Post-COVID cardiac care is important, says health expert

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New Delhi: Heart specialists and cardiologists have sounded the alarm on the COVID-19 virus affecting the heart and its processes, causing many fatalities.

Ravindra Singh Rao, Specialist, Structural Heart Disease, Jaipur who is an expert in the Shock Wave Lithotripsy Angioplasty Technique, shares insights on heart problems commonly seen in COVID-19 patients, non-COVID cardiac care and post-COVID recovery.

Q: It is common to see heart problems amid COVID-positive patients, with young people getting affected as well. What have been your experiences with the virus affecting the people's hearts?

A: Heart problems are seen in COVID-19 infection. It can vary from sudden cardiac death to minor problems in heart rate. Sudden cardiac death can be due to heart attack. There can be clot formation in heart blood vessels. Clots can also be formed in lung blood vessels causing pulmonary embolism. Virus can also affect heart muscles causing cardiomyopathy and heart failure. A common problem post COVID-19 is variation in heart rate. Slow heart recovers in the majority of patients spontaneously in a few weeks. No active treatment is required. SARS-CoV-2 is the virus that causes COVID-19, and studies have shown that many viruses can cause arrhythmia and even heart attacks. COVID-19 causes a severe inflammatory response in the body, and inflammation is the biggest cause of heart attacks. Myocarditis, or inflammation of the heart muscle, usually only occurs in people who have severe illness from COVID-19, and can be caused by the virus entering the heart. Recent studies have suggested that a milder form of heart muscle inflammation may be more common than previously thought.

Q: What is causing heart-related fatalities in such patients?

A: Heart-related patients are seen due to heart attacks (myocardial infarction). COVID creates a millen for thrombus formation. COVID-19 patients who suffer a cardiac arrest either in or out of hospital are far more likely to die than patients who are not infected with the coronavirus. In particular, women have the highest risk of dying: they are nine times more likely to die after suffering a cardiac arrest in hospital.

Q: Doctors have sounded an alarm on how changing lifestyle will increase the burden of heart disease in India. What are your thoughts on this, as a doctor?

A: Heart disease and high blood pressure (hypertension) put you at greater risk with COVID infection. Around 28.4 million elective surgeries worldwide were cancelled or postponed in 2020, which is a huge burden on healthcare and also makes the patients more vulnerable for bad outcomes. Coronary heart disease prevalence rates in India have been estimated over the past several decades and have ranged from 1.6 to 7.4 per cent in rural populations and from 1 to 13.2 per cent in urban populations. Physical inactivity, stress about health or future and other factors are increasing the risk of heart diseases.

Patients must continue their medications. With confusing news about common blood pressure medications and their connection to COVID-19 risk, you may be tempted to stop taking them. But the pendulum is swinging toward there being no cause for concern. In fact, a New England Journal of Medicine study concluded there was no link between blood pressure meds and COVID-19 risk.

If there is a non-essential medication or a good alternative ask your doctor, he may well change it, but if it is an essential medication it is suggested that it should be continued as there isn't any concrete evidence to stop them at the moment.

Q: How can a recovered COVID patient take care of their heart at home? What are some care tips?

A: Post-COVID cardiac care is important. Cardiac patients should continue their medicines timely. Aerobic activity is encouraged. Blood thinners should be continued. Sometimes patients with elevated d-dimer need anti-coagulants for a few weeks as per consultation. What is important is: 45 minutes daily exercise, a balanced diet, and a positive mindset to keep their heart healthy.

Choose heart-healthy foods and snacks (plant-based and unprocessed foods are good choices). Maintain a normal body weight: Having obesity increases your chance of serious illness from COVID-19. Exercise daily. Stay hydrated by drinking plenty of water; Get enough sleep by aiming for seven to eight hours of shut-eye a night. Don't smoke or overindulge with food or alcohol. Follow your care plan, stay up-to-date with vaccines and call if you have questions or concerns; use telehealth options if new symptoms or concerns arise. Ensure you have at least one month of prescribed medication at home.

Finally, maintain social distancing, but don't socially isolate yourself. Stay connected with family and friends.

Q: Five final tips for people who gained a few extra kilos in this altered lifestyle?

A: If you are on a keto diet and because of limited supply of food material and also lack of domestic hired help, you are not able to do a keto it is fine and you can plan a low-carb diet. When things normalise you resume your earlier diet.

Intermittent fasting is a very good idea. You can skip either a breakfast or a dinner start within the duration of 12 hours gradually increasing to 18 hours of dieting for at least five days a week.

Try not to snack in between the meals.

Keep exercising and working out -- dancing, rope skipping, yoga aerobics and exercising. Use apps.

Calories is what matters the most, less calories, less weight. Make a menu on what you have ahead for a week so that you don't end up in out of the stock situation and land up in a high calorific diet.

Q: What are your experiences with non-COVID cardiac care?

A: Non-COVID cardiac care can't be put on hold. Cardiac emergencies don't come with an appointment. We need to designate an area in the hospital which is segregated in terms of ventilation, patient movement, staff movement. The cardiac emergencies are handled and attended to on time. The advantage in the second wave is that all healthcare workers are vaccinated and ready to race the 'enemy virus'. We have to focus on COVID-free cardiac care.

Recently one patient in Kolhapur, his coronary artery had calcified blockages that were likely to cause the artery to rupture or block the stent back if normal stenting was done. But the intravascular shock wave lithotripsy (IVL) technique not only broke their calcified blockages, but also saved his lives with safe stenting. The patient felt breathless when walking a little. When the investigation at the local centre revealed their calcified blockage, IVL was the effective option for its treatment. For this, when he reached Jaipur, providing him with COVID-free cardiac care was a big challenge. But better medical management enabled successful angioplasty of the patient. During the procedure, the OCT check fixed the stenting position inside the artery and fixed their blockage. This case is showing that patients should not hold their procedure in a pandemic.

Shock Wave Lithotripsy Angioplasty Technique has come now as an option to treat calcified blockage patients. It is now possible to insert stents through intervention by doing Angioplasty. This will be helpful for those patients who do not have the capacity to bear bypass surgery. Until now, it was difficult to perform stenting from interventions in arteries with calcified blockages as there is a 30-50 percent risk of re-closure or rupture of arteries after stenting. Shock wave lithotripsy is a sonographic technique. In this technique, calcium is broken through a sonographic wave and a stent is inserted. This causes no damage to the artery and fine particles of calcium become part of the artery. Angioplasty with this technique takes 45 minutes to an hour and the chances of recurrence of blockage remains about five to seven per cent only.