Five critical answers for the protection of the heart from the Rector of EKUA, Professor of Cardiology Gerasimos Siasso

How does the infection with COVID-19 affect the cardiovascular system?

As is known, the SARS-Cov-2 virus that causes the disease COVID-19 can affect the cardiovascular system and the heart function itself, especially in the presence of heart disease and heart failure.

The cardiovascular system is affected either directly damage of the heart either in disorder of the functionality of the arteries and endothelial dysfunction as it has been seen from our own studies. In addition, due to the disturbances in the mechanisms of thrombosis, the activation of the coagulation cascade and the inflammatory response, both during the period of the disease and the first period after the acute disease, mobilization of enzymes of myocardial damage can occur with an increase mainly in troponin, an increased incidence – possibility of causing myocardial infarction, myocarditis, pericarditis and a variety of cardiac arrhythmias.

For people who do not have a diagnosed cardiovascular disease, what do you recommend if they get sick with COVID-19 or other viral infections?

All patients who have been ill, especially those who are over 40 years oldhave a family history of early onset of cardiovascular disease or with comorbidities, it is an opportunity to be examined for classic cardiovascular risk factors (dyslipidemia, hypertension, Diabetes, kidney disease etc.) so that they take the appropriate preventive measures, and the preventive treatment that will protect them from future cardiovascular events.

It is also an opportunity to join a program of intensive monitoring and systematic modification of unhealthy lifestyle habits. If they exist symptoms such as chest pain or discomfort, shortness of breath, palpitations or evidence of cardiovascular complications (as determined by clinical examination, imaging tests eg chest x-ray, and biochemical markers eg increased serum troponin and natriuretic peptides) should in principle to carefully check the heart function with an electrocardiogram and ultrasound imaging of the heart.

What are the main symptoms from the cardiovascular system as a complication of a COVID-19 infection or other viral infections?

Cardiovascular complications are not common, but special attention should be paid to patients who present symptoms. The appearance of pectoral pain, angina (constrictive chest pain in the procardium), difficulty breathingeasy fatigue“shortness of breath” – tachypnea and arrhythmias that can be perceived as a heart rhythm disorder or “palpitations” must in any case be evaluated by a medical specialist.

What should heart patients be aware of?

Heart patients and especially those with heart failure or uncontrolled hypertension or who are obese have an increased risk of developing complications from COVID-19.

As a precaution, it is important that they have completed their program vaccinations their. They must also have regulated all underlying diseases (heart failure, diabetes, hypertension) in the best possible way so that if they do get sick, they can better cope with the “stress” of being sick from COVID-19.

When people with underlying cardiovascular diseases are sick with COVID-19, depending on the severity of the disease, they should immediately contact their treating physicians for the possibility of receiving specific antiviral treatment. In this case it is often necessary to modify a row medicines that heart disease patients receive and this must be done in consultation with their cardiologist in order to protect themselves in the best possible way. Also, high fever alone can lead to deregulation in people with heart failure, and for this reason, the doses of cardiac drugs must often be modified. In conclusion, it is important for all heart patients to be in close contact and communication with their attending cardiologist if they become ill with COVID-19.

What tests should be done during or after recovery?

Tests to be performed during or after recovery (from infection with COVID-19 or other viral infections) vary and are individualized depending on the patient’s history, symptoms, and clinical course of the disease. In particular, if there are signs of cardiovascular complications, it is recommended: clinical examination, electrocardiogram, laboratory test (general blood count, biochemical control of liver and kidney function, troponin, markers of inflammation such as CRP, natriuretic peptides), imaging usually with simple echocardiogram. Depending on the results of the tests and the clinical picture, additional tests such as magnetic resonance imaging of the heart may be deemed necessary by the cardiologist.

Some of the tests that may be requested after recovery from COVID-19 and especially if some symptoms persist are: Electrocardiogram, chest X-ray, echocardiogram, Rhythm Olter, magnetic resonance imaging of the heart (on image of myocarditis), fatigue test / dynamic echocardiography and tests of blood such as general blood, glucose and glycated hemoglobin, indicators of renal function (serum urea and creatinine), indicators of myocardial necrosis (troponin), indicators of cardiac function – natriuretic peptides – and measurement of inflammatory markers.

A special category of people are also those who exercise regularly. Returning to sporting activities should be done with caution. In any case, they should not return to sporting activities before symptoms subside, and cardiorespiratory fatigue testing may be useful in this group of patients.

The cardiology assessment and follow-up of those who have been sick with COVID-19 can also be carried out in special cardiology clinics. At the “I SOTIRIA” GNNTHA, in the 3rd University Cardiology Clinic, a cardiology follow-up clinic for patients after a COVID-19 infection is already operating, staffed by experienced cardiologists (tel. appointment 1535, Clinic Code 08758).