Young fatalities: Virus could be attacking heart

Young fatalities: Virus could be attacking heart

Sunitha.Rao@timesgroup.com

02.07.2020

Bengaluru: Globally less than 1% of Covid-19 fatalities are those below 40 years, a trend in Karnataka too. Over the past four days, four men below the age of 40 have suddenly died of acute breathlessness, prompting doctors to suggest it could be a sign of viral myocarditis.

A 32-year-old was brought dead to a hospital in Belagavi on Monday, while a 29-year-old died soon after being admitted in Mysuru the same day. A day previously, a 31-year-old from Ballari died of breathlessness soon after hospitalisation, and a 40-year old from Ramanagara died hours after being admitted. None of the four had comorbidities.

Doctors say patients suddenly collapsing and dying suggest viral myocarditis, a condition where the virus attacks heart muscles, disrupting electrical pathways that are vital for the heart to pump properly. While doctors suspect viral myocarditis, it cannot be scientifically established as autopsies of Covid-19 fatalities are not allowed.

To better understand cardiac manifestations in Covid-19 patients, Sri Jayadeva Institute of Cardiovascular Sciences and Research Institute (SJICSR) had provided Covid-19 dedicated hospitals of Bangalore Medical College and Research Institute with an ECG and Echo cardiogram machines each.

“It is possible that like other viruses, SARS-CoV-2 too is leading to viral myocarditis,” said Dr CN Manjunath, director, SJICSR. “First infection, followed by inflammation of the heart muscle and then clotting (thrombosis) is a typical pattern of viral myocarditis. In some patients, the virus may have caused acute respiratory distress due to infection in the lungs as well.”

Experts say host immunity matters in a viral infection and hence the experience of patients differs. The largest study to examine the association between cardiac involvement and Covid-19 was performed in Wuhan, China. Of 416 patients at Renman hospital in Wuhan University, 82 (19.7%) had cardiac injuries. Mortality among those with such injuries was significantly higher (51%).

“A heart biopsy will show inflammation in the heart muscle,” said Dr Rahul Patil, head of the project, Young Age Heart Attack, SJICSR. “Inflammation is secondary to viral infection. It might mimic a heart attack, but confirmatory tests are cardiac MRI, myocardial biopsy and Covid-19 testing if the patient is brought dead.”

Covid-19 hospitals here are not multispeciality centres, so we do not have a setup to constantly check Echo and ECG of patients. Studies done in the US say three of 1,000 patients had viral myocarditis and it could be true in India too. However, some brought dead cases had comorbidities, so we can’t draw definite conclusions

Dr Ramesh Revanna PULMONOLOGIST, B’LORE MEDICAL COLLEGE & RESEARCH INSTITUTE

We have so far seen at least 10 brought-dead cases. The virus has multiorgan involvement so we can’t categorically say death is due to viral myocarditis. There could have been concurrent renal failure or end stage sepsis

Dr KV Trilok Chandra NODAL OFFICER, CRITICAL CARE, TELE ICU TEAM