Long COVID may stroke you out

CHENNAI: If your heart skips a beat, it’s more than likely you’re having a heart attack even if you’re young, and especially if you’ve survived long COVID-19.

While there is a study underway to find out if there is a link between the rise in the number of heart attacks and the virus, experts say that the long COVID symptoms indicate heart-related complications.

With incidents of heart attacks becoming common, even among youngsters, the increase in fatalities and common occurrence can be attributed to the infection.

Omicron connect

A research article published in Journal of Medical Virology led by Yee Hui Yeo titled ‘Excess risk for acute myocardial infarction mortality during the COVID-19 pandemic’, stated that acute myocardial infarction (AMI)-associated mortality during the pandemic rose significantly among young adults via the Omicron outbreak.

The research data showed that the increase of heart attacks was most significant among individuals ages 25-44.

The Indian Council for Medical Research (ICMR) is working on a study to understand the post COVID-19 impact on an individual’s health. cardiologist of the study, Dr Guruprasad Sogunuru, senior interventional cardiologist and electrophysiologist, Fortis Hospitals, explains the 3 stages: initial phase of infection, manifestations and finally, complications.

“Viral pro drone phase is the first phase when the infection commences. Next is the Viraemia stage when the virus spreads in the body. And the last is the intense inflammatory stage when the body’s immune system is unable to kill the virus, and infects the organs,” he says.

It’s at this stage that cytokines are released into the body. Cytokines are small proteins that are crucial in controlling the growth and activity of other immune system cells and blood cells. When released, they signal the immune system to do its job.

It can cause a cytokine storm – a severe immune reaction in which the body releases too many cytokines into the blood too quickly. It’s a descriptive term to encompass a variety of events that may ultimately result in multi-organ failure and death.

“The cytokine storm can mainly impact lungs and heart and cause severe damage. At this stage, many people succumb to the infection,” adds Dr Sogunuru.

The study is looking at how COVID-19 impact stays post recovery. The scarring cannot be immediately cured. The heart can become weak, clots can be formed and there are other complications. And this can lead to increase in heart attacks.

“Myocarditis, heart failure and arrhythmias (abnormal heart beating), thromboembolism (formation of blood clots) and increased risk of heart attacks are some of the common complications,” says Dr Sogunuru.

Long COVID impact

The risk of heart attacks is related to viral respiratory infections and any form of influenza plays a significant role in exacerbating it. Medical research states that influenza increases the risk of heart attack by 8-10 times but there’s no specific data to quantify how COVID is related to heart attack and heart failure.

“However, it’s established that COVID plays a role in the increasing risk of heart attack. Last year, we saw a high number of influenza cases as well, so it can also be a contributing factor,” clarifies Dr Subramanian Swaminathan, director-infectious diseases, Gleneagles Global Health City.

There are problems up to 6-12 months post COVID and even this varies with every person. Long COVID outcomes also include heart-related complications such as rhythm problems, heart attacks and heart failure.

“Long COVID is not related to severity of the infection. Even people with mild symptoms can have long COVID disorders,” describes Dr Subramanian. “The younger population lead a largely sedentary lifestyle. Their dietary changes must also be factored in. These play a significant role in risk of heart attack and other non-communicable diseases.”

Climate change

According to several research findings, the risk of a heart attack during the winter is twice as high. Fortunately, this can be avoided by making a few lifestyle modifications, say doctors.

“One of the main problems that many of us get fever from the flu which is more common in winter. For those with heart disease, it can be dangerous,” Dr Guruprasad explains. “The increased oxygen demand caused by fever causes your heart to beat faster. BP may drop due to dehydration, which again limits the amount of oxygen delivered to the heart. Blood vessel constriction could decrease the amount of oxygen-rich blood flowing to the heart, increasing the risk of a heart attack, particularly for those whose cardiac health is subpar.”

By default, the body adjusts the internal temperature in response to changes in the outside temperature. The body’s sympathetic nervous system will be activated by the drop in temperature, causing vasoconstriction, or constriction of blood vessels. This, in turn, raises BP, pulse rate, and cholesterol levels.

“When the temperature rises, cholesterol level may suddenly break down to produce a blood clot that causes a heart attack. People with heart conditions, high BP, excessive alcohol use, and smoking will make the condition worse during the winter,” he adds.

Doctors say that while long COVID can be a reason for heart attacks, there’s usually a rise in heart-related ailments from September to February, mainly due to a drop in the temperature.

“There are heart attack cases when there is only a blood clot and not a heart blockage especially within the 25-35-year age group. The risk is higher in people who drink alcohol, smoking, and daily consumption of outside food post COVID,” says Dr Anbuselvan, senior cardiologist at Prashanth Hospitals.

Generally, COVID-19 infection is likely to cause a blood clot.

“That’s why we’d give blood thinners to patients even after they’re discharged. It’s also one of the reasons for increased cases of heart attack. Out of 100 COVID cases, at least 5 are at risk of getting a heart attack,” he points out.