Patients who have recently recovered from Covid-19 have been found to have abnormal hearts, while those who died from the disease were found to have cardiac infections.

This is according to two studies done in Germany and published at the start of this week.

In the first study, 60 patients were found to have an inflammation of the heart muscle, which was “independent of pre-existing conditions, severity and overall course of the acute illness and time from the original diagnosis”.

Another 78 were found to have cardiac involvement, which consists of inflammation of the heart muscle, as well as inflammation on the tissue sac surrounding the heart. This causes irregular heartbeats, medically known as diastolic dysfunction.

CARDIAC INFECTION

A second study, which involved an autopsy on 39 patients who had died of Covid-19, states that “cardiac infection with Sars-CoV-2 was found to be frequent”.

The researchers found that out of the 24 corpses with heart infections, 16 cadavers that had high viral loads had six genes that promoted inflammation.

“While a response to this infection could be reported in cases with higher virus load versus no virus infection, this was not associated with an influx of inflammatory cells,” the study report states.

The study is not exclusive to Germany, said Dr Dan Gikonyo, Chief Cardiologist at The Karen Hospital. In Kenya, for example, heart or cardiovascular complications have been cited as leading co-morbidities in people testing positive for Covid-19.

 “Covid-19 causes exaggerated inflammatory response and may damage blood vessels in the heart, lungs, kidney and even in the brain,” Dr Gikonyo said.

BLOOD CLOTTING

Covid-19 has been known to cause clotting of blood (thrombosis) even in the heart, he said.

“We have come across this in a couple of patients,” he said, adding that the virus attaches itself on particular cell components in the body, including the heart, and it could explain the infections found in hearts of cadavers in the German study.

Another study published by the Pan African Medical Journal shows that Covid-19 is likely to increase the burden of atherosclerotic cardiovascular disease in Kenya.

  • Atherosclerosis occurs when fats, cholesterol and other substances accumulate in and on artery walls and can restrict blood flow. According to the study, Covid-19 and cardiovascular disease share some pathological features and risk factors.

These include angiotensin-converting enzyme 2 (ACE2) receptor invasion and renin-angiotensin system signalling, oxidative stress (imbalance between the production of free atoms and the ability of the body to counteract or detoxify their harmful effect), systemic inflammation and endothelial dysfunction.

COMMON RISK FACTORS

The University of Nairobi study states that the common risk factors for atherosclerotic cardiovascular disease and Covid-19, which comprise of hypertension, diabetes mellitus, obesity, cigarette smoking, respiratory tract infections, pulmonary thromboembolism, chronic obstructive pulmonary disease, and renal disease “imply that Covid-19 may increase the burden of atherosclerotic disease in Kenya”.

Covid-19 also causes inflammation of other body parts including the lungs. The Kenya Society of Thrombosis and Haemostasis states that “there is a major inflammatory response which can lead to micro-clots, or immunothrombosis, within the lungs”.

This has likely contributed to the high mortality in patients with Covid-19 pneumonia, the society explains.

According to Dr Gikonyo, Covid-19 patients with such heart conditions are being treated with blood thinners like aspirin and warfarin to stop the clotting. However, some countries have difficulties in accessing blood thinners, says the KSTH.

“Mortality is less in patients who received some form of anticoagulation than those who did not,” said KSTH, while urging the investigation of cases of hypertension, coronary heart disease, previous thrombosis, deep-vein thrombosis, stroke, diabetes mellitus and endocrinopathies.