Patient dynamics
THE post-Covid-19 cardiovascular disease (CVD) setting is comprised of a variety of patient categories and problems.
The first category of patient now presenting is one who did not contract Covid-19 but has underlying cardiac disease. This disease may have been previously established or may be new in onset. The key issue is that the patient has been reluctant to seek medical attention during the lockdown and pandemic. This has resulted in the patient presenting with decompensated chronic cardiac issues where there is a gradual exacerbation of signs and symptoms, or delayed presentation of new cardiac issues.
The second category of patient presenting is one who has had Covid-19 with either established cardiac disease, new cardiac disease that occurred and was diagnosed during Covid-19, or now postCovid-19 recovery new CVD.
To focus specifically on the last of these – now post-Covid-19 recovery new CVD – we are seeing a number patients presenting with:
1. Arrhythmias: the main presentation is that of palpitations with mild to moderate activity. I have had a number of patients presenting with similar profiles to the fit young individual who has apparently “recovered” from Covid-19 yet is unable to undertake any exertion. I have young patients presenting with changes on their electrocardiogram and features on cardiac sonar suggesting a cardiac inflammatory process that is still ongoing. The interesting thing is that these patients did not have Covid-19 requiring hospital admission. There is no precise profile of patient who is likely to present with the symptoms.
It is established that Covid-19 can affect the heart through a number of mechanisms. Although these seem to result in an element of inflammation, it is different in nature to the inflammation seen in other viral illnesses.
2. Coronary artery disease: Viral illnesses are well known to unmask underlying coronary disease. This is primarily due to the inflammatory response associated with the viral illness and the changes in blood vessel function. Covid-19 is associated with blood vessel clots which may occur in the blood vessels supplying the lungs, but also those supplying the heart muscle.
3. Cardiac failure: To date I have not seen any patients presenting with a heart that has failed in its ability to pump sufficiently as a result of Covid-19.
4. Anxiety: A significant number of patients are presenting with high levels of anxiety as a result of having had Covid-19 or because of the pandemic. They present with atypical and non-specific complaints. The diagnosis of underlying anxiety as a cause for the symptoms is only made after an assessment and tests.
There are also patients who developed cardiac disease during Covid-19 illness.
As an example, I have a young and fit athlete who presented with a heart attack as the only manifestation of Covid-19.
The outcome was good with full restoration of blood flow to the heart, yet this patient now has established cardiac disease that requires lifelong management.
In summary: we are seeing several patients, young and old, presenting with CVD presentation post-Covid-19.
Some are new presentations after apparent “recovery”, some developed during infection as a result of Covid-19 and others are presenting with established disease that is now unstable because of non-follow-up during the lockdown and pandemic.
Levin is a cardiologist who practises at Netcare Milpark Hospital in Johannesburg.