Patients with COVID 19 typically present with symptoms and signs of lung infection but the cardiovascular manifestations are common too. While some patients show no symptoms of heart disease but have cardiac test abnormalities, others may come with chest pain, palpitations, blackouts or even sudden cardiac arrest.
SPECTRUM OF CLINICAL PRESENTATIONS:
Asymptomatic heart disease: only abnormal cardiac tests. No symptoms
Myocardial Injury: a) Myocarditis b) Stress Cardiomyopathy c) Myocardial Infarction
Patients would usually present with central chest pain or breathlessness. The management guidelines are the same as for those without covid disease.
Heart failure: Patients present with breathlessness not explained by the lung injury. It may be precipitated by acute illness in a patient with pre-existing known or undiagnosed heart disease, or an acute myocardial injury. Patients with a known history of heart failure may suffer from an acute episode due to development of covid disease.
Dysrhythmias: Patients commonly comes with palpitations. High incidence of sinus tachycardia, sinus bradycardia. Some patients have had atrial fibrillation or worse, ventricular fibrillation. It has been seen mostly in association with the medications.
Venous thromboembolism: mostly seen in patients who have had severe form of the disease and those with certain risk factors like age, other comorbidities. It is also seen in association with the COVID
MEDICATION INTERACTIONS: The newly studied medications for management of COVID 19, have been found to interact extensively with other drugs (mostly cardiovascular). Most commonly seen are electrolyte abnormalities, QTc prolongation, and cardiotoxicity. Most common drugs known for cardiovascular adverse events are remdesivir, lopinavir-ritonavir, HCQs
VACCINE ASSOCIATED CARDIOVASCULAR COMPLICATIONS:
Vaccine-induced immune thrombotic thrombocytopenia: seen with the AstraZeneca and J & J vaccine (recombinant adenoviral vector encoding spike protein antigen of SARS-CoV-2).
Myocarditis: rare reports seen with the mRNA vaccine (Moderna). Among those reported, the cases were mostly mild with onset within 1st
Whether cardiac injury, as a consequence of COVID 19 infection, results in permanent cardiac damage in the survivors, remains to be determined.