In the second wave of the pandemic, doctors are seeing a delayed presentation of complications such as stroke and heart attacks in patients recovering from Covid, sometimes, as long as two months after the patient having been discharged from the hospital. Doctors say they are treating more than 30 such patients every month. While such issues are mostly being seen in those who had moderate to severe Covid, not even people without comorbidities and those younger in age are spared, doctors have observed.
Prof Dr Charan Lanjewar, interventional cardiologist and hon. consultant, Global Hospital, said, “It has been our observation that currently young people with no comorbidities are experiencing heart attacks, strokes, pulmonary embolism and other thrombotic complications. Vascular endotheliitis remains the key patho-physiological factor for multi-organ dysfunction and vascular complications has been revealed by multiple autopsy studies. Recent ICMR data reveals that people who have not been vaccinated are at a greater risk of severe Covid infections, making them more vulnerable to vascular complications.
“A large chunk of the so-called mildly symptomatic patients also have elevated plasma D-Dimer levels, a test which detects the hypercoagulability of the blood, within the first two weeks of the disease. High clinical suspicion, early virus identification by RT-PCR, elevated D-Dimer levels, ECG, echocardiography and CT scan of the heart and lung vessels are cornerstones for timely diagnosis of such cases. Certain blood thinners are effective therapeutic options for such patients. Thus, it appears, the coronavirus may leave the risk of delayed vascular complications even among those who have recovered from it,” said Prof Dr Charan.
Neurologists from civic-run hospitals say they have seen over 20 cases of strokes, heart attacks and aggravation of deep vein thrombosis in patients who have recovered from Covid. “A big percentage of mucormycosis patients have come down with a stroke. Either the fungus itself messes with the blood circulation, or once it reaches the carotid artery (neck vessel), it compresses it, causing a stroke,” said a senior doctor.
Dr Naeem Hassanfatta, cardiologist, Wockhardt Hospital, Mumbai Central, said that per 100 Covid patients, the incidence of cardiac complications and acute heart attacks was almost the same in both waves, though the numbers were higher in the second wave due to a larger number of cases. The major reason behind cardiac complications is the increased thrombotic milieu in Covid infection with severe inflammation, which also involves the cardiovascular system. There may also be direct inflammation of the cardiac muscle, causing myocarditis. “Prevention is basically to avoid Covid infection as much as possible, with social measures and vaccination. If you have moderate to severe Covid infection, antithrombotic therapy may be given under doctor’s guidance. Risk factors like hypertension, diabetes, dyslipidemia need to be controlled in all patients,” she said.
Dr Gautam Bhansali, consultant physician, Bombay Hospital, said that Covid has been found to lead to the development of a pro-thrombotic state, which means the blood of the patients has a tendency to thicken or become sticky, which blocks blood vessels, thus hampering the blood supply to the brain. “When blood supply to a particular part of the brain is cut off due to clotting, it causes strokes. The infection can cause clots in different parts of the brain,” Dr Bhansali said.