As the Covid-19 scourge spreads across the world, it is causing devastating consequences due to its direct and indirect effects on cardiac health. Initially, all indications pointed to critical lung failure due to pneumonia as the only way in which the virus affects the body.
In what could be extremely dire news for patients and medics, new information indicates that the virus’s effects are not only restricted to lung damage but could also damage the heart.
So far, the response to the novel coronavirus has centered on treating respiratory problems, which have been the primary cause of death. With data building up from countries with higher case numbers such as Italy, China, and the US, it has emerged that many Covid-19 patients are dying of cardiac arrest.
Covid’s Impact on the Heart
Preliminary studies show that up to 20% of patients are developing heart problems even without the primary respiratory issues. Among the earliest documented cases was a 64-year-old New York man in mid-March who arrived at the hospital with symptoms of myocarditis, which was later linked to the coronavirus.
Even in people with no underlying heart disease, evidence of heart damage has been found in a substantial number of coronavirus cases. When heart damage has accompanied respiratory issues, the risk of death is four times higher. Heart damage has been observed from previous coronaviruses such as MERS and SARS, giving further credence to this observation.
With this new information, it may necessitate a change in the way the healthcare sector responds to the pandemic, especially in the early stages. Along with the use of ventilators and other respiratory support, it could require doctors to check for heart damage and to respond accordingly in mitigating heart damage in patients.
Covid’s Thereupudic Impact on the Heart
Another concern relating to the comorbidity of coronavirus and cardiac disease arises from possible effects of quinolone derivatives hydroxychloroquine and chloroquine. The two drugs have been touted by various sources, including medics, journalists, and President Trump, as a promising treatment for severe cases of covid-19.
Limited studies, primarily in China, have shown that the drug, which is primarily used to treat malaria, reduces viral load in covid-19 patients. This has given hope to health care providers that a cure for the disease will soon be found.
A challenge, however, is that the two drugs are known to cause cardiac ECG QT prolongation and arrhythmias even when taken according to physician recommendations.
The QT interval in an ECG represents the time difference between the beginning of ventricular depolarization and repolarization. Normal QT intervals range between 400 and 440ms. A prolonged QT interval (over 450ms for men and 470ms for women) increases the risk of cardiac arrest, suggesting that the so-called “miracle” could exacerbate heart complications from Covid-19.
This is a new dimension of the possible therapy that doctors need to take into account if the two formulations are used as a medication for managing Covid-19.
EMS Response Protocols Changing for Cardiac Patients Due to Covid
Side effects of new medication and treatments are not the only way that the coronavirus is impacting cardiac arrest patients and response. With healthcare resources stretched to their limit, response practices for out-of-hospital cardiac arrests have been adjusted by emergency services.
In New York, the worst-hit US state by Covid-19, a new directive by the Regional Emergency Medical Services Council of New York, is advising EMT personnel to avoid bringing to the emergency room cardiac arrest patients who are not revived in the field, for fear of further spreading the virus.
Under normal protocols, EMTs drive patients to the hospital as they continue applying CPR and attempting defibrillation, but this will cease to happen on most calls until at least the coronavirus pandemic is brought under control.
For those in the cardiac arrest and resuscitation industry, limiting the transportation of cardiac patients to only those “revived in the field” is telling in another way.
The decision, while likely difficult for agencies to make, goes to show how EMS systems are forced to view cardiac arrest calls. That is, when 9 out of 10 patients die in cases of out-of-hospital cardiac arrest, it’s a logical way to limit patient transport in an attempt to slow the spread and reduce the burden on hospital systems.
If EMS arrived on scene to patients with higher rates of bystander CPR and increased lay-responder defibrillation – thus, more patients who had already been “revived” in the field – EMS systems may have looked for other methods of containment.
There you have it:
- The Covid virus is directly impacting the heart, leading to a higher likelihood of cardiac arrest for infected patients.
- Medication used to treat some patients who are diagnosed with Covid can have side-effects that increase the odds of experiencing cardiac arrest.
- Emergency response protocols in some of the country’s largest cities are evolving in their treatment of cardiac patients in the field. Protocols designed to limit the spread are also delaying advanced life support treatment options available in the hospital and catheterization labs.
Covid is brewing a perfect storm for the loss of life due to cardiac arrest; wave after wave of more patients left with fewer options.
If there ever were a time for an affordable, public access AED to help patients at home and in other out of hospital settings, it is now.