The frequency of cardiovascular complications in patients suffering from COVID-19

Authors

  • Muhammad Zahid Ali Raza Nawaz Sharif Medical College, Gujrat
  • Irfan Younus Bhatti Rajput Nawaz Sharif Medical College, Gujrat
  • Kashif Zafar Punjab Institute of Cardiology, Lahore
  • Faiza Altaf Hawa Memorial Hospital, Wazirabad
  • Sobia Aziz Nawaz Sharif Medical College, Gujrat

DOI:

https://doi.org/10.55958/jcvd.v18i2.91

Keywords:

COVID-19, cardiovascular complications, acute myocardial injury, myocarditis, arrhythmias

Abstract

Background: Pandemic caused by Corona virus infection has damaged the population throughout the universe. Cases of COVID-19 increased rapidly in whole world. COVID-19 has been associated with a number of cardiovascular co-morbidities including hypertension, ischemic heart disease, diabetes mellitus, dyslipidemia, atrial fibrillation and cardiac failure.

Aims and objective: To determine the frequency of cardiovascular complications in patients with COVID-19.

Material and methods: This observational cohort study was conducted in corona ward of DHQ Hospital, Gujrat from 1st January to 31st June 2021. Total 216 patients between 18-70 years of age, admitted who had COVID-19 confirmed by PCR after taking informed consent; patients already suffering from any cardiovascular, respiratory or other life threatening illness were excluded while hypertensive, diabetics and smoker were included in the study. Duration of admission was according to the severity of illness. Detailed history was taken from all patients followed by relevant examination. Investigations like ECG, echocardiographically and troponins were done to diagnose cardiovascular complications. All the patients were treated conservatively. Frequency of cardiovascular complications was noted. The patients who had clinical relief of symptoms, fever free, normal X-Ray chest and at least two consecutive negative PCR results for covid-19 were discharged. p value <0.05 was considered as significant.

Results:  Out of two hundred sixteen patients, 30(14%) patients were diabetics and 21(10%) were hypertensive. Myocardial injury in 12% (myocarditis 4%, myocardial infarction 1%, raised troponins without myocarditis and ECG changes in 7% thromboembolism 1%, right ventricle dysfunction 5%, arrhythmias in 9%. Most of the patients had mild symptoms and recovered by conservative management. About 4-5% patients required invasive ventilatory support. Age, gender, diabetes, hypertension and previous cardiovascular co-morbidities increase the frequency of cardiovascular complications. Overall mortality was around 2%. p value was calculated as significant < 0.05.

Conclusion: COVID-19 is known for cardiovascular complications in which acute myocardial injury, myocarditis, arrhythmias, thromboembolism, right ventricle dysfunction are common. These complications are more common in those having cardiovascular disease (CVD) or other co-morbidities

Author Biographies

Muhammad Zahid Ali Raza, Nawaz Sharif Medical College, Gujrat

Assistant Professor of Cardiology

Irfan Younus Bhatti Rajput, Nawaz Sharif Medical College, Gujrat

Assistant Professor of Gastroenterology

Kashif Zafar, Punjab Institute of Cardiology, Lahore

Assistant Professor of Cardiology, Lahore

Faiza Altaf, Hawa Memorial Hospital, Wazirabad

Woman Medical Officer

Sobia Aziz, Nawaz Sharif Medical College, Gujrat

Woman Medical Officer

References

Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. J Med Virol. 2020;92(4):401-402. doi:10.1002/jmv.25678

Hui DS, I Azhar E, Madani TA, et al. The continuing 2019-nCoV epidemic threat of novel

coronaviruses to global health: the latest 2019 novel coronavirus outbreak in Wuhan, China. Int J

InfectDis.2020;91:264-266. doi:10.1016/j.ijid. 2020.01.009

Paules CI, Marston HD, Fauci AS. Coronavirus infections: more than just the common cold. JAMA. Published online January 23, 2020. doi:10.1001/jama. 2020.0757

Wuhan Municipal Health Commission. Report of clustering pneumonia of unknown etiology in Wuhan City. Published December 31, 2019. Accessed January 31, 2020. http://wjw.wuhan.gov.cn/front/web/showDetail/2019123108989

Iaccarino G, Grassi G, Borghi C, Ferri C, Salvetti M, Volpe M. Age and Multimorbidity Predict Death Among COVID-19 Patients: Results of the SARS-RAS Study of the Italian Society of Hypertension. Hypertension. 2020;76:366-372.

Richardson S, Hirsch JS, Narasimhan M, Crawford MJ, McGinn T, Davidson KW. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323:2052-2059.

Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time.Lancet Infect Dis. 2020; 20:533–534. doi: 10.1016/S1473-3099(20)30120-1

Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging. (Albany NY) 2020;12:6049-6057.

Lang JP, Wang X, Moura FA, Siddiqi HK, Morrow DA, Bohula EA. A current review of COVID-19 for the cardiovascular specialist. Am Heart J. 2020;226:29-44.

Hendren NS, Drazner MH, Bozkurt B, Cooper LT Jr. Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome. Circulation. 2020;141:1903-1914.

Fried JA, Ramasubbu K, Bhatt R, Topkara VK, Clerkin KJ, Horn E, et al. The Variety of Cardiovascular Presentations of COVID-19. Circulation. 2020;141:1930-1936.

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5

Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. Published February 7, 2020. doi:10.1001/jama.2020.158

Tao Guo, MD; Yongzhen Fan, MD; Ming Chen, MD et al Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol Published online March 27, 2020 AMA Cardiol. doi:10.1001/jamacardio.2020.1017

Edwards S, Small JD, Geratz JD, Alexander LK, Baric RS. An experimental model for myocarditis and congestive heart failure after rabbit coronavirus infection. J Infect Dis. 1992;165(1):134-40. doi:10.1093/infdis/165.1.134.

Inciardi RM, Lupi L, Zaccone G, et al. Cardiac involvement 1 with coronavirus 2019 (COVID-19) infection.JAMA Cardiol. 2020. doi:10.1001/ jamacardio.2020.1096 67.

Hu H, Ma F, Wei X, Fang Y. Coronavirus fulminant myocarditis saved with glucocorticoid and human immunoglobulin. Eur Heart J. 2020: ehaa190. doi:10.1093/eurheartj/ehaa190

Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol.

;5:802-810.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323:1061-1069.

Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers. 13 March 2020. https://www.escardio.org/

Fabre A, Sheppard MN. Sudden adult death syndrome and other non ischaemic causes of sudden cardiac death. Heart. 2006 Mar;92(3):316-320. Epub 2005 May 27.

Peiris JS, Chu CM, Cheng VC, et al; HKU/UCH SARS Study Group. Clinical progression and viral load in a community outbreak of corona virus associated SARS pneumonia: a rospective study. Lancet. 2003;361(9371):1767-1772. doi:10.1016/ S0140-6736(03)13412-5 27

Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, Wang H, Wan J, Wang XLu. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19) [published online March 27, 2020]. JAMA Cardiol. 2020. doi: 10.1001/jamacardio.2020.1017

Deng Q, Hu B, Zhang Y, Wang H, Zhou X, Hu W, et al. Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China. Int J Cardiol. 2020;311:116-121.

Shi Z, Fu W. Diagnosis and treatment recommendation for novel coronavirus pneumonia related isolated distal deep vein thrombosis. Shanghai Medical Journal, 2020. Available: http://kns.cnki.net/kcms/detail/31.1366.R.20200225.1444.004.h

Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, Kucher N, Studt J-D, Sacco C, Alexia B. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy.Thrombosis Res. 2020; 191:9–14.

Edwards S, Small JD, Geratz JD, Alexander LK, Baric RS. An experimental model for myocarditis and congestive heart failure after rabbit coronavirus infection. J Infect Dis. 1992;165(1):134-40.doi:10.1093/infdis/165.1.134.

Published

2022-09-30

Issue

Section

Articles