Speaking at a MIMS Learning webinar this week, Dr Sukhjinder Nijjer, consultant cardiologist at Hammersmith Hospital in London, said that the reduction seen in patients attending for primary angioplasty for myocardial infarction (MI) could result in late presentations with heart failure, ventricular septal defect and mechanical mitral regurgitation.
He said: ‘What we didn’t expect with the first lockdown was that there would be a massive reduction in those patients attending with ST-elevation myocardial infarction and this data is incredibly concerning to us and suggests that we may have a heart failure surge after all of this is done and dusted.’
Dr Nijjer referred to a paper in the journal Heart confirming a decline in primary percutaneous intervention procedures for ST-elevation MI.
He said: ‘This has been seen across the whole of the UK and in fact has also been seen globally in all countries that have had lockdown. So this implies that we’re going to see late presentations now of patients who’ve had a heart attack and did not get state-of-the-art treatment with primary angioplasty.
‘These patients are likely to present with heart failure, they’re likely to present with mechanical complications, with a VSD, a ventricular septal defect, or mechanical mitral regurgitation, LV thrombus or sudden death.’
Dr Nijjer added: ‘Unfortunately over the last six months or so we have seen a massive increase in all of these things. VSDs and [mechanical] mitral regurgitation is essentially something that’s consigned to the textbooks of history and is not something that typically occurs but we’ve had multiple occurrences of this that we’ve ended up having to send for urgent surgery.’
Fear of COVID-19
He added that some of the reduction in attendance could be due to factors such as a reduction in work-related stress, but fear of COVID-19 infection was also a likely factor.
‘All of us working in interventional cardiology have experienced stories of patients saying that they had severe crushing pain but they were so worried about the prospect of picking up COVID from being an inpatient that they simply did not call for an ambulance.’
The webinar provides tips for primary care on management of patients experiencing breathlessness and palpitations, including considering Holter monitoring, NTproBNP testing and referral for echocardiogram.