Patients With Heart Disease Are More Difficult To Tolerate COVID-19 - Observations Of Western Doctors

Patients with heart disease are more difficult to tolerate COVID-19 - observations of Western doctors

Coronavirus infection can also cause heart complications in people who have never had high blood pressure or other heart conditions.

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It is known that most often severe complications from COVID-19 occur in patients with a history of chronic health problems. As noted by Dr. David Gaze, Emeritus Cardiology Research Fellow at the University of Westminster, about 10% of COVID-19 patients suffer from heart disease, diabetes and hypertension. Moreover, diseases such as asthma or chronic obstructive pulmonary disease (COPD) account for only 6% in the statistics of severe complications. These data are similar in their characteristics in patient reports from China, Italy, the UK and the USA.

However, in all severe cases, the coronavirus provokes an inflammatory reaction called myocarditis. The virus infects heart cells, causing severe inflammation in muscle tissue. This weakens the heart's ability to pump blood and supply oxygen to all organs.

Similar observations were voiced by scientists from the Icahn School of Medicine at Mount Sinai Health System hospitals in New York City. In a study published on the medRxiv preprint website, doctors reported that elevated levels of troponin, a regulatory protein involved in muscle contraction, were observed in about 40% of 2,736 patients at a Mount Sinai hospital.

Fewer than 20% of hospitalized COVID-19 patients had troponin greater than 0.09 ng / mL, but even those with these rates had a significantly higher risk of mortality compared to those with troponin within the reference range. Only 2% of patients had a troponin level of 2 ng / ml, indicating severe complications. In their findings, the researchers focused on the need to use troponin as a risk marker that will help clinicians reduce myocardial damage.

According to David Gaze, scientists have not yet figured out why the coronavirus affects the heart, but there may be several reasons for this. First of all, damage to the heart can be associated with the penetration of the virus into cells. A spike-shaped protein on the surface of the virus binds to a receptor on the cell surface called ACE2. Patients with heart disease have more ACE2 receptors on the surface of the cell, which can cause more viral particles to enter the cell, causing significantly more inflammation than people with healthy hearts.

It is also possible that damage to the heart causes the body to respond to the pathogen. The immune system fights the virus, and this requires a significant expenditure of energy with an increase in metabolic rate. In a relatively healthy person, the immune system is able to adequately respond to infection and produce antibodies to fight the virus. But the body of a person with a weak immune system - for example, the elderly or with chronic diseases - cannot sufficiently strengthen the immune response and fight the virus. As a result, the infection rages in the body and affects vital organs, especially the lungs and heart. Also, like his American colleagues, David Haze proposes to control this process using troponin analysis.

The expert recalled that during the pandemic of influenza caused by the H1N1 virus (swine flu) in 2009, infected patients had a greater number of cardiovascular complications than with typical seasonal infections, while fulminant myocarditis was recorded in 62% of cases.

“Many viral viruses hit the body hard, which the heart cannot handle, so more people die from heart disease than from lung disease. In this sense, COVID-19 is similar to other respiratory pandemics,”writes Haze.