Covid-19, the Sars-CoV-2 virus infection, “bites” the heart. And not only by altering the mechanisms of coagulation due to the inflammatory reaction, with a consequent increased risk of heart attack, nor by directly infecting the cells of the myocardium. Sometimes, in fact, the simple “presence” of the pandemic, with the fears it induces and the tension that the often contradictory information provokes, combined with the need for isolation to curb contagions, affects the heart. As? With intense stress, which does not stop. And it can get to the point that the discharge of catecholamines acts as a real repeated “whip” that is given on the back of a horse, causing the myocardial cells to contract to exhaustion, which remain stunned.
Stress cardiomyopathy
For many people, especially women, this translates into the symptoms of heart attack, the rush to the emergency room, the exams that then discover how the coronary arteries have no limit to blood flow. In short, the picture of stress cardiomyopathy occurs, better defined as sindrome di tako-tsubo. To signal a surge in forms of this type, albeit in only two centers in Ohio, is a research recently published in Jama Network Open, coordinated by Ahmad Jabri of the Cleveland Clinic. The study compared the incidence of tako-tsubo during the pandemic with its incidence at similar dates in the past, considering only subjects who had not contracted the Sars-CoV-2 virus infection.
Longform
Covid beyond Covid: the legacy it leaves in the body of those who heal
by Giuliano Aluffi
25 November 2020-
The data, relating to just under 2000 patients hospitalized for acute coronary syndrome (therefore with the classic signs and symptoms of heart attack), were taken from subjects admitted in the months immediately preceding the onset of the pandemic and in the first weeks of the same , comparing the numbers with those observed in the same periods of previous years. During the pandemic period, the two hospitals recorded a significantly higher number of cases (we are in the order of four times) of tako-tsubo compared to the pre-Covid periods: mortality did not change, but the hospitalizations were longer during the pandemic period. According to what the authors of the research report, this increase in incidence would be due solely to the indirect, psychological, social and economic stress related to the pandemic.
From stress to tako-tsubo
“In tako-tsubo syndrome, the catecholamine storm that lasts over time leads to a prolonged increase in oxygen demand by the myocardial cells, which eventually lead the muscle to” sit down “, as happens for example to a marathon runner, squeezed to the last drop of energy, which falls after the finish line – explains Claudio Cuccia, director of the Cardiovascular Department of the Poliambulanza Foundation in Brescia – adrenaline and noradrenaline produced by the adrenal glands in response to stress cause damage to the myocardium not due to the formation of occlusions along the coronary arteries, which in this form remain open, but due to an abnormal demand for energy by the myocardial cells themselves. This mechanism, in addition to economic, social and emotional stress, can be linked to a bereavement and manifests itself in the days immediately following the loss. On the Italian Journal of Cardiology the case of a woman, Covid positive, who had experienced the death of her husband precisely because of Covid-19 and after a short time she herself developed a tako-tusbo was recently published “.
So I mold your heart
by Elisa Manacorda
13 December 2020-
In short: regardless of the triggering cause, various elements contribute to determining the intense stress reaction that is maintained over time and is fueled by a condition of insecurity and fear such as that linked to the pandemic, the final phenomenon becomes a sort of “heartbreak” induced by emotional stimuli, such as to cause symptoms similar to those of a heart attack such as pain in the chest or arm. The syndrome got the Eastern name of tako-tsubo and would affect nearly two out of a hundred people, especially postmenopausal women who have suffered recent severe stress (muggings, home thefts, sudden deaths), obviously among those who are hospitalized for suspected heart attack. The picture causes severe pain in the chest and even changes in the electrocardiogram typical of infarction, with a left ventricle that takes on a typical appearance, that of a pot-bellied and narrow-necked vessel, hence the name tako-tsubo. Fortunately, in those suffering from angina crisis, there is often no damage left because the fatigue of exaggerated contraction is so severe enough to remove energy from the heart, but not severe enough to cause heart cell death as occurs in a ‘traditional’ heart attack.
Longform
Covid, women’s hearts are risking more
by Giuseppe del Bello
15 December 2020-
Not only tako-tsubo, so stress attacks the heart
“In general terms, a strong emotional tension leads to an increase in blood pressure and heart rate, two mechanisms that tend to make the atherosclerotic plaque present in one or more coronary arteries less stable – continues Cuccia – in these cases one can encounter to a heart attack linked, for example, to the great tension that accumulates during a football match, as well explained in a research conducted in a German cohort on the occasion of the final phase of the 2006 World Cup. The study shows how a very hard-fought and tense match, especially if there is a favorite team on the field, it can lead to triple the risk of acute cardiovascular events in the ninety minutes, among the spectators ”.
Covid, more fragile heart in recovered patients
22 December 2020-
Finally, at times, stress can even lead to the “dissection” of the inner wall of a coronary artery, which is “frayed” by the sudden and very acute increase in pressure. It happens for example for a congenital ‘weakness’ of the artery wall or after a cocaine abuse, and again, in situations of particular stress, such as a sudden and serious bereavement: in this latter population, according to epidemiological studies, the ‘heart attack occurs up to twenty times more, but always in patients at cardiovascular risk and in the very first days after the triggering event.
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