COVID-19 - Mysterious Heart Damage
Last updated on July 31, 2020, John Hopkins Corona Virus Dashboard and Worldometer
John Hopkins Worldometer
Recovered Recovered - 11,161,510
Cases in the U.S.
POPULATION - 331,002,651, as of 30 July 2020
Recovered - 1,438,160 Recovered - 2,327,572
Cases in California
Covid and children worldwide – 890,000 cases, 45,000 deaths
7/31/2020 Cases Deaths Recovered
Daily death totals: 7/29 – 186, 7/29 – 216, 7/30 – 253, 7/31 - 257
The focus of the COVID-19 pandemic has been on respiratory problems, but doctors are grappling with a new medical mystery. In addition to lung damage, COVID-19 patients are also developing heart problems and dying of cardiac arrest. Physicians have reported changes to the circulatory system in people with COVID-19, sometimes leading to blood clots and cardiac complications, such as changes to the heart rhythm, damage to heart tissue and heart attacks.
As more data comes in, cardiac experts believe the COVID-19 virus can infect the heart muscle. An initial study found cardiac damage in 1 in 5 patients, leading to heart failure and death even among those who show no signs of respiratory distress. COVID-19 seems to be more of a respiratory picture first and then at the later stages becomes more of a cardiac issue.
How does COVID-19 affect the heart?
The effects of COVID-19 on the lungs are well-known. As COVID-19 continues, more information is becoming available about the role the virus, SARS-CoV-2, has on the heart. "Individuals with known cardiovascular disease are at an increased risk of more severe complications from respiratory viral illnesses, including the flu and COVID-19," says Dr. Leslie Cooper, chair of the Department of Cardiology at Mayo Clinic.
During severe SARS-CoV-2 infection, heart function may decrease, sometimes a consequence of systemic inflammatory response to infection and occasionally direct viral infection in the heart. Recent evidence into COVID-19 shows the disease can also cause neurological, cardiac symptoms and includes a cough, shortness of breath and pneumonia.
In a new study appearing in the journal Cell Reports Medicine, scientists are showing that SARS-CoV-2 can infect heart cells and change their function. Their findings from experiments in human stem cells, suggests the cardiac symptoms of COVID-19 may be the direct result of the infection of heart tissue.
Scientists used a type of stem cell called induced pluripotent stem cells (iPSCs) to generate heart cells, which can be produced from a person’s skin cells, then reprogram them to become any cell type in the body. They provide a useful tool for research into human disease and a way to test new treatments.
In this study, the team programmed the iPSCs to become heart cells and later incubated them with SARS-CoV-2. Researchers found that SARS-CoV-2 could directly infect the heart cells. The research also showed the virus can rapidly divide inside heart cells, which caused changes to the heart’s ability to beat after a period of less than 3 days.
Additional experiments focused on the different genes expressed by heart cells before and after the virus infected them. These studies showed activation of the immune response and antiviral clearance pathways to help fight the virus.
How does the virus get into the heart in the first place? One way may be by using angiotensin-converting enzyme 2 (ACE2). This is the same receptor the virus uses to infect cells in the lungs.
Studies have shown that treatment with an ACE2 antibody can help stop SARS-CoV-2 from replicating and save cells in the heart.
“By blocking the ACE2 protein with an antibody, the virus is not as easily able to bind to the ACE2 protein and cannot easily enter the cell. This helps in understanding the mechanisms of how the virus functions and therapeutic approaches that could be used as a potential treatment for SARS-CoV-2 infection.”
2 Main Cardiac Issues
"For many people who present with heart failure in the context of COVID-19 infection, we don't know if the heart failure is related to myocarditis or to a response to systemic inflammation from COVID-19," says Dr. Cooper.
For older patients, with existing coronary artery disease or hypertension, it is likely heart failure resulting from the increased demand placed on the heart and the body’s decreased cardiac reserve capacity. In younger patients, it's likely primary myocarditis caused by the virus.
Virus or Illness?
The question of whether the emerging heart problems are caused by the virus itself or a byproduct of the body’s reaction to it is one of the critical unknowns facing doctors. Determining how the virus affects the heart is difficult, in part, because severe illness can influence heart health.
There are many reasons viruses can become deadly. Three common reasons are:
“Cytokines are proteins that regulate several biologic functions such as inflammation and repair,” said Dr. Ashesh Parikh, DO, FACC, RPVI, a cardiologist at Texas Health Presbyterian Hospital Plano and Texas Health Physicians Group. The inflammatory response of cytokines can lead to heart damage via the mechanism of heart failure which can cause a deadly condition called myocarditis, the inflammation of the heart muscle which can result in weak pumping function of the heart muscle.
Dr. Robert Bonow, professor of cardiology at Northwestern University Feinberg School of Medicine and editor of JAMA Cardiology and other cardiac specialists believe a COVID-19 infection could lead to damage to the heart in four or five ways. Some patients may be affected by more than one of those pathways at once.
Why does the coronavirus cause blood clots?
Evidence indicates that COVID-19, leads to blood clots in an estimated in 20–30% of critically ill patients. A blood clot or thrombus, increases the risk of complications and death among those who have COVID-19. This disease causes blood clots.
One theory is that the clotting occurs when the coronavirus attacks the endothelial cells that line the blood vessels. The virus does this by binding to the ACE2 receptors, which are present in the endothelial cell membrane. Once the virus binds to these receptors, the blood vessels start releasing proteins that trigger blood clotting.
Blood clotting is a natural body response to injury. It occurs when the volume of blood changes to a semi-solid state in order to prevent excessive blood loss. Chemical reactions in the body facilitate this change. Clots forming inside a deep vein can be extremely dangerous and may not dissolve on their own and can stop blood flow - which can be fatal. A clot that breaks off and travels to other parts of the body are known as an embolus. If the embolus reaches the brain, heart, or lungs, it can result in a life threatening condition, such as a heart attack or stroke. According to a paper in the British Journal of Haemotology, people with COVID-19, clots appear to form within the lungs. Typically, clots tend to form in other areas of the body before breaking off and traveling to the lungs. Clots seem to form in the tiny vessels of the lungs, rather than the major vessels, as is the case in typical strokes
The symptoms include:
Other factors may also play a role in blood clotting in people with COVID-19, such as those requiring hospital care due to the disease. Other factors include:
Initial Data From China
In March, doctors from China published two studies how prevalent cardiac problems were among patients with COVID-19. The larger of the two studies looked at 416 hospitalized patients. The researchers found that 19% showed signs of heart damage and were significantly more likely to die: 51% of those with heart damage died versus 4.5% who did not have it.
Patients who had heart disease before coronavirus infections were more likely to show heart damage afterward. Patients with no preexisting heart conditions who incurred heart damage during their infection were more likely to die than patients with previous heart disease but no COVID-19-induced cardiac damage. It’s unclear why some patients experience more cardiac effects than others.
Ideally, doctors take biopsies of the heart to determine whether the heart muscle is infected with the virus. COVID-19 patients are often so sick it’s difficult for them to undergo invasive procedures. Many hospitals aren’t using electrocardiograms on isolated patients to avoid adding additional staff into the room and depletion of protective equipment.
That work has already resulted in changes in the way hospitals deal with the cardiac implications of COVID-19. Doctors have found that the infection can mimic a heart attack. Patients have been taken to the cardiac catheterization lab to clear a suspected blockage, only to find the patient wasn’t really experiencing a heart attack but had COVID-19.
New protocol includes bringing in a cardiologist and getting an EKG or ultrasound to confirm a blockage. Sorting out how the virus affects the heart should help doctors determine which therapies to pursue to keep patients alive.
There has been debate if medications used to support blood pressure increases the risk of heart failure. Dr. Cooper advised, “right now, there is no evidence that commonly used medications for any cardiovascular disorders in the United States creates a heightened risk of contracting COVID19 or the consequences of infection. People should continue their medications, unless their physician has directed them otherwise.
Doctors may treat or prevent blood clots by prescribing blood-thinning medications. Many start treatment during a hospital stay, continuing for 2 weeks after discharge to reduce the risk of blood clots. Taking blood thinners increases the risk of bleeding, which is unsuitable for high risk patients. Some reports indicate people on mechanical ventilation with COVID-19 prescribed blood thinners had a lower mortality than those who did not take the medication.
The FDA Trusted Source has removed the Emergency Use Authorization (EUA) for hydroxychloroquine and chloroquine for the treatment of COVID-19. Based on a review of the latest research, the FDA determined that these drugs are not likely to be an effective treatment for COVID-19 and that the risks of using them for this purpose might outweigh any benefits.
The Latest Research Projections on COVID-19 Treatments and Medications.
Hospitals and research labs all over the world are testing different therapies on coronavirus-positive patients in an effort to find a potential COVID-19 treatment. Below are a few medications and treatments that have been making a buzz in the science community.
Early results from a study of 1,063 patients showed hospitalized patients who received Remdesivir recovered faster than those who got a placebo, 11 days vs. 15 days respectively. The death rate in the Remdesivir group, 7%, was lower than that of the placebo group, 12%. Patients who needed oxygen saw the most benefit.
RECOVERY, a randomized clinical trial in the UK, is studying many medications, including dexamethasone, for effectiveness against COVID-19.
This is a stressful time because of the economic and social impact of this disease. For those with known heart issues, high blood pressure or other diseases, stay focused on good heart health practices. Being health conscious with vigilant hand hygiene, maintaining an exercise regimen and healthy diet are vital to maintaining health. Although trying to adhere to social distancing by avoiding large group gatherings seems impossible, build in time to stay connected through social media or telephonically – which keeps the heart emotionally healthy.
The Immune System
White blood cells are the first line of defense! The immune system fights off disease causing microorganisms and engineers the healing process. The immune system is vital to fighting every assault on the body! Understanding the role the immune systems plays in overall health will provide you the ability to take responsibility for your own health. The responsibility of the immune system is to learn and identify those things that naturally belong in the body and those foreign or harmful.
The Best Immune Boosters
When taking probiotics for an immune boost, get one with a variety of Lactobacillus and Bifidobacterium strains and a high concentration of CFUs, colony forming units – this is the amount of live microorganisms that help to populate the gut.
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