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Covid-19 is considered primarily a respiratory illness. If the coronavirus reaches the lungs, it can cause severe inflammation. However, more and more data suggests that the heart and circulation also influence the progress of the disease. The summary:
Blood clotting: Does Covid-19 promote clot formation in the lungs?
Blood clotting allows the body to seal the injured vessels quickly, but also to fight pathogens. Then, among other things, it serves to catch intruders like bacteria or viruses using small clots. However, with severe inflammation, the interaction between the immune system and blood clotting can sometimes get out of control.
Laboratory values indicate that the blood of seriously ill Covid-19 patients coagulates significantly faster than would normally be the case. This can cause clots to form, which block important blood vessels in the lungs, for example. Could explain why some Covid-19 patients suddenly stop breathing.
“Deep vein thrombosis or pulmonary embolism was observed in a third of Covid-19 patients requiring intensive care,” said cardiologist Ilka Ott, chief physician at the Helios Clinic in Pforzheim.
An impression confirmed by Nikolaus Marx, cardiologist at the University Hospital of Aachen. Even in his intensive care unit, Covid 19 patients developed more and more clots in the lungs. “One hypothesis is that the virus can also affect endothelial cells, the cells that make up the inner wall of blood vessels,” says Marx. “These can trigger blood clotting.”
It has not yet been finally clarified how seriously ill Covid 19 patients benefit from anticoagulants. A small study from China showed that heparin increases the chances of surviving the disease. However, the study alone is not sufficient as scientific evidence.
Regardless of this, the drug is already used in Germany to treat seriously ill Covid 19 patients. “As a precaution, we treated all Covid-19 patients in the intensive care unit with anticoagulants,” says Holger Thiele, director of the university clinic for cardiologists at the Leipzig Heart Center. “This is something that we would not otherwise routinely do for all intensive care patients.”
Marx also administered heparin to his intensive care patients with Covid 19 to counteract coagulation. “We decreased his blood,” he says.
Pump needed: how Covid-19 stresses the heart
In some Covid 19 patients, the lungs become inflamed, in a particularly pronounced way: both lungs are often filled with fluid. As a result, the vessels in the lungs narrow. This has two consequences: the body receives less oxygen. And the right half of the heart, which pumps blood through the lungs, is under increased stress.
“Pneumonia is always a burden on the heart,” says Marx, who is the director of the Medical Clinic I in Aachen. However, if bacteria cause them, you could give them an antibiotic, and after a week or two the inflammation is gone and the stress on the heart has passed. “At Covid, we see patients with pneumonia that lasts for several weeks.”
If patients have to be ventilated, stress on the heart does not decrease in any way: “Covid-19 ventilation is particularly stressful for the right heart. This leads to increased pressure and resistance in the small circulation,” says Ilka. Ott. Some patients need additional cardiac medications, Marx explains.
“Each inflammation puts pressure on the cardiovascular system and therefore increases the risk of a heart attack or heart failure,” says Thiele. Whether Covid-19 causes heart attacks more frequently than the flu, for example, cannot yet be determined from the above data.
The Gateway: Does Covid-19 Disrupt Blood Pressure Regulation?
When you see the corona virus, you notice the spikes that cover its surface. With its help, the pathogen gains access to human cells. However, viruses dock at places on the cell surface that belong to one of the most important regulatory systems for blood pressure: ACE2 receptors.
The consequences of this have not yet been sufficiently investigated. ACE2 receptors are actually, from a health point of view, good parts of blood pressure regulation. They ensure that a substance that closes the vessels is broken down, thereby increasing blood pressure. If a virus docks, the cell loses the receptor. Doing so could already damage the infection.
However, the topic has been discussed for another reason: in Germany alone, around 16 million people take so-called ACE inhibitors every day, which lower blood pressure and are involved in exactly this system. Taking the drug can increase the amount of ACE2 receptors on the cell surface. The only question is: what are the consequences?
It would be conceivable that the greater extension of the coupling sites helps coronaviruses to penetrate cells. However, it is also conceivable that additional receptors protect lung tissue, for example, by compensating for loss of receptors to some extent by viruses.
“There is a lot of discussion about ACE inhibitors, although their impact on the Covid-19 course is not yet completely clear,” says Marx. “A lot of patients talk to me about it. Then I reply that they should definitely continue to lower blood pressure.”
A piece of advice that Thiele expressly endorses: “All specialized societies, regardless of whether they are American, European or German, agree that patients should never stop taking their medications,” says Thiele, board member of the German Society of Cardiology. is “Regarding Covid-19, it is important that the blood pressure is well adjusted.”
Direct attack: can the virus cause myocarditis?
Case reports of patients with Covid 19 who have developed myocarditis are increasing (here, here, and here). Myocarditis can also be the result of other viral infections.
If the heart muscle is inflamed, this can manifest itself through various symptoms: Some people feel weak, out of breath when under stress. Some feel severe chest pain or their heart skips. Myocarditis can cause arrhythmia and cause cardiac arrest.
Nikolaus Marx, who cares for several Covid patients in Aachen, reports that they all pay attention to certain laboratory values that indicate cardiac inflammation. If the values are noticeable, doctors look at the heart using ultrasound or MRI and look for signs of inflammation. “Not all Covid patients have myocarditis,” says Marx.
Indirect danger: go to the doctor if you experience heart attack symptoms!
Since the outbreak of the Corona outbreak in Germany, doctors have noted with concern that fewer heart attack or stroke patients show up in the emergency room. In March last year, 61 people with a heart attack went to the emergency room of the Aachen University Hospital, says Marx. This March there were only 37.
There is no reason to suppose that fewer heart attacks will occur. So despite the symptoms, people run away from the hospital. Some also come days later. “Please, no one should be so afraid of Covid that he doesn’t go to the hospital with a heart attack,” says Marx.
This appeal is also important to Thiele: “There is probably not negligible collateral damage because heart attack patients do not dare to go to the clinic for fear of being infected,” says the director of the University Cardiology Clinic at the Cardiac Center in Leipzig. He and his team also saw a 30 to 40 percent drop in patients.
“We fear that lack of treatment after the pandemic will result in an avalanche of patients with heart failure and heart arrhythmia,” he said. “We have to avoid that. Otherwise, there could be damage as great as the damage caused by the virus.”
