A 53-year-old healthy man, who had a mild Covid infection a year ago, experienced sudden discomfort one morning. After arriving at the hospital, he was suspected of having coronary artery blockages. While undergoing angiography, he suffered a cardiac arrest and died unexpectedly. He had no prior risk factors for heart disease. His bereaved family members were informed that he could have had clotting in the heart’s blood vessels due to the Covid infection. The Covid-19 pandemic ended three years ago and caused numerous deaths and health issues worldwide, negatively impacting many lives. People without any previous risk factors for heart disease who maintained a healthy lifestyle later experienced symptoms like chest pain, restlessness, and breathlessness, even one to two years after the pandemic. The investigation revealed that individuals either had blockages in their coronary arteries or weakened heart muscle. Those with pre-existing cardiac issues experienced worsening symptoms. Although primarily a respiratory disease, Covid-19 has been associated with many cardiac complications. Even those who have had mild infections or were asymptomatic after testing positive for Covid developed cardiac problems later. As the virus spreads in the respiratory tract, it tends to enter the heart as well. Other factors have also contributed to the development of heart disease after Covid-19, including stress from restrictions, anxiety for loved ones affected by the virus, loneliness, reduced physical activity during lockdowns, and increased alcohol consumption to cope with these challenges. The body's acute inflammatory response (cytokine response) to fight the infection also causes damage to the heart. Injury to the outer layer of the heart leads to fluid build-up and swelling around the heart, which eventually causes heart failure. Damage to the middle protective layer of the heart leads to weakened heart muscle and rhythm disturbances. When the heart rate becomes irregular, it is a risk factor for stroke, which results in paralysis and other neurological problems. Moreover, the risk of clotting is also increased due to the virus, thus aggravating pre-existing cardiac problems or causing fresh issues in an otherwise healthy individual. New onset of hypertension and heart failure has been seen in persons who have recovered from Covid even over a year ago. Common problems seen are disturbances of heart rhythm, heart failure, and coronary artery disease. Individuals have developed hypertension and or type 2 diabetes, heart attacks, and or strokes as complications of Covid infection. Elderly and weak persons are more vulnerable to these problems. Those with prior cardiac issues are more susceptible to aggravation of the problem or the development of new ones. Diagnosis is based on the symptoms, physical examination, and suitable relevant investigations like electrocardiogram, and cardiac echo. Coronary artery blockade if suspected is confirmed by angiography, i.e. direct visualisation of coronary arteries after injecting a dye in one of the thighs or upper limb veins. Treatment for any of these heart-related problems is based on the underlying cause. It is the same for other non-covid-infected individuals with cardiac problems. That includes medicines, and if needed, some interventions like stent placement, coronary artery bypass surgery, etc. Anyone who tested positive for Covid during or shortly after the pandemic should seek medical advice if they experience any heart-related issues, such as breathlessness, chest pain during exertion, palpitations, or feelings of restlessness. The intensity of symptoms varies as per the severity of the disease, the individual's lifestyle, and his or her overall health status. Prevention lies in adopting a healthy lifestyle and if possible, living and working in spaces with good sunlight and ventilation. Dr Rachna Pande is a specialist in internal medicine. rachna212002@yahoo.co.uk
