Doctors say the damage seen in deceased coronavirus patients “is not consistent with typical patterns of inflammation of the heart muscle.”
NEW ORLEANS – In recent months it has become quite evident that COVID-19 can have an adverse effect on the heart. Still, scientists and doctors are still struggling to fully understand the relationship between COVID-19 and heart health. Now, a series of autopsies performed by pathologists at Louisiana State University yield some unusual observations.
LSU team says damage done to hearts of COVID-19 patients It is not consistent with the typical patterns of heart muscle inflammation observed with myocarditis (inflammation of the heart muscle). Instead, the observed pattern of cell death is quite unique, and it spreads across individual scattered heart muscle cells.
“We identified key macroscopic and microscopic changes that challenge the notion that typical myocarditis is present in severe SARS-CoV-2 infection,” says Dr. Richard Vander Heide, professor and Director of Pathology Research at LSU Health New Orleans. School of Medicine, in A Launch. “While the mechanism of cardiac injury in COVID-19 is unknown, we propose several theories that require further investigation that will lead to a better understanding and possible treatment interventions.”
Furthermore, pathologists also point out that SARS-CoV-2 was no present in any cell of the heart muscle. This is especially strange because the first SARS coronavirus of 2003 was found within the heart muscle cells of SARS patients.
The COVID-19 patients also showed no signs of blockage of the blood vessels in their coronary arteries.
‘Extreme stress in the heart’
A total of 22 autopsies are included in this study. All of these patients had died from COVID-19 while receiving treatment at the University of New Orleans Medical Center. Most of the patients are African-American, being 10 men and 12 women. Their ages range from middle age (44 years) to the elderly (79). Most had pre-existing high blood pressure, half had type 2 diabetes, and 41% were obese.
So what was found? Diffuse alveolar damage (DAD), or damage to the small lung airspaces that facilitate gas exchange, was observed among autopsy patients. In addition, blood clots and bleeding were observed in the blood vessels and capillaries of the lungs. All of these factors were found to be the main contributors to patient death.
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“These findings, along with severely enlarged right ventricles, may indicate extreme stress on the heart secondary to acute lung disease,” says Dr. Sharon Fox, Associate Director for Research and Development in the school’s Pathology Department.
Pathologists also point to viral infections between cells in the lining of patients’ smallest blood vessels (endothelium). While these infections were at relatively “low” levels, the LSU team theorizes that they might have been enough to induce individual cell death.
The “cytokine storm,” or the immune system’s overreaction to infection, may also contribute to these observations.
“Since inflammatory cells can pass through the heart without being present in the tissue itself, a role for cytokine-induced endothelial damage cannot be ruled out,” concludes Dr. Heide.
The study is published in Circulation.
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