Could COVID-19 precipitate cardiac arrests in asymptomatic patients?

The onslaught of the novel coronavirus in late 2019 has affected every part of the world. COVID-19, caused by SARS-CoV-2, is associated with symptoms such as fever, cough, shortness of breath and pneumonia which may ultimately lead to death.

Most people who fall sick with COVID-19 will experience mild to moderate symptoms and recover without special treatment.

As of end April 2021, there have been 152 534 452 confirmed cases of COVID-19 and 3 198 528 people have lost their lives to this deadly illness. In Bangladesh alone, there have been 761,943 confirmed cases and 11,579 deaths.

Aside from the symptoms mentioned previously, the COVID-19 diseases SARS-CoV-2 can be related to cardiac events such as coronary thrombosis and cardiac arrests.

icddr,b in collaboration with National Institute of cardiovascular diseases (NICVD) hospital and Orebro University of Sweden conducted research to determine the prevalence and three-month outcomes of SARS-CoV-2 infection in patients with myocardial infarction (MI) who do not meet the World Health Organization’s (WHO) clinical criteria for suspected COVID-19 (e.g. fever, cough, sneezing etc). It was conducted during the first wave of the COVID-19 pandemic when the Bangladesh daily testing positivity rate was at a peak of around 20%.

Between June to August 2020, the study enrolled 280 patients with myocardial infarction and between the ages of 23–95 at the NICVD. Of the total, 220 (79%) patients were male;

Among the 280 participants, asymptomatic COVID-19 positivity in patients was 13%. Furthermore, generalised weakness was found as the second most frequent reported symptom (47%) and was significantly more often among SARS-CoV-2 infected participants.

After three months, a slightly higher mortality was observed among SARS-CoV-2 positive patients compared with SARS-CoV-2 negative patients (14% vs 11%). Moreover, the proportion of recurrent MIs was numerically higher (5%) vs (3%) among SARS-CoV-2 negative participants (Figure 1).

This study found a substantial rate of undiagnosed SARS-CoV-2 infection in patients with MI who would not have been routinely tested because they do not meet the WHO criteria for COVID-19 symptoms. Thus, these findings highlight the need for screening of all patients with myocardial infarction and adopting preventive measures for frontline healthcare workers, including cardiologists, to avoid spread of COVID-19 in hospital environments.