Autopsies reveal surprising cardiac changes in COVID-19 patients

Autopsies performed by LSU Health New Orleans pathologists show that the damage to the hearts of COVID-19 patients is not the typical expected inflammation of the heart muscle associated with myocarditis, but rather a unique pattern of cell death in individual scattered heart muscle cells. Findings from detailed heart study of 22 confirmed deaths from COVID-19 reported in research letter published in Circulation, available here.

“We identified key macroscopic and microscopic changes that challenge the notion that typical myocarditis is present in severe SARS-CoV-2 infection,” says Richard Vander Heide, MD, Ph.D., professor and director of pathology research at LSU Health New Orleans School of Medicine. “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.”

The LSU Health team of pathologists led by Dr. Vander Heide, a seasoned cardiovascular pathologist, also found that, unlike the first SARS coronavirus, SARS-CoV-2 was not present in heart muscle cells. There was also no occlusion of blood clots in the coronary arteries.

Their previously reported results revealed that Diffuse Alveolar Damage (DAD), damage to the small air spaces of the lung where gas exchange occurs, along with blood clots and bleeding in the small blood vessels and capillaries of the lung, were the main contributors to death.

“These findings, along with severely enlarged right ventricles, may indicate extreme stress on the heart secondary to acute lung disease,” adds Sharon Fox, MD, Ph.D., Associate Director for Research and Development in the Department of Pathology. from LSU Health New Orleans School of Medicine.

The autopsies, believed to be some of the first reported in the U.S., were performed on 22 patients who died of COVID-19 at the University of New Orleans Medical Center. Most were African-American. The ten male and twelve female patients ranged in age from 44 to 79 years. Although there were other underlying conditions, most had high blood pressure, half had type 2 diabetes treated with insulin, and about 41% were obese.

Pathologists at LSU Health New Orleans, like others, also found viral infection of some of the cells in the lining of the smallest blood vessels (endothelium). Although at low levels, it may be enough to cause dysfunction leading to individual cell death. The effects of the so-called “cytokine storm” (severe overreaction of immune system cells fighting infection) associated with COVID may also play a role.

“Since inflammatory cells can pass through the heart without being present in the tissue itself, the role of cytokine-induced endothelial damage cannot be ruled out,” says Dr. Vander Heide.

In addition to Drs. Vander Heide and Fox, the LSU Health New Orleans team included residents of Pathology Aibek Akmatbekov, MD; Fernanda S. Lameira, MD; and Jack L. Harbert, MD. Guang Li and J. Quincy Brown from Tulane also participated.