March 27 (UPI) -- In new findings released Friday, a review of studies in China highlights that COVID-19 can cause death in people with underlying cardiovascular disease and cause cardiac injury even in those with no history of heart problems.
With the new coronavirus spread rapidly in the United States -- now with nearly 100,000 confirmed cases, tops in the world -- healthcare providers are still coming to grips with how the disease progresses and what happens to those who develop serious illness.
"It is likely that even in the absence of previous heart disease, the heart muscle can be affected by coronavirus disease," review co-author Dr. Mohammad Madjid, an assistant professor of cardiology with McGovern Medical School at the University of Texas Health Sciences Center, said in a press release. "Overall, injury to heart muscle can happen in any patient with or without heart disease, but the risk is higher in those who already have heart disease."
In fact, research published after earlier coronavirus and influenza epidemics -- including SARS, MERS and H1N1 -- suggests viral infections can cause acute coronary syndromes, arrhythmias, and the development of, or exacerbation of, heart failure, Madjid and his co-authors noted.
Data suggests that also SARS may have resulted in cardiovascular complications, such as acute coronary syndrome and myocardial infarction, in some of those infected.
According to the U.S. Centers for Disease Control and Prevention, more than 18 million American adults have coronary artery disease, the most common heart ailment in the country. In general, heart disease is the leading cause of death in the United States, killing nearly 650,000 people annually.
In a clinical bulletin issued by the American College of Cardiology in February, it was revealed that the case fatality rate of COVID-19 for patients with cardiovascular disease was more than 10 percent. Data also points to a greater likelihood that individuals over age 65 with coronary heart disease or hypertension are at increased risk for infection, as well experience more severe symptoms that will admission to a hospital intensive care unit, or ICU.
ICU beds have been filled to capacity in some places since the pandemic spread to the United States.
According to Madjid and his colleagues, critical cases are those that include respiratory failure, septic shock or multiple organ dysfunction or failure.
"It is reasonable to expect that significant cardiovascular complications linked to COVID-19 will occur in severe symptomatic patients because of the high inflammatory response associated with this illness," Madjid said.
Indeed, this was confirmed in one of the studies released Friday, which found that in 187 people with confirmed coronavirus infection in Wuhan, China, epicenter of the outbreak, nearly 28 percent experienced heart injury as a result of the disease. These injuries resulted in "cardiac dysfunction" and/or irregular heartbeat.
In addition, the researchers in China observed that risk for death from COVID-19 was more than three times higher in patients with a history of heart disease than in those without. In all, 23 percent of the 187 people in the analysis died as a result of the infection.
Some of this damage could be caused by a lack of oxygen reaching the heart due to the lung complications caused by the virus, Dr. Raj Dasgupta, a pulmonolgist and critical care medicine specialist at Keck School of Medicine of the University of Southern California, told UPI.
Dasgupta and his colleagues at Keck Hospital in Los Angeles have already been treating patients with suspected COVID-19, and he said that these research findings will likely change how they screen for the virus and manage those diagnosed with it.
"This makes me aware as a clinician that this virus is not going to spare any organ in the body," he explained. "The way we are screening for it we are all focused on the lung, which is fine with me because I'm a pulmonologist, but we can't forget about the heart."
On a practical level, this will likely mean that cardiologists will be asked to consult on COVID-19 patients, and that patients may be monitored with regular electrocardiograms to assess the affect of the virus on their heart.
In a separate case report, researchers in Italy describe how a 53-year-old woman with no history of heart disease developed acute myopericarditis, or inflammation of the pericardium, which is the sac that envelopes the heart.
The woman's heart condition resolved, as she recovered from the virus, but in rare instances myopericarditis can become permanent and lead to severe heart problems.
It can also cause a condition called cardiac tamponade, in which excess fluid accumulates in the pericardium, leading to a significant drop in blood pressure. Cardiac tamponade can be fatal if it isn't promptly diagnosed and treated. According to Dasgupta, this would need to be drained, which may further complicate treatment in a patient with COVID-19.
Notably, he added, the patient in the case report also complained of shortness of breath, despite the fact CT scans of her lungs revealed no signs of the disease. It's likely that her shortness of breath was caused by damage to her heart, which may not have been able to pump sufficient blood supply to her lungs.
"The take home message for clinicians is that if a patient says, 'Hey, I'm short of breath,' that doesn't necessarily mean it's the lungs," he said.