On their EKGs, some patients with the coronavirus appeared to be having a major heart attack. But their X-rays said otherwise.
Doctors this week were perplexed to find that some coronavirus patients showed symptoms associated with a heart attack, namely a spike in their electrocardiogram (EKG) readings, even if they never had the kind of arterial blockage that comes with the health emergency, according to a study from cardiologists at NYU Langone.
Patients arrived at hospitals “with [a] spectrum of symptoms,” such as fever, shortness of breath, cough and chest pain, Dr. Sripal Bangalore, interventional cardiologist and professor of medicine at NYU Langone Health, tells The Post.
The doctors found several COVID-19 patients who presented with what looked like a major heart attack on an EKG reading, something that is usually triggered by a buildup of fat deposits in a coronary artery. But more than half of the 18 patients included in the report showed no blockage in any major artery.
Overall, 13 of the 18 patients in the study died of coronavirus complications. Of those 13 deaths, 10 people showed no coronary myocardial injury in their angiogram, meaning the damage done to their heart was not caused by a blockage, according to the doctors, who published their findings in the New England Journal of Medicine on Friday.
About 33% of the patients whom the researchers studied had chest pain, Bangalore says.
The study was important because it could help doctors provide more effective treatment for coronavirus patients experiencing chest pain — a symptom that usually triggers an emergency response from medical staff. Bangalore says that “clot busters,” drugs administered through an IV to break up blood clots and plaques, may not be effective in coronavirus patients with this symptom.
“I think the take-home from our study is that maybe that idea of clot busters … may not be the greatest option now,” Bangalore says.
Normally, patients with elevated EKG readings would be rushed to the catheterization, or “cath,” lab for an angiogram, which takes images of vessels in order to detect blockages. According to Bangalore, this is considered the first and best course of action. However, “since there is a small risk of exposure to the cath lab staff from this potential COVID patient,” he says, some groups have suggested “maybe we should be giving them clot busters” as a first line of defense.
“If they don’t have obstructive blockage, giving clot busters to them . . . won’t give you any benefit because there is nothing for them to work on,” says Bangalore. Another potential drawback to anti-clot meds is a risk of “major bleeding.”
Bangalore says that myocarditis, or inflammation of the heart muscle, “is known to occur with other infections [and] it could cause similar EKG changes.”
Bangalore and his colleagues say they can’t be sure what’s causing the elevated EKG readings, but there are a number of possibilities depending on the patient.
“It could be that many of these patients are profoundly hypoxic,” or lacking in sufficient oxygen supply, a condition that impairs blood flow to the heart, causing EKG changes, he says.
It’s possible, he says, that the biological stress caused by the COVID-19 infection can cause a “plaque [to] rupture,” leading to a clot, which may also impede blood flow through an artery.