Covid and heart patients

We have a large population of high-riskindividuals in the valley with diabetes, high blood pressure, Previous heartattacks, patients with low left ventricular function (ejection fraction lowerthan 45%). Besides this a large population has chronic lung disease likechronic bronchitis, healed tuberculosis etc. These are the individuals who ifthey get COVID19 due to contact with a positive patient or his contacts have anoutcome which is poor with high mortality.

Besides this there are reports showing thatCorona virus infection itself can produce heart problems. This is because lungsare primarily affected through the virus entering from droplet mode andproducing pneumonias. Lungs and heart have an intimate relation ship bothbecause of contiguity and may be extension of inflammation. This can produceECG picture mimicking a heart attack, inflammation producing swelling of heart(myocarditis), disorders of heart rhythm leading to chaotic and bizarrearrhythmias (Ventricular tachycardia, ventricular fibrillation) leading tosudden death. Many of these individuals are on treatment for high bloodpressure, heart failure drugs, anti-diabetic drugs, anti-platelets like(aspirin, clopidogrel etc), anti-coagulants (Warfarin or agents likedabigatran, apixaban, rivaroxaban).

   

The general hygienic measures which arebeing propagated extensively like Social distancing, repeated washing of handswith soap and water, using handkerchief to cover mouth and nose while coughingand sneezing need to be observed very rigorously by all these patients.

Besides these it is very important that allpatients with high blood pressure must continue their BP lowering medicines. Ithad come in as a news in some media reports that patients on Ace inhibitors(Ramipril, lisinopril, enalapril etc) or Angiotensin receptor blockers(Losartan, Telmisartan, Olmesartan etc) should not be taken because the Coronavirus also acts through the ACE receptor. These reports were however refutedand guidelines were released by American and European Societies that thesedrugs are absolutely safe and in fact should be the preferred agents. BP shouldbe measured often at home only to ensure that it is less than 140/90 mms Hg. Ifit is not or is causing concern to the individual, then an opinion should besought. They should contact the treating physician on telephone, watts up orsocial media and take action accordingly. Self-medication or altering medicineswithout consulting should be strongly discouraged.

Like wise patients on other medicines forthe cardiac problems must continue as such. In response to some media reportsthere has been an upsurge in some people to take hydroxychloroquine andazathioprine etc. These are not recommended except in some special situationslike for asymptomatic healthcare workers involved in the care of suspected orconfirmed cases of Covid-19 and asymptomatic household contacts of laboratoryconfirmed cases.

As per the advisory from Indian Council ofMedical Research (ICMR). Hydroxy-chloroquine is found to be effective againstcoronavirus in laboratory studies and in-vivo studies. Its use in prophylaxisis derived from the available evidence of benefit as treatment and supported bypreclinical data,” the advisory said. The drug is not recommended forprophylaxis in children under 15 years of age. According to the advisory, the drughas to be given only on the prescription of a registered medical practitioner.

Chloroquine and Hydroxy Chloroquine aredrugs traditionally used for treatment of malaria, rheumatoid and some autoimmune diseases. One has to be very careful regarding administration of Hydroxychloroquine in elderly people and also in patients with a background of heartdisease. It can produce ECG changes leading to serious arrhythmias and death.This drug has also interaction with anticoagulants making them more prone toserious bleeding and needs frequent checks of INR if on warfarin.

Any body with a contact with a positivecase of COVID-19 or his close family members or contacts should be verycareful. He or she should contact the designated Govt centre to get a test forCOVID done which at present is a nasal and naso-pharyngeal swab taken byprofessionals trained to take it. They wear a special attire called Personal protection instrument (PPI) toprotect themselves and the community from infection . The sample is highlycontagious and is to be transported in a sealed tube un exposed to theatmosphere.

Lastly it is extremely important to keepthese high-risk individuals isolated. It is the duty of the family to ensurethis in the larger interests of the society at large.

Author is a Cardiologist. Recipient of Padmshiri and Dr B C Roy Award

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