Peter wrote:
There could be bad reporting e.g. is it really 75% of all survivors which have the heart attack signature?The two studies are from Germany so maybe @medewok might know more.
Airborne_Again wrote:
So what is a “survivor”? Anyone who has had the disease and not died from it? Those who have been in intensive care and survived, or something in between…?
The Cardio MRI study included 100 patients from the State of Hesse, who contracted Covid-19 between April and June (Diagnosis by swab/PCR test) and where then examined at least two weeks after the initial diagnosis and after “the resolution of respiratory symptoms”. 66% of the patients had recovered at home, while the remaining third had required stationary hospital treatment (no mention of ICU/no ICU in the paper). Median age was 49.
The MRI of the heart was done 71 days (median) after the initial diagnosis. It showed abnormal findings in 78% of all patients! 71% also had elevated Troponin (a highly sensitive cardiovascular marker, usually used for the initial diagnosis of myocardial infraction) at the time of the study. 60% of all patients where found to have an ongoing myocardial inflammation at the time of study (remember, median 71 days after Covid-19 diagnosis)
In the 1st one, the median (interquartile range) age of patients was 49 and in the 2nd one (the autopsy data) it was 85. The 1st is rather scary; the 2nd perhaps less so.
From the 1st one: “patients recently recovered from COVID-19 had lower left ventricular ejection fraction”. Now that has a definite potential for messing up your flying, because more or less any cardiac issue or intervention, under EASA Part-MED, triggers a nuclear perfusion scan (or the less risky dopamine scan) and they look for stuff including the ejection fraction. I don’t know what the threshold is however; it will be published somewhere.
The autopsy study examined 39 dead bodies of people who had died with a confirmed SARS2-CoV infection. Post-mortem, the diagnosis was confirmed with rtPCR. The cases were part of the autopsy study of the first 80 patients who died from Covid-19 in Hamburg, which I had mentioned way earlier in this thread (it took place in April).
Median age of the dead was 85, 59% of whom were women. In 89,7%, Pneumonia was confirmed as the cause of dead during the autopsy. The remaining four died of cardiac decompensation and heart failure, bacterial bronchiitis, necrotizing fasciitis and in one the case of death could not be established.
None of the patients in the study were diagnosed as having clinically fulminant myocarditis.
This is notable as it somewhat contradicts what one would expect after reading the first study, as posted above.
In 15 of the 39 patients, no RNA of SARS2-CoV could be found in the myocardium (which doesn’t mean it wasn’t there at some point earlier…a virus dies if the host dies, although this is not immediate). In 5 patients, there were signs of active replication of the virus in the myocardium (which, afaik, was not previously known…the virus was so far thought to replicate mainly in the respiratory tracts).
Overall, the implications of this study are difficult to interpret. The virus certainly is present in the heart (in the majority of those who died from it), but by established criteria, none of the patients had suffered from a massive inflammation of the heart (“fulminant myocarditis”). The autopsied patients mainly died from (viral) pneumonia.
Peter wrote:
Now that has a definite potential for messing up your flying, because more or less any cardiac issue or intervention, under EASA Part-MED, triggers a nuclear perfusion scan (or the less risky dopamine scan) and they look for stuff including the ejection fraction. I don’t know what the threshold is however; it will be published somewhere.
With the disclaimer that I am not an AME, I would agree. The study shows an effect on the heart in the vast majority of patients (>70%) several weeks after initial diagnosis (median was over two months later). The clinical relevance is less clear, however. The autopsy study indicates that there is no massive damage to the heart tissue itself, but the “follow-up” time is naturally too short yet to draw any conclusions of the long-term relevance of this. It may be years until we really know.
We had a minor flurry of youngish patients (university students, 20s) with myocarditis early on during the pandemic. They weren’t tested for COVID as they didn’t meet the criteria and tests were strictly rationed, but there was a fair amount of speculation about whether there might be a link.
My understanding is that there is a fair amount of microvascular involvement in COVID, and that can affect any organ. i.e small blood vessels block with clots. In addition, SARS-COV2 can probably infect cardiac cells directly, and they can be damaged by the immune system. So patients who have had COVID may have a number of different types of cardiac damage either individually or in combination. It seems likely that their recoveries will be similarly variable.
Peter wrote:
That’s an amazing find, Dimme. Of course you won’t be able to buy the stuff now
There is plenty of it available, I don’t know about other countries.
I’m not sure entirely where this should go but I think it’s relevant to the CV discussion. It seems pretty odd that Facebook, google/ youtube and twitter have decided to ban a video stream from a group of doctors. Breitbart link
I’d like to know what the actual discussion was saying. There seem to be a number of people saying Hydroxychloroquine, azithromycin and zinc seems to be quite effective, but without seeing research and being able to have a discussion how can we make informed decisions ourselves?
without seeing research and being able to have a discussion
If you want to see research try www.google.com/scholar. We don’t seem to have been banned from discussing things here.
kwlf wrote:
We don’t seem to have been banned from discussing things here.
I highly value this and the discussion.
Thanks for the link, I’ve gone through and managed to turn this up, which is I think what they’re talking about Link to paper Interesting.
