Many recovered Covid patients experience long-lasting health issues, or long Covid. Two years into the pandemic, what do we know about cardiac long Covid, or long-term effects of the infection on the heart?
Why is Covid-19 causing cardiac complications?
I would first move away from this question. Because as South Asians, we are anyway prone to heart disease. This is now proven through multiple research done on Indian diaspora abroad, where they compared the risk of South Asians to that of the native population. The risk varies from study to study, but if I have to give a broad ballpark estimate, it is about two times higher among South Asians. Heart diseases typically develop a decade earlier in South Asia as compared to the West.
Traditionally, there are five risk factors for developing cardiovascular disease: tobacco use, diabetes, hypertension, bad cholesterol, and family history. I would put Covid-19 as one of the risk factors now.
So how do we detect this early, especially when many healthy, young, asymptomatic patients complaining of long Covid complications?
We should focus on what can be done to prevent these complications. The focus should be on risk factors. Any which way, every person should have one preventive cardiac check. It is a very simple check: of your blood pressure, blood sugar, blood cholesterol levels, of your weight, and diet.
We know that almost half of our people with hypertension are not aware of their condition because they have never measured it. High blood pressure is a silent killer — it won’t show symptoms most of the time. If you look at the population level, just 10% in rural and 20% in urban areas have their blood pressure under control. So everybody should go for a preventive check-up. Even more now.
We are seeing people undergoing ECHO tests, and cardiac MRIs. Is that needed?
Clearly, in an asymptomatic person, that is not needed. There is a guideline we developed for the Health Ministry on post-Covid cardiac management. We have very clearly said that besides the very basic tests you need to do, if you don’t have symptoms — you are doing well, you are back to doing your usual activity like you can do a good walk for 20 minutes without getting breathless, or you can walk with a person of your age and fitness as much as he can — then you do not need to go for any further tests.
But yes, if you have episodes of palpitations, breathlessness even when you walk a flight of stair, in those cases, we may need further tests.
There is a study from Germany, which does a detailed analysis of people who have Covid-19 versus uninfected people. It showed that even cardiac MRIs were no different in people who had Covid-19 versus those who did not have Covid-19. There was no additive value in doing these high-end tests. So unless you have symptoms, you don’t need to do anything more than the very basic tests.
So, when does a patient need to consult a specialist?
In your convalescent stage, if you continue to have one of these symptoms — breathlessness, palpitations, faster heartbeat with minimal activity, or if you feel your heartbeat is irregular, or if you notice swelling on your limbs, or when you walk you feel some heaviness in the chest — these are the symptoms when you definitely need to quickly consult a specialist.
Other than that, if you are back to your usual physical activity, then there is nothing more needed than simple blood pressure, blood sugar, and blood cholesterol test — which are anyway mandated for anybody after 25 years of age.
What are the preventive measures?
This begins with very simple lifestyle measures. It includes absolute abstinence from tobacco. The second is maintaining optimum body weight. Third is having regular physical activity in your day-to-day life, which means a good, brisk walk of 20 to 30 minutes, at least 5-6 days in a week. Fourth is a prudent diet —lots of fruits and vegetables; avoiding too much sugar and salt and rich fried food in the diet. Additionally, you should have a routine preventive cardiac check of a very basic nature. If they are out of range, you must initiate therapy early.