Nair: A closer look at COVID-19 and heart failure
Heart failure (HF) can affect multiple other organs such as the kidneys, liver and brain. As the disease goes untreated for longer periods of time, there is poorer blood supply to these organs leading to multiorgan failure.
The total disease spectrum of COVID-19 infections in humans is not completely understood, but an immense amount of research is underway worldwide. The virus as we understand it primarily affects the lungs but can be detrimental to other organs such as the heart as well. Individuals with HF are more susceptible to a severe clinical course once infected with COVID-19.
HF is essentially due to heart muscle damage, which weakens the heart to a point that it can barely pump blood out to the body for circulation. Damage to the heart muscle is seen in 10% of patients infected with COVID-19 in general. In patients with a more serious course of infection 25% to 35 % have heart muscle damage and HF. In individuals who have concomitant heart disease, HF can be seen at higher rates.
Heart muscle injury occurs in all severe infections due to fever, faster heart rates, increased adrenaline as well as an exaggerated inflammatory response causing severe inflammation of the heart muscle and resulting in profound failure. In previously healthy people, the global death rate from COVID-19 is around 6.9%.
In patients with HF, the death rates climb above 10%. HF patients are exceptionally vulnerable to this disease because of decreased immunity, general frailty, and poor ability of the heart to cope with more blood pumping demand in severe infections.
At the onset of infections there is usually a release of proinflammatory biochemicals or cytokines which stimulate certain types of white blood cells to cause a severe inflammatory storm. Such inflammatory storms worsen the initial injury.
Under these conditions there is an increase in metabolic demand, which results in worsening heart function. In a previously healthy individual, this causes new-onset HF and in people with chronic HF it leads to worsening heart function. New onset HF occurs in as much as 25% of hospitalized COVID-19 patients and in about a third of the patients admitted to the intensive care unit (ICU).
Another factor that contributes to poorer heart function and death is the disarray of the clotting function of the body caused by sepsis resulting from severe function. Abnormal clotting function can cause dangerous clots in the lungs, heart and blood vessels resulting in strokes. Strokes have been noted in severe COVID infections.
Therefore, HF patients should be additionally cautious and prevent COVID infections because they can cause acute exacerbation of chronic HF. In addition to social distancing and other preventive measures, HF patients need to be compliant with diet/medications, exercise and a healthy lifestyle.
Dr. Nandini Nair is Medical Director for Advanced Heart Failure/ Mechanical Circulatory Support/Transplant Cardiology programs at UMC and Professor/Vice Chief (Clinical Advancement) in the Department of Medicine at Texas Tech University Health Sciences Center.