Healthcare system needs to prepare for potential cardiomyopathy and heart failure in a large number of COVID-19 patients: Dr Ajay Kaul

Dr Ajay Kaul, Chairman and HOD – CTVS, BLK Super Speciality Hospital shares details about cardiac care in times of COVID-19, the impact of the coronavirus infections on the heart, emerging treatment protocols for COVID-19 patients with underlying cardiovascular disease and more, in an interview with Lakshmipriya Nair

How has the COVID-19 pandemic affected cardiac care in our country?

Cardiac care has fundamentally upheld the quality of care during COVID-19 times. In the ischaemic heart group of patients, only the emergent or critical disease is being managed by intervention – be it angioplasty or CABG. Valvular, heart failure or congenital heart disease patients are also being treated in accordance with the ‘standard of care’ guidelines, with respect to surgical or intervention. There has been surely a rise in preference of the endovascular approach to curtail the hospital stay and exposure to COVID-19. Also, at various levels, there is a redistribution of staff and infrastructure towards the COVID-19 which should be understood by all.

Even before the pandemic, India was seeing an alarming rise in the incidence of CVDs. How is this pandemic going to aggravate the problem?

The disease incidence and prevalence has not seen a dramatic change. What essentially has changed is the patient profile visiting the hospital. Stable patients or patients with mild symptoms are being managed with online video consultancy. Even the follow up is being done in the same way. Patients with moderate to severe symptoms are most welcome to visit our completely functional units. Patients are avoiding visiting hospitals for minor complaints.

Do we have any data on the correlation between COVID-19 and heart ailments? Does the novel coronavirus infection cause cardiac ailments/conditions in some people?

This is a novel pathogen and affects the body not only by itself but also by self-destruction through an exaggerated immune and inflammatory response of the body towards it.

Consequently, there has definitely been a rise in two types of heart conditions –

1. Myocarditis – which is the inflammation of cardiac muscle and the resulting weakening in its pumping action. This may also cause a change in the regular beating pattern to change into certain ‘arrhythmias’ which may be sometimes fatal.
2. Exaggerated clotting in the coronary or vascular tree due to a hypercoagulable status causing an increased incidence of heart attacks. Patients with previous cardiac ailments are not only more vulnerable but are at increased risk of these complications.

Is it true that COVID-19 could presage heart failure, even after recovering from the illness? If yes, what needs to be done by the healthcare ecosystem to manage the huge burden of heart disorders that it could pose on the country?

More than one study proves that COVID-19 could lead to heart failure in the long run and may impact the heart’s ability to pump blood. It may not be a fact yet, but the cardiovascular complications are going to increase in the future. It is too soon to determine the course of action here as the claim is yet not established. But, the healthcare system needs to prepare itself for the potential cardiomyopathy and heart failure in a large number of infected patients.

Are we seeing any data-driven therapies/treatment protocols emerging for the care of COVID-19 patients with underlying cardiovascular disease or those who have developed heart disease due to the infection?

One of the fresh approaches is administering plasma therapy that has shown positive results in the recent past. The therapy has been conducted in Delhi and Mumbai with promising results so far and works well with the theory of SARS-CoV-2 virus. The blood is extracted from a previously infected patient as its plasma component is separated and now contains antibodies against the virus. Doing this kills the virus and keeps it from spreading further.

Are the existing drugs that are being used for the treatment of COVID-19 safe for the consumption of people who have heart ailments?

All drugs come with few side effects and are not for self-medication. Yes, the drugs are safe for people with heart ailments but it goes without saying that it needs an opinion of a doctor. Certain technical things are checked before administration for example an ECG and certain combination of drugs are not supposed to be given together.

So, are there any learnings and experiences that we can bring into our standard of care for COVID-19 treatment to make it safer and more effective for patients with cardiovascular complications?

Each day is new learning. Teleconsultancy will surely be incorporated in the existing system at all levels – a practice we were using in our set up for a long time now. Also, an upsurge in endovascular management of complicated disease may see an uprise, but this will definitely go through our rigorous medical analysis.

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