A CORK City-based cardiologist said he is bracing for a surge in patients with heart conditions resulting from side-effects of Covid-19.
Dr Heiko Kindler, from the Bon Secours Hospital, has been consulting with colleagues in Italy and the UK to ensure he is prepared.
The third wave of the virus has been a grave concern, given reports of the long-term effects of Covid-19, which can pose a risk to the heart.
A study of 100 Covid-19 patients in Frankfurt, published last July, detected that 78 endured some form of cardiovascular damage.
Dr Kindler said that a number of Covid-19 cases are showing signs of serious strain on the heart months after a patient’s recovery.
He described why the long-term effects of Covid-19 are posing fresh concerns. “When the first wave hit, we were foreseeing all these critically-ill patients,” Dr Kindler said.
“Thankfully, it didn’t materialise to the extent that we are expecting this time.
“When we consider how new this condition is, there is still so much that is unknown. Nobody in the world can truly call themselves an expert.
“For 18 years, I’ve been developing a special interest in the field associated with heart failure and pump function related to various conditions.
“This isn’t something that any doctor from my generation, or even previous generations, would have encountered. We are mentally preparing ourselves for being very busy,” Dr Kindler said.
There are still people who doubt the existence of long Covid-19.
“It’s natural to have doubt, when you are not affected yourself,” Dr Kindler said.
“I have seen patients who have recovered from Covid and their view has totally changed. One patient I had never believed this could happen, until a brain fog affected him for months.
“People are only now coming round to the fact that this is not just a cold. It can affect so many different parts of the body, from the brain to the heart.”
Dr Kindler listed some potential effects of Covid-19 on the heart.
“The focus isn’t just on the respiratory part of the disease. As the numbers increase, we are going to be dealing with a lot of long-term consequences that wouldn’t have been expected, including heart failure, reduced ejection fraction (HFrEF) — also referred to as systolic heart failure — and breathlessness and fatigue symptoms that can come with inefficient pumping of the heart.”
For many severely ill patients, respiratory symptoms are just the start of their battle. “We often find ourselves being asked to consult with patients who have symptoms or features that don’t just tie in with the respiratory condition,” Dr Kindler said. “In these situations, we would carry out additional tests, like cardiac ultrasounds and MRIs.
“Often, we find that these issues aren’t detected until four months later. Someone might have had a normal heart before a Covid infection. However, the chambers then become dilated, resulting in heart failure.
“This is why you have to prepare people to do the right thing. By avoiding contact, you are refusing to offer the virus a host system.”
Dr Kindler urged the public to adhere to health guidelines to avoid what could potentially result in years of suffering. “No amount of money in the world could afford enough intensive care beds in the time scale. If this keeps going, we risk the potential for completely overrunning our healthcare system,” Dr Kindler said.
“We know what the virus can do. We know the percentage of people who will become really sick and end up in intensive care.
“It’s all about managing this virus and hoping that the vaccines coming out will counter this severe epidemic.
“I’ve heard reports from the UK that this has got so bad, and run on for so long, they are now beginning to run out of oxygen. There are things you cannot prepare for at the best of times, which makes it so important that the virus is contained.”
That is why Dr Kindler has been consulting with colleagues in Italy and the UK, to be as prepared as possible for the surge in admissions.
“Compared to other countries, Ireland has been doing quite well until now. I’m hoping that we can get on top of this again, in the near future,” Dr Kindler said. “There is a lot of fear around me. I try to live in the present moment and deal with what I can with the abilities and technologies available to me.”
Dr Kindler said it may be years before we see the full extent of cardiac issues stemming from Covid-19.
“Preliminary reports from doctors in Wuhan’s first observational studies are now coming through. Through these studies, we’re seeing that a lot of people’s hearts have been affected,” Dr Kindler said.
“The heart is very close to the lungs, so can be deeply affected by severe Covid. We see a fair amount of data supporting this. What we have seen with other viruses before, although it’s not as prevalent, is the inflammation response of the linings around the heart, or the pericardium.
“This also affects the adjacent heart muscle, known as the myocardium. The Wuhan study found that 20% of people with Covid had an elevation detected by cardiac blood tests. 20% would be considered high for that scenario. However, there was another study in Germany that came out in July,” Dr Kindler said.
“This found that up to 79% of patients had MRI findings of inflammatory heart conditions. It will probably be a few more years before we see the real numbers filter through. My guess is that this figure will lie somewhere in between.”
He said that a number of patients involved in the studies showed no outer signs of a heart condition.
“There are blood tests available that can diagnose the effects on the heart. They offer early warnings signs to determine if there is any inflammation of the heart,” Dr Kindler said. “Even though the heart becomes inflamed, people may not experience any pain. A number of patients were fatigued and suffered from standard symptoms similar to other patients, but there was no outside indication that the heart had been affected.”