They died of cardiac arrest, but did SARS-CoV-2 break their heart?

They died of cardiac arrest, but did SARS-CoV-2 break their heart?
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Within a month two COVID-19 patients, both of them over 70, died quickly after they tested negative for the virus. They were not included in the list of COVID-19 deaths in Kerala.

Officially, it was said that 85-year-old Veerankutty of Keezhatur in Malappuram and 73-year-old Padmanabhan of Kulathupuzha in Kollam had died of “cardiac arrest”, the older man on April 18 and Padmanabhan on May 4. Both died in the hospital where they were undergoing treatment for COVID-19.

Question is, will a person not be considered a COVID-19 patient once he or she tests negative for the virus even when multiple morbidities aggravated by the virus persist in the patient.

A retired government doctor said COVID-19 is like obesity that triggers a wide spectrum of diseases like diabetes, hypertension, dyslipidemia, cardiovascular disease, fatty liver, reproductive dysfunction, respiratory abnormalities, and even cancer.

“When such a person dies, say of cardiac arrest, obesity will still be considered the root cause. COVID-19 also triggers multiple other ailments, and cardiogenic shock and multiple organ failure are some of them. The cardiac arrest is the result of COVID-19 and these two deaths, therefore, should be listed as COVID-19 deaths,” the former physician said.

In other words, cardiac arrest is nothing but the wind that fell an already broken tree.

However, a top health official in the vanguard of Kerala's fight against COVID-19 said the issue was complex but offered an example to justify the official stand.

“Take for instance a pregnant lady crossing the road. She gets hit by a car and dies. It would not be entirely wrong to say she died because she was pregnant because, if she was not, she could have crossed the road faster and the impact would not have been so severe. In that very limited sense, we can say that COVID-19 was the cause of the death of these two patients,” the doctor said.

But he said to contain the virus, a definite policy distinction had to be made. “Once a person is free of the virus, for the proper understanding of the pandemic, it would be strategically wise to remove the person from the list of COVID-19 cases. At the most, like any viral infection, SARS-CoV-2, the virus that causes COVID-19, would have aggravated pre-existing morbidities in an individual. But after the virus has left the body, it cannot be blamed for issues that were present even before its intrusion,” the doctor said.

Veerankutty's weak heart

The official's argument is compelling in the case of Veerankutty. The 85-year-old man was a chronic heart patient; the man had his first heart attack in his early forties and had refused to do a bypass but was forced to do an angiogram four years ago.

“Uppa had a weak heart and his chest pains were so frequent that uppa himself did not take them seriously,” said his son Muhammad Ali, who, it was suspected, had given the virus to his father after his return from Umrah. Ali, and all others in Veerankutty's family, had tested negative. 

Veerankutty died three days after two consecutive tests showed negative. He was still in the hospital as his heart condition had worsened and he also developed a urinary tract infection. The actual role of SARS-CoV-2 infection in Veerankutty's death is hard to assess given the heart, kidney and urinary problems he had suffered. 

The curious case of Padmanabhan

As for Padmanabhan, he did not have any pre-existing medical condition. He died barely a day after two consecutive tests showed negative. “He did not have any heart problems. Nor did he have pressure, cholesterol or even sugar,” said Shyla, his eldest daughter as she was waiting at Punalur Taluk Hospital for the arrival of her father's body from Parippally Medical College on Tuesday.

SARS-CoV-2, a heart-breaker

Studies have revealed that COVID-19 patients could suddenly develop heart trouble. In a study of Wuhan patients published in The Lancet, it was revealed that only less than half had pre-existing conditions like diabetes, hypertension and cardiovascular diseases, and some of them had gone on to develop cardiovascular problems after the virus strike. More than 10 per cent of the patients, the study said, had developed acute cardiac injury after the virus attack.

Another study by doctors of Zhongnan Hospital of Wuhan University, Wuhan, Hubei, has also affirmed that cardiac injury can be part of coronavirus-induced harm. In other words, SARS-CoV-2 could both irritate pre-existing heart problems and weaken a strong heart.

This leaves open the possibility that the cardiac arrest in Padmanabhan could have been triggered by SARS-CoV-2.

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