Clear spike in heart attack cases after Covid-19 outbreak, say doctors

“If my hospital was handling 50 heart attack patients a month before Covid-19, now it is seeing 60 patients every month,” says Dr Tiny Nair, head of department of cardiology, PRS Hospital in Thiruvananthapuram.

Speaking from personal experience, Dr Nair outlines that there has been a 10-20 per cent rise in heart attack cases after the pandemic. “During the first wave and the nationwide lockdown there was a dip in heart attacks. Now it is back — and is more prevalent than the pre-Covid-19 levels,” he says.

In recent times, several young celebrities, from politics to music to films, have succumbed to sudden heart attacks.

While large-scale studies are yet to capture the extent of rise in heart attacks across the world, doctors seem to agree that Covid does impact cardiac functions and increases the risks of a cardiac event — not just during or weeks after infection, but almost up to a year later.

An article published in the Nature in February quotes a study by Ziyad Al-Aly at Washington University in St Louis, Missouri, and the chief of research and development for the Veterans Affairs St Louis Health Care System.

The researchers based their study on an extensive health-record database by the United States Department of Veterans Affairs. They compared more than 150,000 veterans who survived for at least 30 days after contracting Covid with two groups of uninfected people — a group of more than 5 million people who used the BA medical system during the pandemic, and another group of a similar size that used the system in 2017.

The study showed that people who had recovered from Covid were 52 per cent more likely to have had a stroke than the control group, and their risk of heart failure increased by 72 per cent.

Indian doctors agree. Dr Ruchit Shah, interventional cardiologist, Masina Hospital, Mumbai, says, “There are studies which show sixfold increase in heart diseases and heart attacks in patients who have a prior history of Covid in the past year.”

Why is this so?
 

Dr Zakia Khan, senior consultant-interventional cardiology, Fortis Hospital, Kalyan, explains: “SARS-CoV-2 causes an inflammation of the arteries of the body which could be anywhere — brain, heart, lungs, bowels, etc. So, it can aggravate a pre-existing condition in these areas like blockages, clots, etc.” She says that doctors are witnessing young people having weakness of the heart muscles, while for the elderly it is usually a problem in the arteries. Covid also affects the nerves of the body, leading to irregular heartbeats.

Dr Nair highlights that the virus causing inflammation of the endothelium of blood vessels lasts much longer than earlier thought. “Moreover, the virus is also thrombogenic, which means it causes clots. This damage of the endothelium and the propensity to form blood clots lasts way longer than we thought — almost six months to a year after getting the disease,” he adds.

He suggests that if a D-Dimer test, which indicates the clotting tendency of the blood, shows higher than normal range a few months after Covid, then the patient is definitely at risk of getting a heart attack.

Those sleep-deprived and/or with multiple low-level risk factors (casual smoking, borderline cholesterol, impaired blood pressure or fasting glucose levels) are at a high risk of getting a sudden cardiac event after Covid-19.

Doctors mostly agree that such events can occur almost up to a year after recovery.

Dr Ashok Seth, chairman of Fortis Escorts Heart Institute, says, “Cardiovascular complications of Covid, including heart rhythm disturbances and heart attacks, can occur up to a year after recovery at an increased rate of 60-70 per cent and affect the young and old alike.”

He, however, highlights that increased heart attacks in the young is unlikely to be for Covid alone as it has been rising over the past 10-15 years and depends upon multiple risk factors.

Dr Seth says that during an acute phase of Covid, it has been recognised to increase clotting of blood that can lead to heart attacks, especially in the young, but these studies were before the vaccination drive began and the currently dominant strain of Omicron of the novel coronavirus.

Thus, there is now a need to do large-scale and long-term studies among recovered patients.

Dr Ajit Menon, consultant, cardiac sciences, Sir HN Reliance Foundation Hospital, feels that a global study is required to monitor patients over five years or more to assess the post-Covid complications.