Coronavirus or better known as Covid19 has taken the world by storm, causing a pandemic as never experienced by any of us before. It being a novel disease unknown to all of us leaves healthcare providers floundering for answers. The mortality rate of Covid19 has been reported as 1-6% in most registries or studies. The cause of deaths related to Covid19 has been mainly secondary to acute pneumonia or respiratory failure of some sort. Covid19 unfavourably affects the elderly population and those with comorbidities.
It was not until recently that Malaysia ordered Covid19 patients with mild or no symptoms to be treated and quarantined at home. Since then we are seeing the numbers of patients brought in dead (BID) rising. BID is not a term the public would not be familiar with. It basically means the patient has been brought in with evidence to suggest the patient has been dead for some time, with no point of commencing or initiating resuscitation.
There is compelling evidence between Covid19 and cardiovascular events like heart attacks and sudden cardiac death (SCD). Increase in incidence of SCD has been reported both in patients in the community and hospital settings. Data in Italy showed a rise of 58% in out of hospital cardiac arrest (OHCA) and Covid19 attributed 77.4% to this increment. From the data from China 27% of Covid19 patients have evidence of myocardial injury with elevated cardiac enzyme markers. Patients with an elevated Troponin I had more frequent malignant arrhythmias. Overall mortality is higher when the heart is involved.
Basically a Covid19 patient with mild or no symptoms can turn bad suddenly and may not make it to the hospital in time for treatment. The exact diagnosis for the sudden cardiac death may be difficult to determine. Both lethal bradyarrhythmia (extremely low heart beats) and tachyarrhythmias (extremely fast heart rate) have both been reported in Covid19 patients. Life threatening arrhythmias are seen in 10-16% of patients hospitalised with severe Covid but the datas for patients with mild or no symptoms treated at home are scarce for obvious reasons. This arrhythmias are probably due to myocarditis (inflammation of the heart muscle) or acute coronary syndrome causing a myocardial infarction (heart attack). There are many other causes of SCD in Covid patients such as acute pulmonary embolism and inadequate oxygen supply, termed as hypoxia.
In an observational study of patients who underwent cardiac MRI within 8-10 weeks following their infection, irrespective of severity of illness or overall course of their Covid presentation, 78% had evidence of cardiac involvement with regional scarring and pericardial enhancement. This means patients with no symptoms or mild disease may still have silent cardiac involvement which can flare up any time during the course of their illness.
Sudden cardiac death in Covid19 patients is not uncommon, and should not be taken lightly even in patients who are treated at home. The numbers of OHCA is now becoming obvious to us all since the commencement of stay at home treatment for patients of category 1 and 2. I think it is not wrong to recommend some form of cardiac and oxygen saturation monitoring for selected if not all Covid19 patients treated at home.
Stay safe and stay home.
Dr Betty Teh
Editor in chief and Founder
Beating Hearts
