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"These complications, which at times are the only features of #COVID19 clinical presentation, have occurred even in cases with mild symptoms and in people who did not experience any symptoms" https://science.sciencemag.org/content/early/2020/09/23/science.abe2813
a
to explain 1/
a
to explain 1/
For those who don't know me, I'm a cardiologist, have been for 35 years, and still practicing. And seeing patients is still my favorite part of what I get to do.
I tried to read all that's been written in English to date on this topic and to contextualize it in this essay 2/
I tried to read all that's been written in English to date on this topic and to contextualize it in this essay 2/
The virus can get into the heart and specifically heart muscle cells because it is drawn by ACE2 on the surface of these cells, along with cooperation of cofactors, such as heparin sulfate. That entry has been confirmed by autopsy series 3/
Two studies of "heart in a dish" (induced pluripotent stem cells transformed to heart muscle cells) showed striking effects when infected with the virus 4/
The @GladstoneInst study https://twitter.com/EricTopol/status/1299027542272172032
The @GladstoneInst study https://twitter.com/EricTopol/status/1299027542272172032
The @CedarsSinai study
https://twitter.com/EricTopol/status/1294376442285789184
The muscle cells stopped contracting. These in vitro iPSC experiments may not be representative, yet concerning 5/
https://twitter.com/EricTopol/status/1294376442285789184
The muscle cells stopped contracting. These in vitro iPSC experiments may not be representative, yet concerning 5/
There are many potential indirect effects on the heart, too, which include a secondary immune response, clotting, endothelial inflammation and/or infection, vasculitis 6/
Indirect heart muscle injury is common in severe covid patients (~20%); that occurrence is an independent risk factor for mortality.
In contrast, inflammation of heart muscle (myocarditis) has been documented in many case reports/autopsies, w/ or without the virus in cells 7/
In contrast, inflammation of heart muscle (myocarditis) has been documented in many case reports/autopsies, w/ or without the virus in cells 7/
Besides inflammation of the heart and weak heart muscle, (and cardiomyopathy) there can be electrical disturbances, such as serious ventricular arrhythmias. In Lombardy Italy, one of the hardest-hit covid regions, there was a 77% increase in out-of hospital cardiac arrests. 8/
An example of myocarditis w/ electrical abnormalities in a 16 year-old-boy https://twitter.com/EricTopol/status/1276357801757949952
There are multiple small series of patients presenting with a picture simulating a heart attack, many without lung symptoms 9/
There are multiple small series of patients presenting with a picture simulating a heart attack, many without lung symptoms 9/
There are several reports of imaging, both MRI and echo, showing heart involvement is not uncommon in patients with covid, albeit without controls. Myocarditis suggestive in many, some w/ biopsy. I contacted authors of this study in Germany https://jamanetwork.com/journals/jamacardiology/article-abstract/2768916 10/
There were 18 individuals who had no symptoms but PCR+ for infection and 12 had distinct heart MRI abnormalities.
We have seen little info on this issue---heart involvement w/o symptoms.
For asymptomatic covid, there are 4 lung CT scan published series with ~50% abnormal 11/
We have seen little info on this issue---heart involvement w/o symptoms.
For asymptomatic covid, there are 4 lung CT scan published series with ~50% abnormal 11/
In #LongCovid there are an array of symptoms. Some people have cardiac signs, but here aren't yet any systematic MRI/echo or immunologic studies.
Most kids w/ MIS-C have heart involvement. A tragic report of 11-year-old girl:
https://twitter.com/EricTopol/status/1296588348224499713 12/
Most kids w/ MIS-C have heart involvement. A tragic report of 11-year-old girl:
https://twitter.com/EricTopol/status/1296588348224499713 12/
Some young athletes have been found to have heart covid involvement. Summarized below. The recent Ohio State report of 4 of 26 athletes screened, 2 asymptomatic, with MRI supportive of myocarditis (link)
https://twitter.com/EricTopol/status/1304435865570009088 13/
https://twitter.com/EricTopol/status/1304435865570009088 13/
Whether this is related to or exacerbated by exercise is unclear, but some recommendations based on other viral-based myocarditis, support rest after a covid diagnosis.
The number of studies in young, athletes or not, and those without symptoms, is very limited 14/x
The number of studies in young, athletes or not, and those without symptoms, is very limited 14/x
In contrast the number of covid infections globally is in the order of tens of millions, so even 0.1%-1% heart involvement would take an enormous toll. We have no idea yet of the incidence, or the different subtypes of diverse heart manifestations, including cardiomyopathy. 15/
We also don't know why certain people develop heart involvement. These are big questions that deserve the highest research priority to unravel. 16/f
