Cardiac surgeons have faced multiple, unprecedented, and unpredictable challenges during last many months since COVID -19. Dr Ramji Mehrotra, director, cardiothoracic vascular surgeon, Fortis Escorts Heart Institute, Okhla, New Delhi believes that in these testing times, it is important for the physician and patients equally to be very careful and practice almost care to avoid exposure. Proper mask, hand hygiene and distancing are important pillars to prevention of spread of this dreaded communicable disease. Hence, during this unprecedented time, one needs to use their heart to beat cardiovascular diseases and stay safe
COVID-19 has taken over our lives by storm and although the major complications of COVID include lung and respiratory disorders, research has shown that it can lead to heart injuries as well. Therefore, COVID can create further complications for a heart patient. Hence, let us have a look at what causes COVID and its relation to heart disease.
Causes of COVID-19
- Increased thrombogenicity
- Inflammatory issues
- Hypoxia
These are the reasons that make heart patients more prone for MI, pulmonary embolism, sudden cardiac death, fatal and non-fatal arrhythmia. Post stent and post CABG patients are also at increased risk. Many heart patients are unaware of heart disease and have sudden cardiac attack as first presentation. Therefore, the following need to be kept in mind for them:
- Need emergency treatment to save life. COVID status is unknown and takes time to check
- Doctors need to take precautions like PPE and treat them
- Thrombolysis is preferred rather than primary PCI
- If thrombolysis fails – rescue PCI is undertaken
Challenges faced by cardiac surgeons
Cardiac surgeons have faced multiple, unprecedented, and unpredictable challenges during last many months since COVID -19. During lockdown no elective surgeries were allowed. No outstation patient could travel as borders were sealed. So, only emergency surgeries were performed. For surgeons and surgical team, to wear surgical loupes, headlight, N-95 mask and PPE is always a big challenge and there is no way to ensure distancing between surgeon & assistant.
An unusual heart surgery generally takes five hours to perform and one can therefore understand the amount and duration of exposure to the team. For anesthetist, it was important to minimise aerosol formation during endotracheal intubation, positive pressure ventilation, ET suctioning, extubation, nebulisation, chest physiotherapy etc. Reintubating patients in ICU demands more precautions.
Heart transplant patients are on immunosuppressive treatment including steroids and therefore are more prone for COVID -19. However, they have not reported COVID -19. It maybe because they many have taken extra precautions. Also, most of them are on steroids. Steroids have shown benefit in limiting COVID -19 disease symptoms to mild level, have shown mortality benefit, and reduced incidence of post COVID -19 sequelae.
Many patients who come for surgeries are tested preoperatively for COVID -19 and some of them have tested positive and because elective or semi elective cases may have heightened risk of COVID -19 exacerbation and therefore there is higher risk of morbidity and mortality and hence they have needed to be postponed till they recover from COVID -19.
Heart patients are more prone for COVID -19 infection because heart conditions have a direct bearing on lung function, pulmonary artery pressure, oxygenation etc. Furthermore the COVID -19 virus gets attached to ACE-II receptors and causes all sorts of sequelae like thrombosis, inflammation and hypoxia.
COVID-19 recovery is linked with an increase in heart ailments again due to its thrombotic inflammatory ad hypoxic potential. Post COVID-19 sequelae result in –
- Myocarditis,
- Lung Issues – fibrosis, compromised PFT,
- Secondary infections due to decreased immunity,
- Home oxygen requirement,
- Low exercise capacity.
Therefore, in these testing times, it is important for the physician and patients equally to be very careful and practice almost care to avoid exposure. Proper mask, hand hygiene and distancing are important pillars to prevention of spread of this dreaded communicable disease. Hence, during this unprecedented time, one needs to use their heart to beat cardiovascular diseases and stay safe.
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