Bedridden by COVID-19 in December 2020, Catherine, a 35-year-old dancer and diligent jogger, expected at most to cash in on a bad flu. The fever passed, however, she remained weighed down by a constant pain in the chest. Three months later, he was diagnosed with pericarditis, an inflammation of the covering of the heart.
Two years later, the young woman (who wishes to remain anonymous) is still on sick leave. His pericarditis is cured, but his heart is still derailed. Washing her bathtub propels her heart rate to 130 beats per minute. She is indeed affected by “PoTs”, or postural tachycardia syndrome, present in 66% of patients with long-term COVID affected by post-COVID arrhythmias. She now relies on beta-blockers to quell the unpredictable panic in her heart muscle.
“I haven’t resumed dancing or jogging. I’m in complete shutdown. I see gains, but very slow. No one can tell me how long these scars will last, and even if they will ever disappear. »
The tail of the comet
After three years of pandemic, the impact of COVID-19 on the incidence of many diseases, particularly cardiovascular, is still difficult to measure, but very real.
“We now know that an infection can trigger several heart diseases. We clearly expect an increase in consultations for various cardiovascular problems in the coming years,” explains researcher Simon Décary, professor at the University of Sherbrooke and co-head of the Pan-Canadian Research Network on Post-COVID-19 Syndrome (SPC ).
After having suffered the acute phase of the pandemic, the health system will have to prepare to face “this tail of the comet”, said this week the chief scientific adviser of Canada, the Dre Or Nemer.
A cometary tail already present, especially in the United States, where studies have measured a clear upsurge in heart attacks, strokes and other cardiovascular problems in the wake of the pandemic.
“For the first time in decades, life expectancy fell below 75 years for American men in 2021 due to COVID, and cardiac events account for 4.1% of this decline,” explains the Dr Marc Ruel, professor and head of the division of cardiac surgery in the Department of Surgery at the University of Ottawa, researcher at the University of Ottawa Heart Institute and president of the Canadian Cardiovascular Society.
Struck in the heart
Almost a million (928,000) Americans died of cardiovascular disease in year 1 of the pandemic, the worst toll in a decade. Among American women, nearly 10% decline in life expectancy in 2021 was attributed to the rebound in deaths from heart disease (5.7%) and stroke (3.5%).
In decline since 1990, the incidence of cardiovascular disease has started to rise again in all age categories in our American neighbours. Even among 35 to 54 year oldsdeaths from cardiovascular disease rose by 10% in 2020, and by 11.2% among non-Hispanic Afro-descendant adultssays a recent report from the American Heart Association.
“We don’t have a 42% obesity rate here like there, but, in my opinion, our situation must be closer to theirs,” said Dr.r Ruel, who deplores the absence of such detailed data in Canada.
Among COVID-19 survivors, in 2020 and 2021, 100,000 had an acute post-infection infarction, and 30,000 a stroke, says another study American. In Europe, a meta-analysis analyzing data from 10 countries observed a 120% jump in cardiac arrests occurring outside of hospitals during COVID.
“COVID has led to major setbacks in cardiovascular health, due to the direct impact of the virus on the heart and arteries, but also the indirect effect due to delays in diagnosis and treatment,” says Dr.r Ruel. According to the Cardiovascular Society of Canada, of all causes of death unrelated to COVID, cardiovascular disease is the one that has the most increased during the pandemic.
Dangerous Liaisons
One thing is certain, the heart and COVID-19 maintain and will continue to maintain dangerous liaisons. From the first months of the pandemic, the impact of the virus on blood coagulation and the vascular system has debunked the image of a virus that is only respiratory, explains researcher Simon Décary. Over the waves, reinfections have increased the risk of developing cardiovascular problems.
In Canada, 1.4 million people say they have developed post-COVID symptoms, and about 4.6% of the population has long-lasting COVID, according to Health Canada. “When you look at these patients, 75% to 80% have various types of arrhythmias, to varying degrees. Some will require care for a few months, others will be followed all their life and limited by disabilities,” he laments.
Waiting lists on the rise
One thing is certain, the waiting lists in cardiology have swelled, according to figures obtained from the Ministry of Health. No less than 1,238 patients were waiting for heart surgery in 2022-2023, compared to 819 in 2019-2020. In hemodynamics (examination of the arteries of the heart and angioplasty), the list jumped from 1884 people to 2401 people. Some 3,811 people are waiting for a pacemaker or defibrillator to be fitted, compared to 2,375 in 2019-2020.
Beyond waiting lists, what traces will the COVID-19 episode leave on the cardiovascular health of ordinary mortals? No one can measure it, says the Dr Normand Racine, specialist in heart failure at the Montreal Heart Institute, flagship of cardiovascular medicine in Quebec. But many signs are already observable.
“The reality is that we are now seeing much sicker patients, who have been slow to consult, and more severe heart attacks,” he says.
The lack of consultation, the interruption of follow-ups and diagnostic examinations during the pandemic has worsened the condition of several patients, adds this expert. “For non-emergency cases, our waiting lists have lengthened by 40%, but our ability to operate has not increased”, explains the Dr Racine.
To limit the damage, we increase the doses of drugs for patients who have been waiting for angioplasty for 6 to 9 months, explains the cardiologist. “Some destabilize, then end up in an emergency. In post-pandemic, we see that [dans tous les types d’interventions cardiovasculaires]. »
More cardiac deaths have also occurred outside of hospitals, says Dr.r Root. “Coronavirus has been known to cause far more myocarditis — some mild, but some fulminant — than any other viral illness. In unvaccinated people, the incidence of myocarditis was five times higher,” he adds.
“And these myocarditis, it leaves a scar in the heart. I suspect that over the long term, many people will develop arrhythmias,” he says.
Hope
Fortunately, vaccines and the arrival of Omicron partly changed the game. The Dre Vicky Tagalakis, internist at the Jewish General Hospital, has been scrutinizing since the start of the pandemic the rate of thrombosis and stroke in patients hospitalized for COVID-19. The attack rate, which was 15% in intensive care, and 9% in bedridden patients on the floors at the start of the pandemic, fell by half. “The evolution of treatments and vaccines have greatly reduced the damage, and the inflammatory effect of the virus on the cardiovascular system,” she explains.
Despite the magnitude of the task ahead, researcher Simon Décary also remains optimistic. “Since Omicron, the risk of sequelae still exists, but it has decreased,” he says.
One thing is certain, Catherine is looking forward to seeing the day when her heart will allow her to dance again.