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Thursday, December 08, 2022

Scientist: COVID-19 may cause more damage to the heart

The pain in his chest was sudden, heavy.

Juan Sosa was at home doing pushups in the bedroom, where he isolated himself for nearly two weeks after testing positive for COVID-19. His mild symptoms were long gone, and it was the last day of his quarantine.

A retired carpenter, Sosa was vaccinated and considered himself a healthy 58-year-old. He thought he had gas and was not too worried. But the pain was severe so he took himself to the walk-in clinic.

Doctors quickly determined that Sosa was having a heart attack. An ambulance took her to HCA Florida Brandon Hospital. The last thing he remembers that day was a nurse ripping off his T-shirt.

Veteran cardiologist Hoshedar Tamboli was attending to patients in his Brandon office when he received a call from a patient in cardiac arrest.

Tamboli hurriedly rushed to the emergency room. After a quick checkup, he orders Sosa to be taken to a cardiac catheterization lab equipped to open up blocked arteries.

Sosa’s blood pressure and vital signs were falling. Tamboli had to quickly figure out why.

He had performed an estimated 20,000 heart catheterizations, but the effort to save Sosa’s heart and his life would be like no other.

Tamboli said, “Time is strong in my business.” “Like the brain, once the heart muscle dies, it doesn’t regenerate.”

Sosa’s case, which surfaced in late September, fits a striking pattern among COVID-19 patients across the country – one that researchers and clinicians alike are working to understand.

Scientists now believe that COVID-19 patients are more prone to respiratory problems. Many studies have shown that this virus can also damage the heart.

The risk is even greater for those with heart disease.

A September 2020 study found that the risk of a first heart attack increased three to eight times in the first week after a diagnosis of a COVID-19 infection. The study, published by the medical journal The Lancet, infected nearly 87,000 people in Sweden over an eight-month period. Their risk of stroke increased up to six times.

Another study published in February in Nature Medicine looked at Department of Veterans Affairs health data for nearly 153,000 veterans who contracted the virus. The researchers found that the veterans had an increased risk of several heart conditions up to a year later.

The study found that the elderly were more likely to experience irregular heart rhythms and potentially fatal blood clots. They had a 52 percent higher risk of stroke, a 63 percent higher risk of heart attack, and a 72 percent higher risk of heart failure.

The study showed that people who were not hospitalized were also more likely to have heart problems. Severe COVID-19 symptoms indicated an even greater risk.

Cardiologist Hoshedar Tamboli displays a picture on his computer screen from the heart angiogram of patient Juan Sosa at Heart Vascular & Vein in Tampa Bay, Brandon. Studies have shown that a COVID-19 infection can increase the risk of heart attack or stroke. Perhaps that’s why Sosa, 58, suffered a heart attack two weeks after being infected. Tamboli operated on Sosa and saved his life.

How does a virus that primarily attacks the lungs put the heart at risk?

Except in damaged cells, COVID-19 can spread through the bloodstream. The same virus proteins that are able to bind to cells in the lower respiratory tract can also bind to heart tissue, said Richard Baker, MD, a physician, professor and director of the Heart, Lung and Vascular Institute at the University of Cincinnati College of Medicine.

The body’s immune response to the invading virus, he said, can also increase inflammation and the amount of injured heart tissue.

Baker said 20 percent of people with severe COVID-19 show signs of heart damage.

Baker said even mild infections can cause damage, mostly from myocarditis, an inflammation of the heart that occurs two to three times in every 1,000 COVID-19 cases. It also increases the risk of blood clots that can lead to a heart attack.

Baker said why patients with COVID-19 have a higher risk of clots is not clear. It may be associated with inflammation of the blood vessels and certain types of antibodies.

“The potential for long-term cardiovascular risk is a concern,” he said.

Sosa had all the symptoms of someone whose artery had become dangerously clogged by a cholesterol plaque or blood clot.

To locate the blockage, Tamboli inserted a catheter — a hollow tube — through a small incision in Sosa’s groin and into an artery directed toward her heart. They injected dye into Sosa’s bloodstream, which appeared on live X-ray images, giving the medical team a peek inside his arteries and heart.

Looking at the images, Tamboli found that Sosa had an unusual anatomy in his heart that he had seen in only two or three other patients in his decades-long career. Functionally, the limb was fine. But this made it difficult to identify the problem.

Tamboli knew that time was under pressure. In the end, he got a clot.

The cardiologist carefully fed the catheter through the blocked artery. Attached was a suction device that Tamboli planned to use to empty the clot.

They then planned to insert and inflate a small balloon to open the artery, followed by a mesh metal tube known as a stent, which would keep the artery open and keep blood flowing.

Then Sosa’s heart stopped.

A dozen medical personnel arrived at the lab. It was a “code blue” – Sosa needed resuscitation.

A critical care doctor guided the respondents. They intubated Sosa to breathe, connecting a tube to a ventilator and inserting it down his throat. He injected her with medicine to increase the output of her heart. With a defibrillator, they rattled his heart.

Three doctors alternately performed CPR.

In the midst of this “organised chaos”, Tamboli was still trying to open Sosa’s blocked artery. X-ray images showed his stopped heart.

“He’s dying on me, literally dying on me,” Tamboli remembered.

Under ideal circumstances, running a catheter wire through the arteries toward the heart is a difficult process, a series of delicate, subtle movements and adjustments.

Tamboli was trying to do it on a body being jolted by defibrillators and doing chest compressions.

“It’s like trying to fix an engine with the engine running,” he said.

Tamboli told the CPR performers that they needed to pause for an interval of 10 seconds. CPR was stopped four times.

Knowing he had little time left and only a rough idea of ​​where the clot was, Tamboli asked a nurse for the longest stent. They then fitted a 1¼-inch-long reticular tube inside Sosa’s right coronary artery.

After placing the stent, doctors were able to restart Sosa’s heart. He was medically dead by about a minute.

Sosa was alive, but barely.

His blood pressure was “in the toilet” and no one in the room believed he would survive.

“The critical care doctor tells me, ‘You know, I think he’s gone. Maybe we should go and talk to his wife,'” Tamboli said.

Tamboli knew it made medical sense to stop. But something inside told him to persevere. He knew that Sosa was relatively young and in good health, apart from high blood pressure.

As a last resort, they decided to install a small heart pump known as an impala inside Sosa. This device does most of the work of the heart, transporting healthy blood to the organs. He hoped it would reduce the strain on Sosa’s heart muscle, allowing him to recover.

The device was inserted through the same femoral artery. But even with the pump on, Sosa’s heartbeat remained weak.

The doctors couldn’t do much. They took Sosa to intensive care and placed him in a medically induced coma. He was given an IV drip of a drug called Inotropes, which makes the heart beat louder.

His body temperature was lowered to about 36 degrees to give him the best chance of survival without damage to his brain.

“I asked his wife and family to pray hard for divine help as we did what we could,” the doctor said.

Sosa had not improved when Tamboli returned to the hospital the next day.

Three days later, doctors began taking Sosa out, slowly warming his body. Tamboli kept calling for updates.

The nurse’s report on the fourth day raised hope in Tamboli. Sosa’s medications were cut short and he was no longer dependent on ventilators.

When Tamboli makes his rounds, he examines Sosa himself. An echocardiogram showed a strong heartbeat. Sosa sometimes opened his eyes. The doctors and nurses standing next to their unconscious patient hugged and wept. They didn’t know Sosa but they knew how hard the medical team had worked to save him. They knew how close he was to death.

On September 28, five days after Sosa’s heart attack, Sosa’s doctors removed the heart pump.

There were still two more days for Sosa to come to his senses.

He found his hands and feet restrained on a hospital bed, a precaution against movements that could disconnect the IV drip and sensors monitoring his vital signs.

He had black marks on his hand. His whole body felt torn.

He thought it had been a day since the ER nurse unbuttoned his shirt. A nurse told that he was unconscious for a week.

When Tamboli entered his room, he was sitting up. The doctor jumped.

“He was very surprised,” said Sosa. “It’s like when you see a dead person.”

Tamboli cannot say with certainty that Sosa’s COVID-19 infection caused a blood clot and caused a heart attack.

The doctor said that typically, clots appear along with plaque, which is a telltale sign of high cholesterol issues. It was unusual to see a clot in an artery without plaque.

Sosa had never had heart problems before. never smoked. never drank

In Tamboli’s experience, people who have caught the virus have a higher tendency to clot. He said many of his patients who are discharged after infection are on blood thinners.

Tamboli cannot explain why Sosa survived. In his 35 years treating heart patients, no patient has lived and lived so close to death. In such matters they believe that a higher power intervenes, be it fate or the future or God.

“It’s the law of the universe,” he said. “Something is higher than us. There is a bandmaster ahead.”

Sosa, who turns 59 in January, says he is in good health, but gets tired more easily.

She is on a daily regimen of 12 pills which includes blood thinners. Every three months he should be seen by a cardiologist.

In the five months since his heart attack, he has experienced many of the same feelings—relief, gratitude, an increased closeness with God, and a newfound joy in life—as others have experienced near-death. Is.

They hope their experience will be a warning to others not to ignore symptoms that could indicate heart trouble.

Sosa still exercises, but slowly. He still works as a handyman around the house, but no longer works until evening.

He takes out more time to enjoy life a little more, to walk on the beach, to be with his wife, kids and three grandchildren.

“I know how fragile we are,” he said.

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