How are hearts faring in a COVID-19 world?

There has been much focus on all of the manifestations of COVID-19, not only physically, but mentally on all of us. Like many of you, I have struggled with the unknowns of this disease, having close friends and family diagnosed with COVID-19 and dealing with all of the changes in our world. Recently, I read two articles that discuss different cardiac aspects of our COVID-19 world.

The first scenario describes non-COVID-19 patients admitted with stress cardiomyopathy. Cleveland Clinic studied admissions from March and April 2020 for 258 patients admitted with symptoms of acute coronary syndrome (ACS). They noted an increase in patients with stress cardiomyopathy.

Pre-COVID-19, the incidence of stress cardiomyopathy in patients presenting with ACS symptoms was about 1.7 percent. Since COVID-19, the incidence is around 7.8 percent. In this study, none of those afflicted were COVID-19 positive. Stress cardiomyopathy is also known as Takotsubo cardiomyopathy or broken-heart syndrome. It is a condition that occurs in response to strong physical or emotional distress, resulting in heart muscle dysfunction or failure. The patient experiences symptoms similar to an MI but upon scan and diagnostic studies, does not have acute blockage of coronary arteries. The exact mechanism is unknown, but it is believed to occur due to a release of stress hormones. The good news is that most patients fully recover their heart function in a matter of days or weeks.

The second scenario is cardiac dysfunction in COVID-19 positive patients. Some patients have presented to the emergency department with ECG changes consistent with an ST-elevation myocardial infarction (STEMI). However, when taken for intervention there was no appreciable blockages to revascularize. The American College of Cardiology is collecting patient information through the National Cardiovascular Data Registry. A similar effort is occurring between American and Canadian interventional cardiology associations via The North American COVID-19 ST-Segment Elevation Myocardial Infarction Registry (NACMI). The registry includes all COVID-19 positive patients or persons under investigation (PUI) with ST-segment elevation or new-onset left bundle branch block (LBBB) with a clinical correlate of myocardial ischemia (including chest pain, dyspnea, cardiac arrest, hemodynamic instability). There is no direct explanation at this time for this presentation, but I eagerly await updates from the medical community as to the cause or mechanism related to COVID-19.

Two different issues with one common theme: COVID-19 causing us distress. One could wonder if these two aren’t related, as perhaps COVID-19 causes stress cardiomyopathy (which commonly mimics as MI). However, that is just pure speculation on my part as I too navigate this pandemic. Take care of yourselves (and your hearts)!

Cheryl Manchenton is a senior inpatient consultant and project manager for 3M Health Information Systems.

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