How Covid-19 affects the heart
Ruff Cajanding explains how to identify the extent of heart damage amongst coronavirus patients in a new article for the American Association of Critical Care Nurses Advanced Critical Care Journal.
Having worked through the first and second waves of the Covid-19 pandemic, I have looked after many patients who developed severe lung infections. Covid-19 usually infects the lungs and weakens them, and many of these patients need to be put on ventilators to support their breathing.
However, there were some patients who presented to hospitals with heart problems due to Covid-19 and they came to the intensive care unit (ICU) with severe heart attacks, inflammation of the heart muscle (myocarditis), and bouts of heart failure.
Reports from all over the world started to emerge showing that Covid-19 can damage many organs in the body, and that includes the heart and the blood vessels. As a specialist cardiac centre at St Bartholomew’s Hospital, we receive a great deal of these patients, ranging from the very young to the very old.
These patients are some of the sickest we’ve looked after in the ICU, and some have to be put on specialist heart-lung machines, known as Extracorporeal Membrane Oxygenation (ECMO), to support their failing heart and lungs.
This inspired me to write an article aptly entitled “Comprehensive Review of Cardiovascular Involvement in Covid-19,” published in the summer edition of the American Association of Critical Care Nurses Advanced Critical Care Journal.
I presented how Covid-19 can affect the heart and cause severe damage which can sometimes be catastrophic and fatal.
In this paper, I have also explained how NHS professionals can identify the extent of the heart damage amongst Covid-19 patients, and how it impacts patient care and management, particularly in the ICU.
My practical tips include:
- All patients with a heart condition, including the elderly, should be encouraged to adhere to protective measures such as shielding and self-isolation to prevent inadvertent exposure.
- Patients with heart conditions should have their medical tests, investigations and procedures performed in a Covid-free environment using appropriate PPE.
- Patients presenting with chest pain or signs of heart attack should not delay medical attention as timely reperfusion and revascularisation is life-saving.
- Routine investigations such as ECGs, chest X-rays, and CT scans should be used judiciously and with the risks to patients and health staff minimised.
- High-risk cardiac patients should be admitted to units with cardiac monitoring as their risk for clinical deterioration is high and their complications are catastrophic.
- Facilities for the delivery of more invasive cardiorespiratory support (for example, cardiac catheterisation, pacing, ECMO, cardiac surgery) may be needed for some cardiac patients who are deteriorating clinically.
This paper will serve as a guide to healthcare professionals who are looking after Covid-19 patients with heart conditions.
Looking after these patients is a real challenge for the entire health care team because we are battling a virus that no one has ever fought before, and whilst more is learned and discovered every day about this disease, there’s still a lot that that we don’t know and is yet to be known.
Similarly, patients who have pre-existing heart conditions appear to have more severe presentations of Covid-19 and they are more likely to suffer from the devastating effects of the disease.
By sharing this knowledge, I hope that we can all do our share in helping patients recover from this deadly disease.
Ruff Cajanding is a charge nurse on the adult critical care unit at Barts Heart Centre, St Bartholomew’s Hospital. You can read his article in the American Association of Critical Care Nurses Advanced Critical Care Journal.