50% reduction in cases of heart attacks reported in lockdown, but death rate up as patients delay treatment due to Covid fears

• Report findings by renowned cardiologists from Meenakshi Mission Hospital and Research Centre, Madurai, in the run up to the World Heart Day.

MADURAI / 28 September 2020 – There has been a more than 50% drop in cases of acute heart attack in three months of the ongoing lockdown, compared to the same period last year.  Increased death rate has also been witnessed among patients of acute heart attacks admitted at the hospital due to delay in seeking medical care because of fear of Covid infection.

Said Dr. N. Ganesan Senior Consultant – Cardiology, Meenakshi Mission Hospital, Madurai: “We have witnessed a significant reduction in cases of acute heart attack during Covid19. Total patients admitted during three months of the lockdown at Meenakshi Mission Hospital is 355, compared to 820 cases during the same period in 2019. Our statistics concur with European and American heart surveys, both of which have shown a 50-60% reduction in cases of acute heart attack in their own countries.”

He added: “People with previously undiagnosed heart disease may also be presenting with previously silent cardiac symptoms unmasked by the Covid infection. In people with heart-vessel blockages, infection, fever, and inflammation can destabilize the heart vessels. In addition, there is a subset of people with COVID-19 — some of them previously healthy — who develop inflammation of the heart muscle due to the virus directly infecting the heart. This type of inflammation could lead to heart rhythm disturbances and cardiac muscle damage.

Said Dr. S. Selvamani, Senior Consultant – Cardiology, Meenakshi Mission Hospital, Madurai: “There are many reasons for a reduction in cases of acute heart attacks, including less stress due to staying at home, reduced air pollution, people not seeking hospital care for fear of the infection and no availability of transport to visit a medical facility. However, there has also been a parallel increase in out-of-hospital sudden deaths during the lockdown, as patients delay seeking care after suffering a heart attack.

Added Dr. R. Sivakumar, Senior Consultant –Cardiology, Meenakshi Mission Hospital, Madurai: “COVID-19 may spark cardiac trouble in multiple ways. It is an infectious pulmonary illness that causes stress on the heart in both healthy people and those with pre-existing heart disease. Second, people may experience heart damage that mimics heart attack injury even if their arteries do not have blockages that cause classic heart attacks. This can occur when the heart muscle is starved for oxygen, which in the case of COVID-19 may be triggered by a mismatch between oxygen supply and oxygen demand.”

Dr. M. Sampath Kumar, Sr. Consultant – Cardiology said: “While majority of COVID-19 patients appear to recover well, a smaller number experience severe, exaggerated inflammation throughout the body, called a cytokine storm. This inflammation, affecting the entire vascular system, is seen in the most severe cases and at the advanced stage of the illness. It can lead to widespread blood clotting, organ failure or damage to the heart. Drug-related heart damage during COVID-19 treatment is also a concern. In particular, the use of antiviral drugs should be monitored.”

Said Dr. P. Jeyapandian, Consultant - Cardiologist & Electrophysiologist, Meenakshi Mission Hospital, Madurai: “Initially thought to be an infection causing disease of the lungs, inflammation of the vascular system and injury to the heart appear to be common features of Covid-10, occurring in 20% to 30% of patients and contributing to 40% of deaths. Patients with pre-existing cardio-vascular disease have five times higher fatality rates than the overall COVID-19 infected population. Nearly a quarter (23%) of people hospitalized for COVID-19 have experienced serious cardiovascular complications. Studies have also shown that 8% to 12% of all COVID-19 patients have acute cardiac injury.”

Our advice to heart patients in Covid times is to observe social distancing, wear face mask and do handwashing, don’t stop their medications, regularly monitor blood pressure in case of hypertension or heart failure, take advantage of telemedicine, and in case of signs of heart attack, don’t let COVID-19 stop them from seeking urgent cardiac care. The risk of dying due to heart attack is much higher than the risk of contracting Covid infection in the hospital.”

The theme of World Heart Day this year is “Use your heart to beat CVD.” Cardiovascular diseases (CVDs) have emerged as the number one cause of death of humans, accounting for 31 percent of all deaths globally, most of them due to heart attack and stroke. Out of the 17 million premature deaths (under the age of 70) due to noncommunicable diseases in 2015 worldwide, 82% were in the low- and middle-income countries, and 37% were caused by CVDs. There is a ray of hope, however. Most CVDs can be prevented by addressing risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol, using population-wide strategies.

****