Heart disease and Covid: A toxic mix!

Sadly during the Covid-19 pandemic there has been a significant increase in deaths from heart disease. The British Heart Foundation have reported that during the first wave of the pandemic there were nearly an additional 5000 deaths from heart disease in England.

This increase in deaths is likely to have occurred for a number of reasons. Direct access to healthcare has been reduced due to the challenges posed by the emergence of a highly contagious, novel infectious disease. Individuals are also likely to have changed their behaviour and put off seeking health advice due to a fear of putting pressure on vital healthcare services. Moreover, the recognition amongst the general public and healthcare professionals alike, of the risk of contracting Covid-19 in a hospital setting, will also have reduced the number of patients seeking advice for potentially life-threatening conditions.

The SARS-Cov-2 virus that causes Covid-19 affects the cardiovascular system in a myriad of ways. The virus enters the body by binding with ACE2 receptors, which are found predominantly on the surface of lung tissue and within the heart and blood vessels. The uptake into the respiratory and cardiovascular system of the viral particles causes a widespread inflammatory effect both within the lungs, the large blood vessels, the small blood vessels, and within the heart muscle itself. Inflammation within the blood vessels can cause disruption of pre-existing fatty cholesterol plaques in the coronary arteries, thus destabilising the plaques and increasing their risk of rupture and a subsequent heart attack.

Furthermore, inflammation of the smaller blood vessels in the heart and Covid induced abnormalities of the body’s clotting mechanisms, can reduce flow rates down the coronary arteries, further increasing the risk of clots forming on the coronary plaques and the arteries suddenly blocking. In addition to these effects on the blood vessels and clotting systems, the heart muscle cells (cardiomyocytes) can become acutely inflamed by the virus and heart damage from myocarditis can result. In autopsy specimens of heart muscle following Covid-19 infection 40% have identifiable viral mRNA present and in patients who have recovered from Covid-19 infections abnormalities within the heart are identifiable in 78% of heart MRI scans.

Despite the challenges posed by the Covid-19 pandemic, Cardiologists and their teams have continued to deliver services, albeit with some unavoidable procedural changes and delays. Many hospital-based scanners and the cardiac catheterisation facilities used to detect and treat coronary disease, have only been able to run markedly reduced services due to the necessities of social distancing, surface cleaning, and air circulation times. This has resulted in many more ‘routine’ procedures being delayed and backlogs developing. Further problems have also occurred in our cardiothoracic surgical centres where whole surgical theatre teams have had to be temporarily withdrawn from front line service due to Covid-19 contact.

Regardless, due to the added risks Covid-19 poses to those with coronary artery disease, it remains more important than ever that patients with suspected coronary disease are assessed and treated in a timely and safe manner.

I hope that as the benefits of vaccinations among the general public and healthcare workers become apparent, this difficult period will pass and we can pick up where we left off, reducing the scourge of premature death that is caused by coronary disease.

Cardiology Factsheet.

• Coronary Heart Disease (CHD) is the leading global cause of death.
• CHD is the leading cause of premature death (<75 years old) in the UK.
• CHD kills twice as many women as breast cancer every year in the UK.
• There are 30,000 out of hospital cardiac arrests every year in the UK, only 1 person in 10 survives. Heart attacks are the commonest cause for cardiac arrest.
• In one out of two people their coronary disease first presents as either a cardiac arrest or a heart attack.
• Cardiac CTs can detect coronary disease years before it causes symptoms allowing for early life saving treatment.