Does COVID-19 cause heart injury?

• COVID-19 is associated with heart injury (also called myocardial or cardiac injury)
• There is a strong link between heart injury and a fatal outcome
• Patients with pre-existing cardiovascular disease appear to fare worse than others

Two studies investigating heart injury in COVID-19 patients tell a similar story

Heart injury, resulting in cardiac dysfunction and heart rhythm problems (arrhythmias), developed in 27.8% of 187 hospitalized COVID-19 patients in China, according to researchers who looked into their cases.

COVID-19 patients who showed signs of a heart injury fared far worse than those who did not have any signs. Heart injury was significantly associated with the patient dying. Patients with pre-existing cardiovascular disease (CVD) had a relatively favourable outcome if they did not show signs of heart injury, although patients with CVD were more likely to develop heart injury than those without the pre-existing condition. Only 7.62% of patients without pre-existing CVD and no signs of heart injury died, compared with 69.44% of those with underlying CVD and signs of heart disease.

A total of 66 of the 187 COVID-19 patients whose cases were reviewed had pre-existing CVD, including hypertension, coronary heart disease and cardiomyopathy. The researchers concluded that aggressive treatment should be considered for COVID-19 patients at high risk of heart injury, which they thought may potentially be caused by inflammation.

Another study in 416 hospitalized COVID-19 patients in China reported similar findings, with 19.7% of the patients developing heart injury, which was associated with a higher risk of death. Almost 60% of patients in the study had pre-existing hypertension. A total of 51.2% of the patients in the study with heart injury died, compared with only 4.5% of the patients who did not show signs of heart injury.

A greater proportion of patients with heart injury also required mechanical ventilation compared with those without heart injury. Complications such as acute respiratory distress syndrome (ARDS) and acute kidney injury, for example, were also more common in those patients with signs of heart injury. The researchers also suggest that the heart injury observed in COVID-19 patients may be caused by an intense inflammatory response.

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American College of Cardiology’s clinical bulletin provides guidance

The American College of Cardiology (ACC) has highlighted that based on the available data, patients with pre-existing CVD appear to be at an increased risk of developing COVID-19 and they are likely to have a worse prognosis. While overall 2.3% of patients who develop COVID-19 are expected to die, this figure is thought to be as high as 10.5% in patients with pre-existing CVD.

People with pre-existing CVD are encouraged to follow Centers for Disease Control and Prevention (CDC) guidance and take additional, reasonable steps to protect themselves during the COVID-19 pandemic, which has been caused by the new coronavirus (SARS-CoV-2).

CDC recommendations for those at higher risk of severe illness from COVID-19

The CDC recommends that people at higher risk of severe illness from COVID-19 should take extra care to:

• Stay at home
• Avoid close contact with others (stay 6 feet away from people who are sick)

The CDC also recommends that everyone:

• Wash your hands often
• Clean and disinfect surfaces that are touched frequently
• Avoid cruise and non-essential air travel
• Call their health care provider if they have concerns about COVID-19 and their pre-existing condition or they are sick

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