How Does COVID-19 Affect the Heart? | Paul Cremer, MD

[Laughter] [Music] welcome to the health essentials podcast brought to you by cleveland clinic i'm your host deanna pogarell as medical experts continue to learn more about cobin 19 every day they're finding that it's not just a disease that affects the lungs it appears that covid19 can cause damage in other parts of the body too including the heart joining us today is cardiologist dr paul kremer he's the associate director of the cardiac intensive care unit here at cleveland clinic and he's going to share what we know so far about how copin 19 can affect the heart hi dr kremmer thanks for being here hi diana thanks for having me for our listeners please remember this is for informational purposes only and is not intended to replace your own physician's advice so dr kremer we've heard since the start of the pandemic that people with certain medical conditions including some heart conditions are at a greater risk for cobit 19. has that been shown to be true with what we're seeing here in the u.s and if so which conditions are people most at risk yeah thanks for that question and i think that really gets at a lot of what patients are asking about and am i at increased risk i think unfortunately what we have seen is that certain patients with cardiac conditions are in fact at increased risk and those conditions include patients with high blood pressure patients with diabetes patients who are overweight or obese and also elderly patients so so these are people that need to be uh particularly cautious uh when it comes to covet 19 but really all of us need to be especially vigilant uh about uh masking appropriately and maintaining social distancing because even though uh certain patients uh like i mentioned are at increased risk for having more serious disease from cover 19 even patients who are otherwise young and healthy we're seeing even though it's less common we're seeing those patients as well get very very sick from covet 19. what is it about the nature of covid19 that makes it particularly dangerous to folks who have chronic conditions right and so it really gets that why is it that certain people get really sick with covet 19 and and i think like everything related to to this disease we're learning more every day but i think there's a couple of observations worth emphasizing uh the first is that in patients with cova 19 what we're seeing is especially in the the second or third week of illness certain patients develop an overwhelming inflammatory response such that the own body's immune system is no longer just attacking the virus but it starts to attack itself and that primarily involves the lungs but can involve other organs such as the kidneys and the heart and i think related to that it may be that certain patients such as people who are older who have chronic conditions may be more likely to to have this inappropriate inflammatory response where the body attacks itself but what i think is is probably more important is that when this does occur uh patients who are older and say have high blood pressure or have diabetes um or are overweight or obese that they have less reserve to be able to to handle and recover from this really high inflammatory state and condition so do we know what that kind of inflammation does to the heart or what kind of specific damage is done from the infection right so how does this inflammatory response related to covid involve the heart so if we take a step back and we look at patients who are sick enough to be in the hospital with cover 19 so patients with with severe and serious disease a lot of those patients will have evidence of involvement of the heart with the blood test and that's something we're calling cardiac injury related to covet 19. and and so it it varies by study and in which patient population you're looking at but generally speaking maybe 10 to 25 percent of patients will have evidence of cardiac injury um in the setting of their of their serious coven 19 illness and that cardiac injury can result from many different causes uh it can be related to the heart muscle just not having enough oxygen um so the heart muscle isn't getting enough oxygen so that can cause some damage it can be related to damage to the small vessels of the heart or the or the lining of the blood vessels of the heart and in addition in covet what we've seen is that a lot of these patients get blood clots and that can involve the small and the large blood vessels and finally covid can directly uh cause toxicity to the heart cells that does occur but that seems to be a rare manifestation of covet 19 where the virus is directly invading the heart muscle cells and causing damage but it seems that a lot of these other causes that we've talked about the decrease in the oxygen the trouble with the small blood vessels and the blood clotting in the heart those issues seem to be related or more common in patients who have this really high inflammatory response so we're beginning to think that it is really this inappropriate inflammatory response that's related to a lot of the different manifestations you can see in patients that have cardiac injury related to covet 19. and do we know if that cardiac injury is permanent or is there a way that people can manage it yeah that's that's an excellent question and it's a question now that we're getting from a lot of patients who've who've recovered from covet 19 i i think at this point we really don't know what we do know is that if we if we look uh with sophisticated testing such as with cardiac mri we can find evidence of inflammation in the heart and a lot of patients who've recovered from covet 19. but as i mentioned the more severe presentations uh of cover 19 involving the heart where the heart muscle is uh severely weakened uh where the heart is having difficulty pumping blood to the to the muscles in the body and the other organs so that really severe form of myocarditis of inflammation in the heart fortunately seems to be uncommon uh in covenant 19. we do see it um but but fortunately it is not occurring in that many patients so what a lot of people are asking is well this inflammation that that may be there that's certainly throughout the body and you can find evidence sometimes in looking at the blood work or if you look with imaging based testing with cardiac mri what are the long-term consequences in terms of developing an abnormal heart rhythm of developing uh heart failure in the future uh i i think at this point uh we really don't know uh and we just need to continue to to research those questions what i would say is that most patients who have either asymptomatic cova 19 or mild disease as it relates to the heart can be expected um to have a i would say an excellent long-term prognosis in that regard but but there's still a lot of questions that need to be answered absolutely and i want to go back to you mentioned blood clots earlier um and i've heard that there's a link between coping 19 and strokes can you talk a little bit about that and are there other vascular concerns with copin 19 right so if we think of covid19 and this association between the increased inflammation we know that the blood clotting can also occur in the setting of a heightened inflammatory response and as we talked about those blood clots can involve the small blood vessels the microvasculature uh it can involve the larger blood vessels such as the coronary arteries the blood vessels on top of the heart and when you get a blood clot there that would be what we think of classically as a heart attack of a myocardial infarction again that can occur in the setting of colvid but like the more severe heart failure presentation myocarditis getting a typical heart attack related to covet 19 also seems to be uncommon but it's important to emphasize you know when we talk about the art the blood vessels on top of the heart we're talking about the arteries in addition you can get blood clots involving the arteries to the brain and that would cause a stroke and it does seem that that strokes are more common in the setting of cova-19 and if we think of the the blood vessels we're talking about the arteries we should also talk about the veins and we've also observed that in cova-19 patients are more likely to get blood clots in the veins such as in the legs and those blood clots can migrate and result in blood clots in the blood vessels of the lungs um so when we're talking about cova-19 and its inflammatory response i mean we really can see an increased risk for blood clots in small and larger blood vessels and in arteries as well as veins and so it's something we very much need to look out for in these patients is it common that a viral illness has this kind of impact on the body and specifically on the heart are there others that we know do this or is this something new that we've never seen before right so i think if we think about myocarditis which is inflammation of the heart uh viruses are the most likely cause so we've known that viruses can cause myocarditis for a long time um and i think the important distinction here is the spectrum of inflammation of the heart of myocarditis i think we're looking much more closely at the heart with covid than we have with with previous viruses but that said we are seeing a lot of uh inflammation of the heart in covet 19. i would say more so than has been previously reported with other other viruses however if we look at the spectrum of the most severe cases what we might call a fulminant myocarditis where the patient comes in with a severely weakened heart that's unable to support uh the necessary uh blood supply to the essential organs with cova-19 that seems to be fairly uncommon and may be less common than other viruses which we're more familiar with such as influenza so i i think it's it's a complicated question uh in that does covet 19 is it more likely to cause inflammation of the heart compared to other viruses i would say probably yes is it as likely to cause the most severe manifestations of myocarditis compared to other viruses i would say probably no but those are both tentative answers and and i think as we do more research we'll begin to understand this uh better in in the days and months to come so speaking of research can you talk a little bit about this some of the studies that you're doing um with specific treatments to prevent this kind of heart and respiratory complications with covid19 right so we have one study um in particular that's looking at blocking this inappropriate inflammatory response related to covet 19. and this study is unique in that it requires patients or were specifically evaluating patients who have this injury to the heart muscle so they have cardiac injury and they have severe covet 19 so serious enough to be in the hospital or in the intensive care unit and i think it's worth noting that coven 19 is primarily a respiratory illness that causes pneumonia but and in some patients it will involve the heart as well most often as collateral damage and we think probably mediated through this very high and inappropriate inflammatory response so the study we're looking at is to see if we give a medication to decrease that body's inflammatory response if we're able to get people to improve more quickly that is can we get them off of oxygen um can we get them out of the hospital and back to their normal lives by decreasing this really high inflammatory response that we see in covid and and often it's that inflammation that causes bystander damage if you will uh to the heart i want to ask about some of the potential secondary effects of this pandemic that could possibly affect our collective heart health and there have been some surveys showing that americans are facing increased stress during the pandemic and since stress is a risk factor for some chronic conditions could this potentially impact our collective heart health over the long term yes i think that's a very important topic that is what are the the long-term consequences uh from kova 19 in terms of of one the stress that it's put us all under and two the impact it's had on our access to health care for our chronic conditions so i would say that that we know that that stress increases uh the risk of cardiovascular disease and complications related to cardiovascular disease and it's incredibly difficult during this pandemic but but i think people really need to be doing as we all need to be doing as much as we can to take care of our mental health and i think for us in in cardiovascular medicine that also involves physical activity um people have been hesitant to uh to exercise and and maybe haven't had the access to exercise uh but i think that's that's great for our mental health and and for our cardiovascular health and in general we recommend that people try and exercise for at least 150 minutes a week so that's about 30 minutes of moderate intensity aerobic exercise most days of the week and and i think you know trying to develop a routine where you're doing that will certainly help with stress and mental health um and overall cardiovascular health and i think the second point in terms of of access uh to care well i'd say that when i was in the intensive care unit last month we had patients who were presenting later in their illness with more advanced disease and i think the reasons for that again are multiple for one i think we have to be wary that not all symptoms are related to covet um so if patients are getting uh chest pain or shortness of breath these would be concerning cardiac symptoms and i think patients may be inclined to think oh maybe this is covid i'm just going to stay home and sit this out so so i really would encourage patients if you're having those kinds of concerning symptoms such as trouble with your breathing or any discomfort in your chest that you do see care um and try and figure out what's going on and second i would say that you know patients for a time were hesitant to come into the hospital um and and were hesitant to seek the care that was was needed so i think they they were sort of um putting off uh necessary uh uh treatments uh and tests for their heart condition and uh i think i'm worried that i think that will have a a a very big long-term impact uh in terms of public health so i think it's very important that with the appropriate measures in place which which we have here at the cleveland clinic that patients continue to seek the necessary care for their high blood pressure their high cholesterol their coronary disease their diabetes because taking care of those conditions now will have a dramatic benefit on the overall quality of life and longevity for the decades to come can you speak a little bit to what the condition that we know as broken heart syndrome and what that is and whether you've seen more of that in the hospital during the pandemic yeah so so broken heart syndrome is where the heart becomes acutely weakened and and that can result uh primarily in in heart failure um and we know that broken heart syndrome occurs oftentimes in the setting of emotional and physical stress and we've all been under tremendous emotional and physical stress uh during the pandemic and some investigators at the cleveland clinic and and also at akron general i did look and see is well given all the stress that we're under is broken heart syndrome uh more common during covet 19 than than in other times and in fact it seems like it is and it seems like it's several fold more common um this broken heart syndrome where patients get an acute weakening and their heart muscle now fortunately with with appropriate treatment uh there tends to be most patients will have recovery of this weakened heart muscle but it's an important point to be aware of and again just speaks to to the trying times we're all having during this pandemic and one of the risk uh to the heart uh that may not be caused by cova 19 uh but is as a result of all the stress we're under because of covet 19. though i would add that that cova 19 in and of itself can also rarely cause this uh broken heart syndrome or stress cardiomyopathy okay and i think you touched on this a little bit earlier but what are some of the best things that we can all be doing to protect our hearts during this stressful and as you said you know emotionally and physically stressful time right so i think that um the best things that we can do to protect our hearts during this time is what we should be doing anyway and it's become more challenging in the setting of the pandemic but we need to to to try and continue to take care of our bodies so so what does that mean well that means as we talked about exercising so moderate intensity aerobic exercise for up to 150 minutes a week a good diet um in general we recommend a mediterranean diet or something with a lot of of whole grains and vegetables and less meat and we need to continue to take care of our chronic cardiac conditions and make sure we're not neglecting our high blood pressure or high cholesterol [Music] or our evaluation for coronary artery disease because of cova 19. so i think it's really important that we continue to live healthy lifestyles and maintain optimal control of our chronic conditions during this difficult time well thank you dr kramer for being here today and if you'd like to schedule an appointment with cleveland clinic's heart vascular and thoracic institute please call 1-800-659-7822 to listen to more interviews with our heart and vascular experts check out the love your heart podcast at clevelandclinic.org love your heart podcast or subscribe wherever you get your podcasts and for more health tips news and information follow us at clevelandclinic on facebook twitter and instagram thanks for joining us you

Channel: Cleveland Clinic

Views: 11,785

Rating: 4.7956204 out of 5

Keywords: cleveland clinic, covid-19, coronavirus, health essentials, video podcast, heart, heart and covid, paul cremer, cardiologist, cardiology

Id: umFjtxiJoXc

Length: 21min 34sec (1294 seconds)

Published: Fri Aug 28 2020