “Some recent evidence shows that in a small number of patients there is evidence of myocardial inflammation even though they have had mild form of the Covid-19 disease,” says Dr Kumar. “Although a lot more needs to be learned about the long-lasting effect of Covid on the heart, a proper cardiac assessment post-covid recovery may be helpful to avoid future complications.”

Dr Wissam Al Sahli, Consultant — Interventional Cardiology, Burjeel Hospital, Abu Dhabi, recommends that healthcare providers encourage patients to do heart check-ups post-Covid to pick up any heart damage or inflammation in the heart or the blood vessels. “Patients experiencing chest pains or chest tightness must visit a cardiologist to find out whether there are any cardiac-related complications post-Covid,” says Dr Al Sahli. “There is a chance that more severe Covid infections can increase the risk for complications in the heart or blood vessels in the future. Everyone should get vaccinated and follow the government norms on vaccination. The UAE government has done a tremendous job of vaccinating the population. Getting vaccinated is very important, and that’s how we can prevent severe Covid-19 infections and related diseases.”

Why age doesn’t matter

In the last few years, several studies have reported a sudden rise of heart failure or heart disease in young adults. A heart attack in someone under the age of 40 was extremely uncommon. However, scientific evidence shows that the prevalence of heart attacks among younger people has been increasing over the last few decades.

“The change in lifestyle to unhealthy patterns has led to the increased prevalence of heart disease in younger populations,” says Dr Ehab Esheiba, Clinical Assistant Professor and Head of Division, Centre for Cardiac Sciences, Thumbay University Hospital. “These patterns may include a lack of regular exercise, unhealthy dietary habits, being overweight, and smoking.”

It’s important to note here that some genetic factors also play an important role in the occurrence of heart disease in younger generations. “This may include diabetes mellitus and abnormal lipid metabolism, which in turn can progress to heart disease in future,” says Dr Esheiba. “To combat this, regular check-up and evaluation can categorise each patient according to the family history and risk factors and, thereon, a management plan can start. When we see patients with their first presentation of heart disease, we commonly find other hidden problems in their bodies that had not been recognised earlier. Experts around the globe have confirmed that early diagnosis and proper treatment and control of such modifiable risk factors can significantly delay and protect the heart from severe complications.”

Lifestyle choices certainly make a huge impact on heart and health, as scientific evidence has shown. Tackling bad habits such as smoking, drinking, and tobacco consumption is critical for younger generations. “They need to be educated about the consequences of consumption at an early age, something that can also be achieved through mass education of the general population,” says Dr Ravindranath. “Doing regular exercise and eating healthy help curb diseases such as diabetes, hypertension and hyperlipidaemia, and prevent cardiovascular disease at a young age. Young people with family history of heart problems, those with early onset diabetes, hypertension, and hyperlipidaemia, and those joining competitive, strenuous sports activities need to get their heart check-up done, like basic 2D echocardiography and TMT at regular intervals.”

In the West, cardiovascular disease is still seen in people in their 50s, 60s and above. However, this is not prevalent among the expat population in the UAE mainly coming from Southeast Asian countries, including India, Pakistan, Bangladesh and Sri Lanka. “Southeast Asian populations carry a genetic background, which puts them at an inherent risk for cardiovascular disease at a younger age,” says Dr Naveed Ahmed, Consultant Interventional Cardiology, Aster Hospital, Mankhool. “It has been observed that most of the expat population eats junk food, which is easily available at lesser cost. Also, many of them are heavy smokers and have psychosocial stress factors regarding the job and other personal matters. They eat less of fruits and vegetables and have less physical activity — these factors increase the risk of heart disease at a younger age than in the West.”

People from the Indian subcontinent should do a complete lipid profile test and fasting blood glucose at least once in five years from the age of 20, and once a year after the age of 40, explains Dr Mittal. “If the reading is normal they need not worry, but if the reading shows some abnormalities, we follow a scoring system and look at it objectively to analyse the risk factors. If, after the age of 30, an individual shows tendencies of hypertension, high triglycerides, impaired fasting glucose and has a family history, we alert him or her in advance.”

While revealing that one in five heart attack patients are younger than 40 years of age, Dr Kumar says, myocardial infarction rate is increasing by 2 per cent every year in this young age group. “The same traditional risk factors for cardiovascular disease play major roles in this age group also such as diabetes, high blood pressure, smoking, family history of premature heart attack and high cholesterol. Additionally, substance abuse is a causative factor for young heart attack patients.”

The best way to prevent cardiac disease in young adults is by promoting a healthy lifestyle, maybe even in schools, so young adults and adolescents understand the risks involved early on. “Smoking and being overweight are the two factors that increase heart disease risk in young adults,” says Al Sahli. “Smoking can cause clotting in the blood supply and suddenly cause a heart attack, even if there are no other risk factors. Being overweight is a significant risk factor for heart disease among the youth in the Gulf Region. We also have a high rate of diabetes among the young population. It is essential to spread awareness in schools among children at an early age about the risks involved in leading an unhealthy lifestyle.”