CORONA CAN TRIGGER AN UNDERLYING HEART CONDITION DR. JAMAL YUSUF
In a study I co-authored along with my colleagues at GB Pant Hospital – Saibal Mukhopadhyay, Abhimanyu Uppal, Ghazi Muheeb, and Rupesh Agarwal – we have established that not only does Corona virus impact the lungs, it can also trigger any underlying heart condition. We came to this conclusion after a 57-year-old male patient with no history of heart trouble was admitted to the emergency ward of our hospital with a dangerously high heart rate.
The manifestations of Coronavirus disease (COVID-19) range from asymptomatic infection to multi-organ failure and death. Among these, COVID-19 related myocarditis and arrhythmias are hypothesized to result from direct viral myocardial injury and inflammatory cytokine-induced damage. The GB Pant team reports a patient presenting sudden onset of palpitations associated with dizziness and profound sweating. Two episodes of VT were documented and needed direct current cardioversion due to haemodynamic instability. After three hours, he was referred to our emergency on IV amiodarone infusion.
COVID-19 related cytokine surge triggering VT storm and unmasking a clinically silent ARVC had not yet been reported. The case highlights a lifethreatening presentation of COVID-19 and indicates a probable link between inflammation and arr hy th mo ge ni city.
The echocardiography of the patient showed dilated RV and RV outflow tract (RVOT), RV fractional area change of 23.3 percent. The left ventricular (LV) dimensions and function were normal. The patient met all major non-histological modified task-force criteria for diagnosis of ARVC. As a part of the protocol in our institute to assess COVID-19 status of all emergency patients warranting admission, reverse transcription – polymerase chain reaction (RT-PCR) assay for COVID-19 on naso-pharyngeal swab was done, which came out positive with a cycle-threshold (Ct) value of 25.4. His laboratory investigations showed a high ESR rate, C-reactive protein, raised neutrophil to lymphocyte ratio (NLR), interleukin 6, D-dimer, and B-type natriuretic peptide (BNP).
COVID-19 infection primarily causes reparatory symptoms but presentations with malignant ventricular arrhythmias without concomitant respiratory symptoms have been reported associated with underlying myocarditis or coronary heart disease. However to the best of our knowledge, VT storm due to COVID-19 induced myocarditis that unmasked an underlying clinically silent cardiomyopathy had not yet been reported. Though the present case represented a rare form of cardio-myopathy, it provides insights into the plausible mechanisms of COVID-19 induced malignant ventricular arrhythmias. The patient had never experienced any cardiac symptoms but the cytokine storm following the COVID-19 infection unveiled the dormant electrical instability.
In conclusion lead author of the study, Dr Saibal Mukhopadhyay and the rest of us who were a part of the study had to agree that COVID-19 triggered cytokine surge can unmask a dormant cardiomyopathy and manifest solely as malignant ventricular arrhythmias like VT storm in absence of any associated respiratory symptoms.