Watch: Covid-19 can cause multiple heart complications, cardiologist says

Tista' taqra bil- Malti.

The novel coronavirus can cause multiple heart complications, Dr Andrew Cassar Maempel, a consultant cardiologist at Mater Dei Hospital and a visiting lecturer at the University of Malta, told Newsbook.com.mt in an interview held earlier this week.

The interview comes after a recent study showed that novel coronavirus infections leave an impact on the heart and has raised concerns about lasting damages.

Speaking to Newsbook.com.mt, Dr Cassar Maempel explained that the severe acute respiratory syndrome coronavirus-2 or Covid-19 is a respiratory virus which causes symptoms typically associated with a respiratory infection. These include coughing, fever, shortness of breath and a sore throat. The virus is also transmitted through the respiratory system, he explained.

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However, he noted, that through the experiences recorded over the past few month, it was found that it also attacks any organ of the body.

“It has been found in the heart, kidneys, lungs, liver, brain and also in the digestive tract,” Dr Cassar Maempel noted, adding that it could present itself in multiple different ways. This depends on which organ it attacks the most and the symptoms which subsequently develop as a result.

Cardiac problems

Asked whether the novel coronavirus affects the heart, Dr Cassar Maempel explained in detail its impact.

‘The coronavirus can cause heart problems in multiple different ways. It can cause direct injury to the heart muscle causing an inflammation of the heart or myocarditis. Covid-19 can also attack the endothelium which is the lining of the heart and cause a heart attack known as myocardial infarction. Other ways it can affect the heart include a stress type of heart attack – stress cardiomyopathy – just because of the stress caused by coronavirus one could get a heart attack. The coronavirus can also cause the heart to become weak such as heart failure as well as it can cause abnormal rhythms of the heart such as palpitations or chest pain which is due to the abnormal rhythms of the heart,” he explained.

A temporary or permanent inflammation?

It is not clear whether the inflammation caused to the heart is a temporary or permanent condition, since the virus has only been around for some nine months, he pointed out.

Dr Cassar Maempel explained that longitudinal studies were required to understand better its impact. By following patients who contracted the virus now, medical practitioners can study the patients along the years to assess the impact.

Speaking about myocarditis caused by coronavirus, Dr Cassar Maempel noted that at present it is not known whether the damage is going to be short-lived or whether the patient would experience continued inflammation over months or even years.

“We don’t know if the damage is going to be short-lived and without any trace of it, or whether there is going to be some damage or whether there is going to be continued inflammation over many months or years. The only way to know this is by studying the patients which have contracted the virus now. We can only answer that question in the future,” he explained.

Specific treatment for the myocarditis of the heart does not exist. Dr Cassar Maempel explained that in this case, doctors apply what is called ‘conservative treatment’ and would support the patient’s heart according to the need.

Covid-19 and blood clots

Dr Cassar Maempel was also asked about the link between coronavirus and the formation of blood clots.

The cardiologist explained that it has been observed that Covid-19 increases blood clots in three ways. A blood clot can form after the coronavirus causes damage to the lining of the blood vessels. Secondly, the coronavirus can cause blood to clot after it causes an inflammation through the whole body with increased blood products which can cause clotting of the blood. A third way in which Covid-19 can cause clotting is when a patient is in intensive care due to coronavirus and is not moving.

‘When you are not moving, you automatically have an increased risk of clots,’ he remarked.

Explaining the difference between clotting in the veins and that in the arteries, Dr Cassar Maempel said that a blood clot in the veins would form in the legs. Blood clots in the veins can break loose, travel through the bloodstream and lodge in the lungs, blocking blood flow. This is known as pulmonary embolism.

On the other hand, clotting in the arteries can happen in the heart causing a heart attack.

78% of ‘recovered’ patients had evidence of ongoing heart involvement – study

Commenting about Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19), a scientific study which was at the end of July in JAMA Cardiology – monthly peer-reviewed medical journal covering cardiology, Dr Cassar Maempel noted that out of the 100 patients who participated in the study some of them were asymptomatic.

The study examined the cardiac MRIs of 100 people who had recovered from Covid-19 and compared them to heart images from 100 people who were similar but not infected with the virus.Their average age was 49 and two-thirds of the patients had recovered at home.

Commenting about the results, Dr Cassar Maempel noted that four out of five patients in the study had some involvement of the heart. Of these patients, 32% not only had a bit of inflammation but also had a scar. In 20% of the patients the scar was a result of the myocarditis inflammation.

‘This is telling us that four out of five patients who contract coronavirus will have some heart involvement. We don’t know at this stage whether they will develop symptoms or not,’ he remarked.

“It is a very important study which worries us about what we are going to see in the future in these patients if they develop long-term symptoms,” Dr Cassar Maempel remarked.

Asked whether such tests are being carried out on patients who contract coronavirus, Dr Cassar Maempel explained that asymptomatic are recovering at home and would not get such scans. Patients who are admitted to hospital because symptoms are more severe would get different tests done. Such patients would get an ECG and a troponin blood test. According to the results and to the patient’s condition, they will be examined further.

MRI scans are not being used routinely but used in some specific cases.

Fear of contracting Covid-19 keeping 50% of heart attack patients away from hospitals

Dr Cassar Maempel noted that various studies carried out in the US, Italy and Spain have shown that during the first wave of coronavirus, the patients presenting themselves with an acute heart attack were about 50% less. It was also shown that cardiac deaths outside hospital were increased.

The cardiologist said that this was one of the collateral damage caused by the pandemic when fear of catching the coronavirus meant that people who were experiencing a life-threatening heart attack were too afraid to go to hospital for life-saving treatment.

A similar trend was observed in the data obtained for the period when Malta was in a partial lock down.

Speaking about a personal experience, Dr Cassar Maempel said that one of his patients spent two days at home having a heart attack before seeking medical help.

In his final message to the general public, Dr Cassar Maempel urged individuals who experience symptoms associated with a heart attack to seek help. He added that the hospital is a very safe place to be, noting that doctors and health care workers are routinely tested for coronavirus. He stressed that every patient is screened for coronavirus upon arriving in hospital while patients who test positive for coronavirus are kept segregated from other patients.

Filming and editing: Miguela Xuereb

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