Severe cases of COVID-19 with pre-existing acute cardiovascular underlying condition are at a greater fatality risk.

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The death rate in such patients is estimated up to 15X higher than patients without co-morbidities. The doctors have observed that one out of five such cases expires while battling the deadly virus.

Amit Bhushan Sharma, Associate director and Unit head cardiology, Paras Hospital Gurugram suggested that people who have non-communicable diseases (NCD) like cardiac diseases are 10X more predisposed to getting COVID-19 and their mortality rate is ten times higher than the non-NCD patient. "Most of the attention in the COVID-19 pandemic has been on how the virus affects the lungs, but evidence shows that up to 1 in 5 infected patients have signs of heart damage and many are dying due to this," Sharma said.

Naveen Bhamri, HOD & Director, Cardiology, Max Super Speciality Hospital, Delhi, also concurred that the prevelance of mortality due to COVID-19 is higher in cardiac patients. "Various studies prove that cardiac patients have more severity of COVID than patients without any comorbid condition. "The symptomatic patients with preexisting cardiovascular problems or undergone bypass surgeries have additional 20 per cent mortality than other patients," he added.

"The mortality in a COVID case with the existence of a single comorbid situation like hypertension is 3 to four times higher than non-NCDs. However, the rate elevates to seven or eight times if the case has additional comorbidity of cardiovascular disease. The rate in this situation reaches around 20 per cent," said Udgeath Dhir, Director and Head, Cardiothoracic and Vascular Surgery, Fortis Memorial Research Institute, Gurugram.

The experts had a little difference of opinion in mortality in cardiac patients with varying severity of the symptoms. Bhamri said that the mortality of 20 per cent is observed in the cardiac patients exhibiting severe symptoms of COVID-19. "This scenario does not apply to the cardiac patients who are asymptomatic," he added. However, Dhir observed that it is just a matter of time that the COVID-19 infection progresses to severe state underlying that all the cardiac patients are at equal risk of the additional mortality.

"The COVID-19 infection never starts with severe sypmtoms. It starts with mild or moderate symptoms but aggregates to severe state rapidly in the cases of cardiac patients. The aggressiveness of the disease depends on the innate immunity reserve of the body. The reserve is less in the patients with multiple comorbidities," he said.

While the patients of preexisting cardiovascular issues are facing higher chances of the death due to Coronavirus, another scenario is coming to the fore where people with no caridac history are coming with cardiovascular issues after recovering from the COVID-19 infection. The disease has started manifesting severe heart problems in many of the recovered patients. "It is one of the residual symptoms of COVID-19. People are coming with a blockage in heart vessels and arteries. They are becoming cardiac patients after contracting the virus," said Bhamri. "We are facing at least 10 per cent of COVID recovered patients whose brain, heart and lungs were damaged by the Coronavirus," Dhir estimated.

Sharma observed that the receptors in the lungs, which attaches with the virus are damaging the heart of the patient as well. "The damage observed in COVID-19 patients could be from the virus directly infecting the heart muscle. Initial research suggests the coronavirus attaches to certain receptors in the lungs, and those same receptors are found in heart muscle as well," Sharma added. Besides, Dhir suggested that cardiac patients should consult with their cardiologist very frequently and immediately inform them in case they develop a new symptom that may or may not related to COVID-19.

"Don't underestimate any new development as a seasonal flu. Monitor your diabetes, blood pressure and keep updating your situation to your cardiologists," he said. "The proper control on sugar, adequate hypertension management, weight control, and to inculcate a healthy lifestyle will help to go a long way in preventing simple corona case to a high-risk corona case. NCDs and COVID-19 have same pathologies," said Sharma also suggested.