COVID 19 and The Heart - Lessons Learnt from this Pandemic Presentation by Dr Jeremy Chow Cardiologist, Electrophysiologist Asian Heart & Vascular Centre www.ahvc.com.sg

1. COVID-19 and The Heart -
Lessons Learnt from this Pandemic
PRESENTED BY:
DR JEREMY CHOW
Consultant Cardiologist & Electrophysiologist
Director of Electrophysiology Service
MBBS, MRCP (UK), MRCP (London), M Med (Int Med)
FAMS, FESC, FHRS
Certified Cardiac Device Specialist
Website：www.ahvc.com.sg
Email: drchow.jeremy@ahvc.com.sg
ZOOM SEMINAR

2. Our Complete Heart Team

4. Overview
Covid 19 infection- 3 stages of the Disease
COVID 19 and cardiac consequences /
complications
Should our cardiac patients consider
vaccination?
Is COVID Vaccine 100% effective and safe?

7. 3 stages of COVID 19 infection
Stage 1 - mild and early, mainly flu
symptoms and resolved in 80%
Stage 2 - moderate disease with lung
involvement “ COVID Pneumonia”
Stage 3 - severe and systemic disease
due to hyper-inflammation
Most cardiac complications occur here

8. Stages of COVID19 Infection

9. Cardiac symptoms of COVID 19: Chest Pain
Acute coronary syndrome
Stress Cardiomyopathy
Myocarditis / Pericarditis
Pulmonary embolism

10. Cardiac symptoms of COVID 19: Palpitation
Sinus
Tachycardia
Premature beats:
PVC/PAC
Paroxysmal AT
Atrial Fibrillation
Ventricular
arrhythmia

11. Cardiac symptoms of COVID 19: Dyspnoea
COVID Pneumonia
/ Pneumonitis
Heart Failure
Pericardial
effusion

12. Overview
Covid 19 infection - 3 stages of Disease
COVID 19 and cardiac consequences /
complications
Should heart patients consider vaccination?
Is COVID Vaccine 100% effective and safe?

15. Consequences of COVID Pandemic

17. Overview
Covid 19 infection - 3 stages of Disease
COVID 19 and cardiac consequences /
complications
Should heart patients consider vaccination?
Is Covid Vaccine 100% effective and safe?

19. Mortality rate among the different ages

20. Should patients with heart condition consider COVID
Vaccination?

23. Myth

25. COVID Case (From RH)
40 year old Male
No medical history
Came to hospital for chest pain and
breathlessness
He was also having fever at 38C
At A&E, he was confused with SpO2 96% on
NRM
COVID PCR +

26. Chest X-ray shows bilateral
lung infiltrates (Pneumonia -
from COVID)
ECG shows acute inferior STEMI

28. COVID Case (From Gleneagles)
81 year old Male
No medical history. COVID Vaccinated in July
Transferred from CCF to us for COVID
Pneumonia
He was transferred to ICU for progressive
dyspnoea with new onset AF with ECG
showing ST elevation
Trop T 29.1 -> 36 pg/mL, normal CKMB <5
ng/mL

29. Case (From Gleneagles)

30. Serial CXR (D-dimer 2602)

32. Overview
Covid 19 infection- 3 stages of Disease
COVID 19 and cardiac complications /
complications
Should heart patients consider vaccination?
Is COVID Vaccine 100% effective and safe?

34. UK S.Africa S.America India

39. Case 1
50 year old Male
No medical history
Went for COVID vaccination (Pfizer) on 9
April 2021
4 days later had palpitation and irregular
heart beat.
He saw his GP and did ECG and was
referred to A&E.

40. New onset atrial fibrillation

41. Case 1
He was sent home from A&E after
spontaneously reverted to sinus rhythm and
was started on Concor.
3 days later he was admitted for expressive
aphasia in NUH.
CT Head was normal and his symptoms
resolved in 24 hours —> TIA
So he came to see me for second opinion
for long term anticoagulation

42. Case 1 - MRI clearly documented an infarct

45. Case 2
45 year old Male
No medical history
Completed COVID vaccination (Pfizer) x 2
uneventful in February.
Went for Booster (Pfizer) on 17 September
Complained of sudden onset chest pain on 21
October with radiation to jaw and dyspnoea.
He saw his GP and did ECG and was referred
to A&E.

46. Case 2

47. Case 2: Coronary angiogram - normal

48. Case 2
ECG showed ST elevation MI? in inferior
lateral territory
Coronary angiogram done showed normal
coronaries
What did the labs show?
Trop T 1033->1133 -> 733
CKMB 66 -> 17 -> 3.6
ESR 21, CRP <4

49. What’s the diagnosis on cardiac MRI?

56. Take Home Message….
COVID-19 is not going to go away!
Cardiac complications are common with
COVID infection.
Our index of suspicion for must be high
for post COVID vaccination complication.
Overall vaccination confers more
protection than risk!

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