Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Mysterious heart damage, not just lung troubles, befalling Covid-19 patients

khn.org

Post reply on HN
Print view View original

81–90 of 197 posts

Re: Mysterious heart damage, not just lung troubles, befalling Covid-19 patients

#81

Post by henearkr »

projektfu wrote: post #79
henearkr wrote: post #72

Earlier quoted context omitted.

I'm not a doctor, but each time I hear about a possible diagnostic about panic attacks, it feels like somebody tells a patient having a rhinovirus "your symptoms are explained by the runny-nose illness!". I.e. just stating the symptom (sympathetic/parasympathetic system going weird, heart too fast, etc) but phrasing it as if it was found to be the cause.

Would you prefer them to say “psychogenic”?

Yes. Because then they have the duty to explicitly rule out non-psychogenic causes (like a pinched vagus nerve, viral infections, a pulmonary oedema, etc).

Sometimes it feels just like the "panic attack" is a wild card they default to when the investigation would be too complicated and the patients looks like anxious anyway (which is probably because the patients' body is playing castanets, who would not be scared of that? But they seem to invert cause and effect).

Re: Mysterious heart damage, not just lung troubles, befalling Covid-19 patients

#82

Post by jobu »

dcolkitt wrote: post #28

This headline is definitely a lot scarier than the actual body of the study. The most likely cause of the heart damage by far is the systemic inflammation induced by pneumonia. We know this because pneumonia patients of all types often have heart strain afterwards[1]. But that damage is very rarely permanent as the risk subsides back to baseline given enough time. Until we see evidence of heart issues in patients wit…

> Until we see evidence of heart issues in patients without pneumonia complications

That's exactly what they're seeing, and why this article was written:

"An initial study found cardiac damage in as many as 1 in 5 patients, leading to heart failure and death even among those who show no signs of respiratory distress."

Unfortunately the article doesn't say what percent of people with cardiac damage did not have respiratory issues as well.

Re: Mysterious heart damage, not just lung troubles, befalling Covid-19 patients

#83

Post by jmull »

cowpig wrote: post #33

There's so much blind speculation in this comment section. The kind that's intriguing and fun when it's about engineering/math/whatever, but dangerous when it's about the health effects of an ongoing pandemic. I hope moderators do something about it.

I think the right place to draw the line is: speculation is fine, medical advice is not.

Of course, we can argue about what constitutes medical advice. I think there needs to be a call to be a call to action (IMO, an implicit call to action would qualify if it's strong enough).

Re: Mysterious heart damage, not just lung troubles, befalling Covid-19 patients

#84

Post by henearkr »

thomashobohm wrote: post #80
henearkr wrote: post #72

Earlier quoted context omitted.

I'm not a doctor, but each time I hear about a possible diagnostic about panic attacks, it feels like somebody tells a patient having a rhinovirus "your symptoms are explained by the runny-nose illness!". I.e. just stating the symptom (sympathetic/parasympathetic system going weird, heart too fast, etc) but phrasing it as if it was found to be the cause.

I mean, panic attacks have no "real" cause by definition. They are your body overreacting in response to a perceived threat that isn't really there; they are a type of cognitive distortion. If a panic attack was in response to a "real" cause, it wouldn't be a panic attack, it would be a normal response to a threat.

I know, but look, it is not the correct behavior of the body, right? So obviously something is wrong, and I find it hard to believe that the problem is from the mind if the patient is not himself stating it. In most cases, if he has an anxiety problem, he would straightly start by talking about it, like "I have been in wrong terms with my neighbors for years, and now just thinking they are next door is hurting my chest and making me hard to breathe"...

I admit that in some cases the problem origin could have been repressed, but this is not very common.

Re: Mysterious heart damage, not just lung troubles, befalling Covid-19 patients

#86

Post by jacquesm »

So, I've been battling this bug for the last three weeks or so, probably caught it on the way back from my last job in Finland. I expected an empty plane instead it was packed like it was the last train out of San Fernando and everybody was scared there never would be another one.

After a week or so symptoms started in spite of having self-isolated already after the flight, so that's why I figure that is where I caught it, no positive confirmation because tests are still pretty rare around here but all the symptoms are present. At least I hope that I did not infect anybody else by taking that precaution. One thing I noticed (besides the hacking cough that does not seem to want to go away) was a pretty highly elevated heartrate at rest. Up to 20% higher than normal.

I already had some lung damage to my right lung due to an earlier pneumonia, but also played saxophone which does a good job of teaching you how to breathe properly and may improve your lungcapacity a bit.

The last couple of weeks have been a continuous rodeo of improvement and falling back again, today is the first day that I have a bit more energy, other than that the time over the last weeks was mostly spent sleeping.

Today is the first time I've seen my heart rate at rest below 60, and I take that as a very good sign that I'm on the tail end of this.

Wouldn't wish this on my worst enemy.

If you can avoid this bug you really should. I totally believe that if I had had a worse general condition that I may have ended up in the hospital, and given the extra strain on the heart I find the heart damage not so much mysterious as logical. After all, if your lung capacity decreases due to fluid in your lungs then your heart and chest muscles will have to work harder (possibly much harder) to get your blood O2 levels to saturation (if they still can...).

Re: Mysterious heart damage, not just lung troubles, befalling Covid-19 patients

#87

Post by daxorid »

throwawaylalala wrote: post #56

Scroll down to figure 1. Non survivors end up with cardiac and kidney injury. Interesting that this might shine light on the cause. https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Thanks. Specifically, from your citation:

"In addition, angiotensin converting enzyme 2, the receptor for SARS-CoV-2, is expressed on myocytes and vascular endothelial cells, so there is at least theoretical potential possibility of direct cardiac involvement by the virus"

The most sane hypothesis I've seen is that the virus will attack any cell with the ACE2 receptor, including the heart and kidneys:

"Angiotensin converting enzyme 2 (ACE2) is an enzyme attached to the outer surface (cell membranes) of cells in the lungs, arteries, heart, kidney, and intestines."

This would require the virus to enter the bloodstream from the lungs, which is possible after sufficient alveolar damage.

ref: https://en.wikipedia.org/wiki/Angiotensin-converting_enzyme_...

As an aside, although Wikipedia doesn't mention it, testicular cells also express ACE2, leading to some worry about downstream fertility effects:

https://www.medrxiv.org/content/10.1101/2020.02.12.20022418v...

Re: Mysterious heart damage, not just lung troubles, befalling Covid-19 patients

#88

Post by DanBC »

henearkr wrote: post #72
Cthulhu_ wrote: post #48

Earlier quoted context omitted.

You could be having panic attacks; based on the fact you've got numbers, it sounds to me like you're actively monitoring your own blood saturation, which already implies you may be worrying too much about things like that. Don't underestimate the effects of worry and stress. If it's temporary and you don't have other symptoms then you probably don't have the virus.

I'm not a doctor, but each time I hear about a possible diagnostic about panic attacks, it feels like somebody tells a patient having a rhinovirus "your symptoms are explained by the runny-nose illness!". I.e. just stating the symptom (sympathetic/parasympathetic system going weird, heart too fast, etc) but phrasing it as if it was found to be the cause.

Panic is a normal response to many situations. Panic can also be an abnormal response to normal stuff. When people experience panic that interferes with their day to day life, and causes them distress they may have an anxiety disorder.

Anxiety disorders are distressing and debilitating, and they lead to years of life lost to disability. Some of them have high rates of death by suicide.

Luckily, they're also very treatable. Most people experience pretty good recovery from an evidence based talking therapy. Sometimes that needs to be combined with medication, and sometimes the talking therapy needs to be repeated in a year or so.

So, hopefully, when people say "this sounds like a panic disorder" what they're really saying is "I understand the distress you're in, and here's some things that may help".

Re: Mysterious heart damage, not just lung troubles, befalling Covid-19 patients

#89

Post by hkai »

JumpCrisscross wrote: post #59
dcolkitt wrote: post #28

This headline is definitely a lot scarier than the actual body of the study. The most likely cause of the heart damage by far is the systemic inflammation induced by pneumonia. We know this because pneumonia patients of all types often have heart strain afterwards[1]. But that damage is very rarely permanent as the risk subsides back to baseline given enough time. Until we see evidence of heart issues in patients wit…

> The most likely cause of the heart damage by far is the systemic inflammation induced by pneumonia Isn’t this premature given the lack of data? We’re seeing an anomaly documented and being studied. It’s not cause for alarm. But neither does it merit such dismissal.

Perhaps you are correct that this is not a cause for alarm, but the way the headline and the first few paragraphs are written, it seems the author is trying to induce anxiety in people reading it, presenting heart damage as inevitable and factual.

Re: Mysterious heart damage, not just lung troubles, befalling Covid-19 patients

#90

Post by SketchySeaBeast »

henearkr wrote: post #84
thomashobohm wrote: post #80

Earlier quoted context omitted.

I mean, panic attacks have no "real" cause by definition. They are your body overreacting in response to a perceived threat that isn't really there; they are a type of cognitive distortion. If a panic attack was in response to a "real" cause, it wouldn't be a panic attack, it would be a normal response to a threat.

I know, but look, it is not the correct behavior of the body, right? So obviously something is wrong, and I find it hard to believe that the problem is from the mind if the patient is not himself stating it. In most cases, if he has an anxiety problem, he would straightly start by talking about it, like "I have been in wrong terms with my neighbors for years, and now just thinking they are next door is hurting my che…

> "I have been in wrong terms with my neighbors for years, and now just thinking they are next door is hurting my chest and making me hard to breathe"...

Not at all. Anxiety is hearing the boss music in a video game and not seeing any enemies. I'll often find myself so tense I'm holding my breath with no ability to rationalize why I'm in that state. It's a real bastard.

Post reply on HN