Doctors could inadvertently be treating COVID-19 patients who suffer heart attacks in ways that may not help save their lives, according to new research.
A letter published Friday in the New England Journal of Medicine involved a case study of 18 patients hospitalized for COVID-19 during the first month of the epidemic in New York City. Researchers found patients had elevated electrocardiogram readings usually associated with having a heart attack yet 10 showed no signs of arterial blockage.
Thirteen of the patients died in the hospital, and of that number, nine showed their heart injury was not caused by a blockage.
Patients with elevated EKG readings would normally have their blood vessels checked for blockages with an angiogram, and if found, would have a stent open the passageway. But healthcare personnel could be exposed to the virus when performing invasive procedures like an angiogram.
Study lead author Dr. Sripal Bangalore, an interventional cardiologist and professor of medicine at NYU Langone Health, said since the pandemic started some clinical groups have proposed avoiding performing angiograms in all cases and instead using what are known as "clot busting" medications to treat heart injury.
But Bangalore said the study shows those drugs would have little effect since many of the patients had no blockages. "We need to individualize the care given that there are multiple reasons that his happens in a COVID-19 patient," he said.
There's been lots of attention on the underlying health conditions that could cause someone to die from COVID-19.
But the latest findings confirm growing suspicions that the coronavirus could cause life-threatening cardiac issues.
A study published in March in JAMA Cardiology found coronavirus was associated with, "…high inflammatory burden that can induce vascular inflammation, myocarditis, and cardiac arrhythmias."
The new study also presents a dilemma for clinicians who must decide when more invasive measures to treat cardiac injury in COVID-19 patients are needed.
"You have to be cognizant of the fact that every patient that has EKG changes or how have positive blood tests for damage to the heart does not mean there could be a blockages," said Dr. Salim Virani, professor in cardiology and cardiovascular research at Baylor College of Medicine in Houston and chair of the American College of Cardiology's Prevention of Cardiovascular Disease Council. "There are other mechanisms that could be at play here."
Potential causes for heart injury besides an arterial blockage include a cytokine storm, or a hyperactive immune reaction to the virus, or low levels of oxygen getting to the heart, among others.
"COVID-19 does cause damage to the heart—now how much of that damage is caused by a block versus all of these indirect other mechanisms...that is what the dilemma is," Virani said.
Dr. Mariell Jessup, chief science and medical officer for the American Hearty Association, said no one knows at this point what the long-term implications might be for those who survive cardiac injuries caused by COVID-19. She said a greater challenge at the moment involved convincing those who experience cardiac symptoms to go the hospital immediately rather than staying at home for fear of getting infected.
"I think people are delaying and one of the consequences is that people are dying at home and whether that's going to be chalked up to COVID-19 doesn't really matter," Jessup said.
In several states, government officials have had to correct death tolls after accounting for people who died in their homes and only posthumously were tested for COVID-19 infection.