Heart scans of coronavirus patients in hospital have revealed a range of abnormalities that can disrupt the ability to pump blood and in severe cases lead to a life-threatening failure in the organ.
Doctors at Edinburgh University examined ultrasound scans known as echocardiograms from more than 1,200 patients in 69 countries and found heart problems in 55%, with one in seven exhibiting signs of “severe abnormalities”.
The scans found damage to the ventricles – the two main chambers of the heart – in more than a third of the patients, while 3% had experienced heart attacks and a further 3% had inflamed heart tissue. The majority had no known heart disease before the scans were done.
“The proportion with an abnormal scan was really high,” said Dr Anda Bularga, a researcher at Edinburgh who worked on the study. “Half of them had an abnormal scan, which makes us think this could be because of the viral infection.”
Doctors give patients echocardiograms only when they suspect there is a problem with the heart, so the high number of abnormalities is not unexpected. How common heart damage is in Covid-19 patients more generally is unclear.
Bularga said the findings showed how crucial ultrasound scans could be for identifying patients with serious heart problems caused by Covid-19. She said some doctors had been reluctant to order them during the pandemic because the procedure involves close contact with patients.
One in three patients in the study had their medicine or care changed as a result of a scan, such as receiving drugs for heart failure, Bularga said. “If a doctor suspects there’s a problem with the heart, these scans should be done.”
The findings build on a growing body of evidence that Covid-19 affects not only the lungs but other organs including the brain and heart. Early studies from China and Italy showed that up to 20% of patients in hospital with Covid-19 had heart damage.
Because the virus causes inflammation and fluid buildup in the lungs, the heart often has to work harder to pump oxygen-carrying blood around the body. The heart can fail from working too hard, or the lack of oxygen can cause tissue damage to the heart. In other patients, the virus can infect the heart muscle directly and make it inflamed.
Writing in the European Heart Journal, the doctors described how raised levels of two compounds in the blood helped to identify patients with heart damage seen on the scans.
Prof Marc Dweck, who led the research, said: “Covid-19 is a complex, multi-system disease which can have profound effects on many parts of the body, including the heart. Many doctors have been hesitant to order echocardiograms for patients with Covid-19 because it’s an added procedure which involves close contact with patients. Our work shows that these scans are important: they improved the treatment for a third of patients who received them.
“Damage to the heart is known to occur in severe flu, but we were surprised to see so many patients with damage to their heart with Covid-19 … We now need to understand the exact mechanism of this damage, whether it is reversible and what the long-term consequences of Covid-19 infection are on the heart.”