Despite the two cases suspected to be deaths due to heart attacks, they are part of the 17 coronavirus deaths in the official records of the state government. (File Photo/Representational)

With at least two recent deaths in Karnataka due to heart attacks later registered as COVID-19 fatalities, one of the advisors to the state government on coronavirus has proposed a study on the co-relation between heart ailments and the infection.

According to Dr C N Manjunath, Director of the State-run Jayadeva Institute of Cardiac Sciences and a COVID-19 advisor to the Karnataka government, what is complicating matters is the lack of autopsy in case of coronavirus cases. “Rather than COVID-19 causing a heart attack, people with pre-existing heart diseases are getting infected. There are a couple of patients I know who were treated a few years earlier for heart attack and then they succumbed to COVID,” Dr Manjunath said.

On April 16, a 42-year-old driver from Vijayapura region died of suspected cardiac arrest after reportedly learning that two persons he was in contact with had tested positive. Two days later, a test result showed he had COVID-19, with Karnataka Education Minister S Suresh Kumar saying the shock at the possibility of being infected had brought on the heart attack.

The other person who died of a heart attack and later tested positive was a 65-year-old, who had a history of heart ailments and collapsed in his hospital ward in Bengaluru on April 13.

Despite the two cases suspected to be deaths due to heart attacks, they are part of the 17 coronavirus deaths in the official records of the state government.

In normal course, an autopsy would have settled the matter. However, coronavirus cases are not being subjected to one due to fear of infection, and the bodies of the two were disposed of without post-mortem.

International medical research — including in Wuhan, China, the epicentre of the pandemic — has found a link between COVID-19 and accentuation of pre-existing heart conditions, especially among the elderly.

“COVID by itself can rarely cause a heart attack — maybe in some 5% cases because it causes thrombosis formation both in the lungs and sometimes arteries. But it could be a precipitating factor,” Dr Manjunath said.

The Jayadeva Institute has proposed to examine the co-relation in a study along with the Rajiv Gandhi Institute of Chest Diseases, which is one of the centres treating COVID- 19 in the state. “Since COVID-19 is a viral infection, it will have a precipitating role. We are drawing up a study to be conducted if cleared by an ethics committee,” said Dr C Nagaraj, the Director of the Rajiv Gandhi Institute.

The study would look at whether persons with predisposition to heart ailments — with habits like smoking — or a history of it, are more susceptible to the infection.

While there is no written order in Karnataka regarding post-mortem in case of coronavirus deaths, doctors are following some standard procedures, said forensic experts. “For the exact cause of death, a post-mortem would be required, but in such cases, an autopsy will be difficult because people who are doing it will be exposed to very high risk,” Dr Manjunath said.

A forensic doctor said, “What is happening is that doctors are not touching bodies in natural death cases but classifying them all as suspected COVID-19 cases and sending them for swab tests. If the tests are positive, the body is disposed of. Only if test reports are negative are autopsies being considered.”

The Journal of American Medical Association Cardiology (Jama Cardiology), in an editorial on March 27, had referred to two papers published in the journal by researchers from academic hospitals in Wuhan which indicated higher death rates among persons with heart ailments who were infected by coronavirus. One of the studies involving 416 patients found that 19.7% of patients developed myocardial infarction after hospitalisation and had a death rate of 51.2%, compared to 4.5% among people with no myocardial infarction. A second study among 187 patients found 27.8% COVID-19 patients developed myocardial infarction in hospital with a death rate of 59.6%, compared to 8.9% among other patients.

Any link between COVID-19 and heart complications has, however, been refuted by medical researchers like Prof Alida Caforio of the University of Padova, Italy, who is part of the European Society of Cardiology.