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Can the heart escape the attack of the “new crown virus”?Critically ill patients fear arrhythmia, heart failure kills their lives

[Chinese Health Net article/Dr. Cai Haoyuan, Department of Cardiovascular Medicine, Yadong Hospital]The world under the new coronary pneumonia

The impact of the new crown pneumonia epidemic on the world is far-reaching. From the initial fear of contracting the new crown virus, it slowly extended to all kinds of worries about the vaccine. However, excessive panic and anxiety, in addition to delaying the existing chronic diseases and losing the opportunity of vaccination, even stretch out the mental depression. Knowing it, facing it, and making the best choice for oneself is the best policy. I will explore the relationship between COVID-19 and the heart from the perspective of a cardiologist.

Can the heart escape the attack of the “new crown virus”?Critically ill patients fear arrhythmia, heart failure kills their lives

The impact of new coronary pneumonia on the heart

The infection of new coronary pneumonia is particularly likely to cause acute respiratory failure, cardiogenic shock, thrombosis, and even death due to serious complications in the elderly and patients with cardiovascular diseases. Although it is regarded as a respiratory disease, the accumulated experience around the world has found that a high proportion of patients have obvious cardiovascular complications. This is because the main target of the new coronavirus attack is in addition to the upper respiratory tract, but also the endothelial cells of the heart and arteries and veins. Therefore, it is easy to cause heart cell damage, myocarditis, thrombosis and cause myocardial infarction, stroke, and pulmonary embolism.

In healthy acute patients, common symptoms often include palpitations, chest tightness, chest pain, wheezing, fatigue, and night sweats. In fact, these symptoms are like a common cold, and they may all appear together, and they will get better in about two or three days. However, the difference is that even asymptomatic patients with new coronary pneumonia, the heart may be more or less affected. In a study published by the Journal of the American Medical Association Cardiology (JAMA Cardiology) on 100 patients who recovered from new coronary pneumonia, even if nearly 70% of the patients were asymptomatic or mild, 80% of them were found through cardiac MRI. Patients have abnormal inflammation in their heart cells, and 70% of patients have increased myocardial enzymes, which represent heart damage. Although this result is worrying, these people actually do not have any heart discomfort, so the clinical impact of this research is still inconclusive.

In addition to severely ill people who may show symptoms of heart discomfort, people with underlying heart disease are more likely to get worse if they are infected. According to a study in the European Heart Journal, as many as 40% of patients infected with new coronary pneumonia suffer from cardiovascular disease, and nearly two of the critically ill patients also become patients with cardiovascular disease. The main reason is severe inflammation and infiltration of the lungs, resulting in decreased alveolar oxygen exchange and decreased blood oxygen, which indirectly leads to insufficient oxygen supply to the heart muscle, aggravating the original blood vessel obstruction and hypoxia in patients with cardiovascular disease, which can cause arrhythmia or heart failure . Poor lung conditions can also cause pulmonary artery pressure to rise, causing right heart failure. In addition, the new coronavirus may also directly attack and destroy heart muscle cells, or cause myocarditis through an immune response, and then cause acute heart failure or shock. Therefore, whether it is mild or severe, the best prevention method is to avoid infection and vaccinate.

心臟能躲過「新冠病毒」的攻擊嗎?重症患者恐心律不整、心臟衰竭奪命

Can the heart escape the attack of the “new crown virus”?Critically ill patients fear arrhythmia, heart failure kills their lives

Side effects of the new crown vaccine

The purpose of vaccination is to induce an immune response, so it may indeed cause discomfort, and even cause changes in the body’s hemodynamics, so that the old chronic diseases suddenly and acutely worsen, requiring hospitalization or death. However, if the mortality rate from infections in mainland China and Europe and the United States is compared with the probability of serious side effects of vaccines, the benefits of vaccination far outweigh the disadvantages. From a clinical point of view, regardless of the vaccine, the most common reasons for visiting the hospital for vaccination are fatigue, heart palpitations, chest pain, breathlessness, arrhythmia, numbness of the extremities and so on. Most of them can get better on their own, a few need medication to help relieve symptoms, and only a few will become fatal.

The most common concern of AZ vaccine is the side effect of thrombosis, which is usually venous thrombosis, including cerebral venous sinus thrombosis, lower extremity venous thrombosis, mesenteric venous thrombosis, and pulmonary embolism. The main symptoms are persistent headache, swelling and pain of the affected limbs, abdominal pain, and shortness of breath. Arterial thrombosis including myocardial infarction and stroke are also occasionally heard.

Modena and BNT vaccines ranked myocarditis/pericarditis as the most worrying side effects. Myocarditis is an inflammation of myocardial cells caused by immune response, which damages myocardial cells, which leads to weakened cardiac contractility, and induces various arrhythmia. In severe cases, it can lead to heart failure and death; pericarditis is a film that coats the heart. The symptoms of acute inflammation are usually chest pain, especially when you breathe in deeply or lie down. It may be accompanied by symptoms such as fever and palpitations. Such side effects are more common in young people and men, usually after the second dose. It usually appears within 1 to 5 days (median 2 days) after vaccination. Although most cases need to be hospitalized for observation and treatment, most of them have mild course and respond well to treatment.

Warning signs that should be paid attention to at home

If you experience severe persistent headache, severe abdominal pain, lower limb swelling pain, severe chest pain, or difficulty breathing within 3 to 28 days of AZ vaccination, you need to consider whether there is a thrombosis caused by the vaccine and thrombocytopenia. Please seek medical advice as soon as possible. Diagnosis and treatment. If you experience chest pain, palpitations, syncope, or exercise intolerance within a week of vaccination with Modena or BNT, you should also seek medical attention as soon as possible.

After vaccination, pay attention to blood oxygen, regular life and diet, add enough water (except for those with kidney or heart failure), press the pulse with your hand at any time to feel whether the heartbeat is regular. We should not be afraid of vaccines, and we should not worry too much, but we must understand its possible effects to protect our health.

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