Intermountain Healthcare, a Utah-based healthcare system, is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes and sustainable costs. Recently, Kirk U. Knowlton, MD, working in the Intermountain Healthcare Heart Institute in Salt Lake City, concluded an effort to examine over 100 published studies related to COVID-19 and its effect on the heart. Based on this exhaustive review, the researcher and physician came to the conclusion that COVID-19 can cause heart disease.
Nothing New to Viruses
Dr. Knowlton points out that this link between heart diseases and transmittable viruses isn’t new. Autopsies of patients who died during the 1918 flu pandemic found heart damage, and 50% of patients who died of polio from 1942 to 1951 had myocarditis, he said. Intermountain Healthcare reports via its press release that heart damage has also been found in people infected with mumps, measles and enterovirus illnesses. What’s less understood, he adds, is what role the virus-activated immune system plays in heart damage.
A Growing Cardiovascular Menace
Most know COVID-19 for its horrific effect on the lungs, making breathing hard or impossible in severe to critical cases. That the pathogen can set off acute respiratory distress syndrome (ARDS) is well known and a major cause of mortality. However, mounting evidence suggests this novel coronavirus directly impacts the heart, causing damage either directly by the pathogen or from inflammation triggered by the immune system’s response to the virus. Or perhaps even some speculate from increasing clotting in heart vessels.
COVID-19 & The Heart
Now researchers are coming to the conclusion that COVID-19 causes heart damage that can actually endure, possibly for life. Although experts are still investigating this unfortunate facet of the coronavirus, they don’t know enough yet about how often or severe the cardiovascular damage is or whether its triggered only in severe cases or perhaps even afflicting patients with mild cases. The threat is real; the recent Intermountain Healthcare press release referred to college football’s opt to postpone games this year out of fear that college athletes who fall ill to COVID-19 could suffer long-term cardiovascular problems.
Real World Observations
Dr. Knowlton, director of the cardiovascular research at Intermountain Healthcare Heart Institute is now on the record that “There’s clear evidence that COVID-19 can cause heart disease.” Although the Salt Lake City-based doctor acknowledges this condition spares some patients at this stage of the research he declared that it “affects around one in five patients admitted to the hospital with COVID-19.” The evidence points to several mechanisms that can trigger heart problems.
During this research, Knowlton uncovered multiple reports of myocarditis or inflammation of the heart muscle that can damage the heart and affect the heart’s ability to pump blood. Professional athletes aren’t immune such as Eduardo Rodriguez, a pitcher with the Boston Red Sox, now out indefinitely during 2020 with COVID-related myocarditis. According to Dr. Knowlton, there isn’t enough evidence to understand the overall percentage of patients who are at risk.
Knowlton’s research points to risks for children as well. Although most children aren’t impacted by the most severe COVID-19-based conditions, the virus can trigger a Kawasaki-like disease in children, known as Multisystem Inflammatory Syndrome in Children (MIS-C).
COVID-19-related cardiovascular manifestations can include thrombotic or clotting disorder that can lead to deep-vein thrombosis, pulmonary embolism, stroke and peripheral artery disease. Intermountain Healthcare reminds in the press release that thrombosis occurring in small and medium size vessels can contribute to cardiac injury.
The Cytokine Storm but Not Clear Link
“Many patients with severe disease experience a cytokine storm, where the immune system goes into overdrive, attacks its own cells, and causes multi-organ failure,” he said. “These attacks to the heart are one of the ways that we believe the virus can cause heart damage and myocarditis, though the link is not absolutely clear.”
Treating COVID-19, he said, “is about finding a balance between allowing the immune system to fight the virus, but not so hard that it hurts the heart.”
Dr. Knowlton thinks treatments that disable the virus itself would stop it from replicating through the body (and being passed onto others) and that prevention of virus replication would prevent such a severe immune response.
This could be one of the most effective ways to treat patients that contract the virus, especially if started early. Most medications that treat other viral infections do so by preventing viral replication.
“Developing a more thorough understanding of the effects of the virus on the heart in the wider population of patients that are infected with SARS-CoV-2 is of paramount importance as we return to activities and events that involve large groups and athletes,” added Dr. Knowlton. “At the current time prevention continues to be the surest way to avoid the complications of heart disease caused by the virus.”
About Intermountain Healthcare
Intermountain Healthcare is a not-for-profit system of 24 hospitals, 215 clinics, a Medical Group with 2,500 employed physicians and advanced practice clinicians, a health insurance company called SelectHealth, and other health services in Idaho, Utah, and Nevada. Intermountain is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes and sustainable costs.
Intermountain Healthcare Research
High-quality care at Intermountain begins long before a patient enters one of our hospitals or clinics. It starts with innovative research.
Our long and distinguished history of leading cutting-edge clinical research began in the 1950s, two decades before Intermountain formally came into being in 1975. At this time, investigators at our original flagship hospital, LDS Hospital, conducted formal biomedical research studies. Since then, our research activities have expanded dramatically.
Over the years, Intermountain researchers have been involved in many thousands of studies across dozens of clinical specialties. Currently, over 1,600 studies are open and actively underway within the Intermountain system. The discoveries that come out of these studies improve Intermountain’s care delivery performance in our facilities, as well as advance medical knowledge within the healing profession.