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Covid and Heart

Covid and Heart

How does Covid-19 affect heart and blood circulation?

European Society of Cardiology and American College of Cardiology, and World Heart Federation have summarized the interaction of Covid-19 and Heart

  • Covid-19 Discovery:  First detected in Wuhan City, Hubei province, China in December 2019
  • Pandemic: On 11 March, the World Health Organization (WHO) declared COVID-19 a pandemic
  • Heart and Covid-19: Heart and Cardiovascular disease top the list of co-morbidity associated with Covid-19 associated death.
  • Direct effect on Heart: Covid-19 can affect heart along with lung infection, or directly heart and blood vessels alone

Demand Ischemia

  • When Covid-19 affects your lungs, your oxygen supply is reduced. Heart has to work harder to supply oxygen to your body.
  • When Covid-19 affects your heart directly, it reduces the pumping power of heart directly.
  • Both conditions depend on how much cardiac reserve you have.
  • In other words, more cardio-vascular fitness you have better is your odd against winning over Covid-19 heart.

Inflammation of Heart Muscle

  • 1 in 5 patients with COVID-19 have signs of heart injury, regardless of whether they had respiratory symptoms  
  • Inflammation of the heart muscle (myocarditis) can be part of generalized hyper-inflammation syndrome or localized inflammation of the heart muscle.

Direct Viral Infection of Heart

  • Coronavirus can directly infect heart and blood vessels by binding on ACE2 receptors
  • Infection of the heart muscle or blood vessel can be part of generalized Covid-19 infection as well
  • The result is poor pumping power of the heart (cardiomyopathy)

Micro-vascular Thrombus or Embolism

  • Excess of blood clotting (thrombus) and clot spreading (embolism) can affect any organ in the body
  • Direct injury to the inner lining (endothelium) of blood vessels, stasis, easy clotting tendency (hyper-coagulability) is three key factors.
  • Cytokine storm is the medical word used to describe this perfect storm

How does Covid-19 Heart Condition Present?

The COVID-19 heart can lead to:

 

  • Acute coronary syndrome: Acute chest pain and palpitation, or heart attack
  • Heart Failure: Pumping power of the heart is reduced
  • Cardiogenic shock: Low blood pressure and collapse
  • Cardiac arrhythmia: Palpitations, skipped beats

Tests for Covid-19 Heart Markers

At our Jiva health clinics we track your cardiovascular reserve and inflammation

 

 

  • Blood tests for anti-inflammatory defense: Omega-3 index
  • Stool test for gut biome anti-inflammatory defense: GI map stool test
  • Sleep tests to reduce sleep apnea and insomnia related aggravation of inflammation

Summary of Action Plan for Covid-19 heart

  • Anti-inflammatory diet and supplements
  • Balancing gut biome with diet and specific Prebiotics and Probiotics
  • Treating sleep apnea and other sleep disorders
  • Treating pre-existing heart and cardio-vascular conditions
  • Treating diabetes and obesity, which are major contributors to heart conditions

Cardiovascular Risk Calculator

Cardiovascular Risk Calculator

What is a cardiovascular risk assessment?

This is a group of tests and health factors that have been scientifically proven to indicate a person’s chance of having a cardiovascular event such as a heart attack or stroke.

Why you need cardiovascular risk calculation?

It helps you to prevent, predict, and monitor cardiovascular diseases (plaque buildup disease). There are 4 main types based on where the plaque buildup occurs:

  • Coronary heart disease:  Heart attack, angina, and/or heart failure
  • Cerebrovascular disease:  Brain attack (stroke), transient ischemic attack (TIA)
  • Peripheral artery disease: High blood pressure, intermittent claudication (leg pains), Erectile dysfunction, etc.
  • Aortic atherosclerosis: Thoracic or abdominal aortic aneurysm (AAA)

What factors included in cardiovascular risk calculation?

Uncontrollable risks:

Age, gender, race (ethnicity), family history

Controllable risk factors:

Cholesterol (total and HDL), blood pressure (medication used to control blood pressure), body weight (BMI), diabetes, calcium score (heart scan), CRP (inflammation marker), smoking, diet, exercise

Risk Enhancers:

  • Family history of early ASCVD (men <55 years old, women <65)
  • High-risk ethnicity (e.g. South Asian Indian Ancestry)
  • Good and Bad Cholesterol particle number (LDL-P, HDL-P)
  • Triglycerides ≥175 mg/dL
  • Elevated lipoprotein (a) ≥50 mg/dL)
  • Elevated apolipoprotein B ≥130 mg/dL
  • Metabolic syndrome
  • Chronic kidney disease
  • Chronic inflammatory conditions (e.g., rheumatoid arthritis, psoriasis, HIV)
  • History of pre-eclampsia or early menopause
  • High-sensitivity C-reactive protein (HSCRP) ≥2.0mg/dL
  • Ankle-brachial index (ABI) ‹0.9
  • Sleep apnea

Impact of Race on Cardio-vascular risk

The Pooled Cohort Equations were developed and validated among Caucasian and African Americans.

Indian diaspora (people of India origin) constitute 25% of the world population but account for 60% of cardiovascular disease in the world.

MESA Risk Calculator (Caucasian, Chinese, African American, Hispanic) BUT no category for Asian Indians

Multiethnic risk calculator is available online. It includes Coronary calcium score data input as well. However, it does not include Asian Indians.

How far do you predict cardiovascular risk?

There are two ranges: 10-year prediction, Lifetime prediction.

What are two Risk Calculation Tools

  • Heart age tool
  • Cardiovascular risk prediction tools

The Heart Age Tool

  • Is your heart older or younger than your real age?
  • Heart Age Test calculates how many years you can expect to live without a heart attack or stroke.
  • This tool is a collaboration between NHS Choices, Public Health England, and the British Heart Foundation. It is FREE and you can take the heart age test at this site.

Cardiovascular risk prediction tools

Pooled Cohort Equations CV Risk Calculator (ACC/AHA)

The current US guidelines for cholesterol and blood pressure management call for use of the “pooled cohort” risk equations to help guide therapy. It is developed by Risk Assessment Work Group, an arm of the ACC/AHA. You can use the links below to calculate your own risk using major

North American (US and Canadian Data Base)

You can choose between 4 different databases by clicking on a specific calculator.

 

  1. Framingham – this calculates the risk of heart attacks + angina/coronary insufficiency + heart failure + strokes + intermittent claudication
  2. QRISK®2-2014 – this calculates the risk of heart attacks + strokes
  3. ACC/AHA ASCVD – this calculates the risk of CHD death + nonfatal heart attacks + fatal/nonfatal strokes
  4. PREDICT – Heart attacks + angina + heart failure + strokes/TIAs + peripheral vascular disease

Astrocharm calculator

Astro-CHARM (the “App”) incorporating traditional cardiovascular risk factors and coronary artery calcium score values. 

Reynolds risk score

This calculator also uses a high-sensitivity CRP level, which is a marker of inflammation

The U-prevent calculators

Our preferred risk calculation tool because it includes all races and ethnic groups, all ages, and also calculates treatment effects.

 

  • This tool helps to calculate 5- or 10-year cardiovascular risk as well as lifetime treatment effect.
  • This online tool incorporates the inputs of scientists and regulatory agencies from North America (USA and Canada) and Europe.
  • U-Prevent offers calculators for the following adult patient groups: 1) apparently healthy people, 2) vascular patients, 3) type 2 diabetes patients, and 4) elderly.
  • This tool is much easier to use compared to looking at the guideline hubs of American College of Cardiology/American Heart Association 10-year cardiovascular risk prediction.
  • To repeat, this tool estimates risk and benefit for primary prevention as well as secondary prevention. It also helps to decide the risk/benefit for the elderly.

 

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