Keeping your heart healthy during COVID-19

Shumona Rahman, 40, started experiencing chest pain, shortness of breath, fatigue and developed certain other symptoms, a while after recovering from COVID-19. Upon consulting her doctor, she was diagnosed with myocarditis, a condition that causes inflammation of the heart muscle and abnormal heart rhythms.

What Shumona experienced is not new for COVID survivors as they are prone to developing heart diseases after recovering from COVID-19. National Professor Brig (Rtd) Abdul Malik, Founder, National Heart Foundation of Bangladesh, shares, "Myocarditis is usually caused by viral infections. People who previously had no record of heart disease can get affected by it after they have been infected with COVID-19. It has also been seen that a patient's electrocardiogram (ECG) test showed the coronary artery to be normal whereas his/her heart has experienced damage due to myocarditis." Dr Malik emphasised on the need for further research to determine the severity of the issue.

According to World Heart Federation, patients with cardiovascular disease (CVD) are more prone to suffering from COVID-19 severely. Diseases and conditions that affect some form of heart condition or heart function include hypertension and diabetes, acute coronary syndrome, injury to muscle tissues of the heart, myocardial injury, heart failure, and less heard of but widespread diseases such as rheumatic heart disease and Chagas disease. To tackle these, the study recommends emphasising on awareness and prevention and reassurance. This includes, giving special attention to ensure the availability of separate facilities for dealing with COVID-19 cardiac patients and non-COVID-19 cardiac patients, including catheterisation laboratories for performing invasive heart examinations.

The Journal of the American Medical Association (JAMA) states that reducing the number of COVID-19 cases will also reduce the number of people with myocarditis in the post-pandemic era.

As per World Health Organization (WHO), non-communicable diseases (NCDs) account for 71 percent of global deaths, with CVD ranked as the number one killer, causing 31 percent deaths globally.

Dr A M Shafique, Consultant & Coordinator, Interventional & Clinical Cardiologist, Department of Cardiology, United Hospital Limited states, "The global mortality rate for COVID-infected patients remains low at 2.3 percent and the mortality rate in Bangladesh has been roughly around 1.29 percent. However, the global mortality rate can jump to around 10.5 percent among patients with CVD and 14.8 percent for patients above 80 years of age."

Research studies funded by the American Heart Association suggest that it is difficult to determine whether the lungs take longer to heal or whether patients suffer from cardiac issues once they recover from COVID-19. Also, whether screenings to detect cardiovascular damage should become a regular part of follow-up care for COVID-19 patients and survivors remains unclear.

Both Dr Malik and Dr Shafique urge everyone to follow the basic protocols such as maintaining social distancing of at least one metre, wearing masks that fit the face properly, washing hands for at least 20 seconds, eliminating smoking and tobacco consumption, etc., since we are still unsure when a vaccine will be available. People with existing CVD or other NCDs such as hypertension, diabetes, cancer, must be very careful; they should try to avoid going outside as much as possible. Factors like air pollution must also be tackled as they contribute significantly towards CVD. Dr Malik emphasises on the economic costs and detriments in terms of achieving the SDGs, which may arise and worsen the situation, if the government does not undertake steps to provide proper facilities to address COVID-19 and NCDs.

Regarding lifestyle changes, nutritionist Jennifer Binte Huque, Green Life Medical College & Hospital, suggests, to boost immunity for an overall good health, we must ensure a balanced diet by consuming fresh and colourful fruits and vegetables along with a good balance of carbohydrates, good fats and protein. Besides, home-cooked meals should be consumed as much as possible and junk foods should be avoided as they contain high amounts of trans-fats and saturated fats. Two to three litres of water must also be consumed as dehydration increases the risk of COVID-19. We must also be active for at least 30 minutes a day. However, patients with CVD who have suffered from COVID-19 can be active for 20-30 minutes for three to four days a week, depending on their health condition.

She recommends that people, especially patients with a history of CVD, must not consume too much salt or sugar. Additionally, they must check their serum electrolytes and cholesterol levels; patients must consult a nutritionist or clinical dietician before making changes to their diet. Additionally, studies by WHO recommend maintaining good personal and food hygiene practices as there is no concrete evidence yet about which particular food can prevent us from getting infected by COVID-19.

Dr Shafique and nutritionist Jennifer advise that the negative news concerning COVID-19 increases stress levels of COVID-infected patients which may hamper their immune system. Therefore, patients should be counseled on managing their stress levels. According to Dr Shafique, patients are at a risk of developing cardiomyopathy which occurs due to viral infections and also due to severe acute mental stress.

Another problem which has arisen due to the pandemic is that patients who have CVD are not seeking medication like they used to before. According to a report by Dr Ferdous Hakim, Health Researcher and Epidemiologist (independent), published in the World Heart Federation website, in Bangladesh, people tend to avoid the hassle of seeking care in a centralised system where testing services are not as widely available as compared to a decentralised healthcare system. Such a centralised system has seen a high turnover of people leading to long queues and lengthy waiting times to obtain COVID-19 test reports and consequently, increasing exposure to the virus.

To tackle the aforementioned crises, experts recommend introducing innovative and effective methods to ensure proper healthcare facilities. Cardiac rehabilitation through phone and video calls and messages can be made more popular, though they have their own set of challenges, such as limited scope for patients to get adequate diagnosis, especially if their conditions are critical. Therefore, formulating national response and preparedness plans to combat COVID-19 is vital to properly address its link with CVD and other forms of diseases.