Covid-19 and cardiovascular diseaseBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1997 (Published 20 May 2020) Cite this as: BMJ 2020;369:m1997
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I appreciate this publication clearly states - The guidance remains valid only for the duration of the pandemic. I don’t know how the non cardiologists feel about this but I have another view considering the reasons given as to why is this guidance was needed, which I quote:
""Based on the evidence so far, cardiovascular risk factors and heart conditions are thought to increase the risk of poor outcomes from covid-19.
Covid-19 may also be a risk factor for the development of cardiovascular disease"".
If I consider the first part of the above reasons, the guidance almost entirely focuses on the acute hospital patients with any acute suspected coronary disease or myocardial infarction. In any such acute situation it is standard practice of any cardiologist to do the acute management of such acute cardiac conditions as necessary, taking account of all appropriate precautionary measures irrespective of whether the patient has Covid-19 or any other similar disease. I doubt if the presence of Covid-19 would make any difference to any cardiologist to follow their standard practice for the diagnosis and management of any acute cardiac conditions. Furthermore the guidance itself is based on the practice experience of a group of cardiologists. So, I am not sure if such a temporary guidance would make a significant difference to current practice.
However, I believe the second part of the reasons for the guidance (Covid-19 may also be a risk factor for the development of cardiovascular disease) has more important implication. But surprisingly I see hardly any notes or comments in the guidance on that aspect, as to how to diagnose or prevent the development of cardiovascular disease in Covid-19 affected patients, who are out there in the society millions and millions in number, either treated or untreated. This could be a huge population with potential risk of developing or progressing cardiovascular disease.
I would expect the European society of Cardiology would consider how to identify people with high risk of developing cardiovascular disease who had been exposed or infected with Codi-19, treated or untreated and symptomatic or asymptomatic.
There are many reports already indicated that Covid-19 has pathophysiological mechanism that can alter the coagulation pathway and produce intravascular clots and we know coronary cause of death has been widely reported in Covid-19 and also been alarmed by the British cardiac society.
But the seriousness of the Covid-19 Cardiovascular impact may not just be limited to acute hospital based patients. If the fundamental mechanism of the disease leads to formation of vascular blood clots, then it should impact on anyone affected by Covid-19. So how can we be sure that the hospital discharged patients or the people exposed or infected with Covid-19 are not already developing or progressing with cardiovascular disease silently as a time bomb? This potential silent clotting mechanism if taken seriously, it can cause major cardiovascular health disaster sooner or later, in a huge population should we not act now, to identify them at early stage.
Competing interests: No competing interests