ABSTRACT
The acute SARS CoV 2 infection causes increased metabolic demand with reduced cardiac reserve, tachypnoea, acidosis, hypoxia causing deleterious effects on cardiac myocytes. Since its heightened sympathetic state these patients are more prone for malignant arrhythmias. The central nervous system involvement of MERS-CoV is mostly caused by the autoimmune reaction against viral antigens rather than viral infection itself. Although coronaviruses can infect the autonomic center in the brainstem, potentially contributing to cardiovascular and respiratory failure, the direct effect of SARS-CoV2 on the autonomic nervous system is not well known yet. The purpose of this review is to emphasise the involvement of autonomic nervous system (ANS) which is an integral part of our human body to adapt for the stressful environment like COVID 19 infection.
ABSTRACT
Background: Admissions for acute myocardial infarction (MI) have declined significantly during the COVID-19 pandemic. The changes in the presentation, management, and outcomes of MI during the pandemic period are not well recognized, and data from low- and middle-income countries are limited.Methods: In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with MI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We sought to determine the changes in the number of admissions, management practices, and outcomes.Findings: We included 41,832 consecutive adults with MI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India with the North zone reporting greater decline (-44·8%) than the South zone (-27·7%). The weekly average decrease in MI admissions in 2020 which peaked around the mid- study period, correlated negatively with the number of COVID cases (r = -0·48; r 2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r 2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume, and teaching programs. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. However, the in-hospital mortality rates did not differ.Interpretation: The magnitude of reduction in MI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing MI admissions during the pandemic.Funding Statement: The study is funded by cardiological society of India.Declaration of Interests: Nothing to declare for all the authors.Ethics Approval Statement: Individual participating centres either obtained an ethical approval from respective Institutional ethics committees or a no objection certificate from the administration.