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Atrial fibrillation a common complication in COVID patients

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Atrial fibrillation a common complication in COVID patients

Public health has a lot to do with populations and statistics in that we tend to think of groups of people and the diseases that affect them in faceless numbers and averages rather than as individuals. But from now on, for me, the COVID-19 pandemic has a face. That face belongs to my eldest brother.

As a physician and county health officer over the past eight years and especially during the COVID-19 pandemic, I have advocated for vaccines and other preventative and safety measures to help minimize the disease and death in our county and the rest of our world. The COVID-19 virus (SARS-CoV-2) has been a particular challenge because so many people seem to believe it to be “no worse than a cold” or “just the flu” and therefore, not worth the effort.

However, many people are particularly vulnerable to complications of the pandemic illness, especially older folks with chronic health problems, like my brother. Having had a sore throat for several days after attending a graveside funeral service, he became weak and fatigued to the point of seeking medical attention at an urgent care center. He was transferred to an emergency department where his blood pressure was low and his heartbeat was fast and irregular, which was diagnosed as atrial fibrillation (AFib) with rapid ventricular response. At the same time, he tested positive for COVID-19, which explained the symptoms prior to that point. Fortunately, he responded well to treatment and is improved as of this writing.

But not everyone is lucky enough to receive such timely diagnosis and treatment, especially in situations like the outbreaks in New York or northern Italy where the disease overwhelmed the resources available and undoubtedly resulted in some unnecessary deaths.

COVID-19 does not just affect the lungs. It infects cells through angiotensin converting enzyme 2 (ACE2) membrane receptors, which are common as part of the cells of the heart and lungs. Especially in patients with underlying cardiovascular disease, this can lead to increased risk of complicated myocardial injury (heart damage), myocarditis (inflammation of heart muscle), congestive heart failure (CHF), blood clots and abnormal heart rhythms.

Atrial fibrillation is the most common abnormal heart rhythm seen in critically ill patients. In an Italian study of 99 patients hospitalized with COVID-19, AFib was found in 19% of all cases and in 36% of patients with underlying cardiovascular disease. AFib was more common in patients who did not survive (42.1% versus 32.5%). In another small Italian study, 75% of elderly hospitalized COVID-19 patients in Italy had a medical history of AFib.

Atrial fibrillation can happen to almost anyone. In fact, 10% to 20% of the general population will experience at least one episode of AFib during their lifetime, even without COVID-19. But it is an especially common complication in hospitalized patients with COVID-19. Medications used to treat atrial fibrillation, such as antiarrhythmic (rhythm treatment) drugs and anticoagulants (blood thinners), may have significant interactions with some the treatments that have been tried for COVID-19. Drug-drug interactions with antiarrhythmic drugs and anticoagulants in these patients may lead to other heart rhythm disturbances or severe bleeding.

Therefore, the choice of drug treatments for COVID-19 patients with AF must be individualized on the basis of drug interactions, mechanisms of drug metabolism, and potential consequences. A baseline heart tracing (ECG) before beginning medications in addition to continuous rhythm monitoring afterward are recommended. If anticoagulation is started, extra caution must be exercised when used in combination with other drugs.

Although I wish that every case of COVID-19 could be prevented, even people who take recommended precautions, like my brother, can still end up in the hospital with potentially life-threatening complications. Although initially he only had a sore throat and fatigue, things deteriorated rapidly with the onset of atrial fibrillation. So, even with one or two symptoms, we must be on the lookout for progression to critical conditions.

The common symptoms of COVID-19 include fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and/or diarrhea.

However, if someone is showing any of the following critical symptoms, please seek emergency medical care immediately (including calling 911 if appropriate): trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake up or stay awake, and/or bluish lips or face.

In the meantime, mask up, maintain social distance, wash your hands and pray for an effective vaccine soon.


Atrial fibrillation a common complication in COVID patients

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