Cardiac Care
ECMO treatment diagram
To avoid such risks , people who want to exercise after a long time away from the gym or sports field should book a cholesterol test cardiovascular system , which in turn can cause unexpected heart conditions .
“ When you exercise to the extreme , you have a higher chance of arrhythmias and other kinds of stuff happening too ,” he said . “ We ’ ve seen lots of people exercising a lot more because they ’ ve been working from home . At the same time , we ’ ve seen that more people are coming in with heart attacks after exercising .”
To avoid such risks , people who want to exercise after a long time away from the gym or sports field should book a cholesterol test , at the very least . Even in younger people , familial hypercholesterolemia is a genetic disorder that causes high levels of cholesterol to build up long before the peak years for developing arterial blockages , which are the forties in men and fifties in women .
With the effects of stress and the ongoing threat of contracting COVID-19 , Dr Nair advises all adults over 30 to be screened for cardiovascular conditions . This entails blood tests and electrocardiogram diagnostics , as well as an assessment by a cardiologist looking for risks due to family history or other medical conditions .
And for those who have recovered from COVID-19 , the risks can be even greater . One of these is a condition called long COVID , which we are still trying to understand . The syndrome appears occasionally in COVID-19 patients with a lack of uniformity of symptoms , which has made it difficult to study with any real authority .
“ We ’ re learning new things about COVID-19 all the time , every week as we go along ,” said Dr Nair . “ We ’ re actually getting a chance to study what a severe viral infection does to your body . COVID-19 can cause heart muscle weakness and infections causing abnormal heart rhythms , lingering fatigue , and sickness in patients over a long period of time .”
It ’ s not unheard of for severe viral infections to cause longer forms of a disease or other long-term conditions , but cases tend to be sporadic , preventing researchers from being able to piece together all the information they need for definitive guidance . Given the sheer number of global COVID-19 patients , the pandemic might be able to shed some light on the causes and best treatments for these lingering conditions , speculated Dr Nair .
One of the few upsides of the current pandemic is that new vaccines , medicines , and technologies are being sped to market . One of these is a new device to help COVID-19 patients with compromised heart muscle .
Last August , the US Food and Drug Administration issued an emergency use authorisation for the use of the Impella left ventricular support system , a device that helps treat critical COVID-19 patients already on extracorporeal membrane oxygenation ( ECMO ) treatment . This paved the way for health authorities around the world to grant similar authorisation .
This means that Impella pumps can be used if the patient develops pulmonary oedema ( fluid in the lungs ) or the heart can ’ t maintain an efficient circulation from myocarditis ( heart inflammation ) while on ECMO support , which pumps and oxygenates a patient ’ s blood outside the body , allowing the heart and lungs to rest .
“ There ’ s a lot of patients coming in with their heart muscle being compromised , having something called cardiogenic shock , whereby the blood pressure drops ,” said Dr Nair . “ They can have cardiac arrests , and we ’ ve been seeing a lot more of these severe diseases .”
The world ’ s smallest pump , the Impella is basically a catheter that is put into the heart and sucks out blood to push it out to the rest of the body . When patients are particularly unwell , it can be combined with an ECMO device , which had not previously been permitted .
This technique has been able to drastically reduce mortality rates , when previously some 50 percent of patients presenting with cardiogenic shock would not have been expected to survive . Research suggests that since the authorisation , the survival rate has reached 70-80 percent for the condition .
“ In this new pandemic era , things have got more difficult for us , and we have had problems trying to treat many patients with COVID-19 and heart conditions ,” Dr Nair said .
“ We ’ ve been unable to do elective procedures at earlier stages of cardiac disease , but now , thankfully , we ’ ve started doing procedures once more for our patients . But still , in this COVID-19 era , we ’ re continuing to find more and more severe disease .” n
54 JUNE 2021 GlobalHealthAsiaPacific . com