My Double Crowns: Untold Stories of CORONAvirus Survivors with CORONAry Heart

Disease

Elijah Keith C. Hiyas

Science and Technology Education Center

Review of Related Literature and Studies

COVID-19 and coronary heart disease. Coronary heart disease is common within the

Philippines. “According to the latest WHO data published in 2018 Coronary Heart Disease

Deaths in Philippines reached 120,800 or 19.83% of total deaths” (World Life Expectancy, n.d.).

In addition, the leading cause of this disease is acute myocardial infarction. Acute myocardial

infarction (AMI), which occurs when an epicardial coronary artery is abruptly occluded due to a

sudden rupture of atherosclerotic plaque, causes myocardial ischemia, is one of the leading

causes of death and morbidity in coronary heart disease (CHD) patients.

According to Naz and Billah that “Several studies suggest an interlink between COVID-19

and ischemic heart disease (Naz & Billah, 2021). This is in relation to the effects of COVID-19

to patients with cardiovascular diseases (CVD) that suggests heart complications based on the

study conducted by Adiba Naz and Muntasir Billah. Furthermore, As stated in Naz and Billah

(2021), the research showed that patients with pre-existing cardiovascular diseases (CVD) have

experienced myocardial injury. This enlightens some of the questions of this research that

patients with coronary heart disease (CHD) have in fact increased the complications of the heart.

It is also worth to point out that the increase levels of biomarkers observed from the study

supports the assumption that myocardial injury had increased due to the presence of COVID-19.

The severity of coronary heart disease (CHD) paired with COVID-19 infection leads to a

lot of risks. As stated in Naz and Billah (2021), the research suggests that the elderly people are

more susceptible to COVID-19. Because an occlusive thrombus can form over a ruptured

coronary plaque due to inflammation causing endothelial dysfunction and increased blood

procoagulant activity, it's safe to assume that pre-existing cardiovascular disease, combined with
an aggravated inflammatory response, can lead to cardiac injury in COVID-19 patients with a

pre-existing cardiovascular disease. This is the leading factor to more complications and risks.

Another thing to note is that in Al-Aly et al (2021) the research suggests that the risks and

burdens include heart failure, cardiac arrest, and cardiogenic shock.

Causes of infection to patients diagnosed with coronary heart disease (CHD). The

virus is considered to spread mostly through respiratory droplets, fecal–oral, and contact

transmission. Viral replication has been observed in the upper respiratory tract mucosal

epithelium as well as the gastrointestinal mucosa. Acute liver and heart damage, as well as

diarrhea and kidney failure, have been recorded, suggesting that non-respiratory symptoms may

play a role, if not the primary role, in COVID-19 patients. It is safe to assume that most patients

got the virus through indirect and direct contact. Furthermore, an insight to how the virus enters

the body of a CVD diagnosed patient As Naz and Billah (2021) explained, that “Once the virus

has entered, the RNA genome of the virus is released into the cytoplasm and viral proteins are

synthesized via transcription and translation, and the viral genome is replicated, and naturally, an

increase in the viral load is observed. Once in the cell, the viral antigen is presented by the major

histocompatibility complex (MHC) and is recognized later by the cytotoxic T lymphocytes [31].

This functional receptor is seen to be highly expressed in the epithelial cells of the lungs, and the

receptor is seen to be expressed at high levels in other organ systems as well, such as the heart,

kidneys, bladder as well as ileum.”

Varied responses or reactions of the possible respondents diagnosed with coronary

heart disease (CHD) upon knowing they were infected with COVID-19. One of the things
that I could not find from the studies that I have found related to the topic of the responses or

reactions of the possible respondents. We cannot assume their responses or reaction without

considering that they might be a specific reaction to that person only. As Al-Aly et al (2021)

explained, that “we provide evidence that beyond the first 30 days of infection, people with

COVID-19 exhibited increased risks and 12-month burdens of incident cardiovascular disease

including cerebrovascular disorders, dysrhythmias, Page 6/19 inflammatory heart disease,

ischemic heart disease, heart failure, thromboembolic disease, and other cardiac disorders. Our

analyses of the risks and burdens of cardiovascular outcomes across care settings of the acute

infection reveal two key findings: (1) that the risks and associated burdens were evident among

those who were not hospitalized during the acute phase of the disease — this group represents

the majority of people with COVID-19 and (2) that the risks and associated burdens exhibited a

graded increase across the severity spectrum of the acute COVID-19 infection (from non-

hospitalized to hospitalized individuals, to those admitted to intensive care). As you can see this

study only talks about the burdens experienced of most people diagnosed with cardiovascular

disease (CVD) infected with COVID-19 and not their reactions. Additionally, the research

published from Research Gate suggests that their reaction is being depressed. Throughout the

years, various theories based on behavioral and lifestyle or biological patterns, have been

developed aiming to shed light on the connection between depression and cardiovascular issues.

A short description of the major mechanisms identified follows (Flouda, Stefanatou, & Apergi,

2020). Based on their research we can assume that depression is the most likely reaction

nevertheless we should consider other reactions and thus leads us to the gaps between the

reviewed studies and the topic at hand.

 Lacking concrete information of what the possible respondents will do to cope with

their stacked illnesses. Like the first one, the studies and articles I have found lack concrete

information that may guide me in asking the possible respondents of what their possible coping

mechanism would be. The two research I found only talk about the causes, severity, and

severities of having both COVID-19 and coronary heart disease (CHD). Additionally, as Khera

et al (2020) explained, “A healthy lifestyle remains the foundation of all CVD prevention efforts.

Unfortunately, the current COVID-19 crisis presents challenges to the implementation and

optimization of lifestyle efforts including physical activity, nutrition, weight management, and

smoking cessation. Nevertheless, aggressive promotion of a healthy lifestyle should continue and

there are unique opportunities that can be leveraged for cardiovascular health promotion, even

amidst the crisis.” The possible respondents may cope with their stacked illness through a change

in lifestyle. Although their coping mechanism may vary as the possible respondents may have

different experiences in dealing with it. Overcoming nicotine addiction is challenging even in

normal times, and negative psychological factors (perceived stress, anxiety, frustration) are

smoking triggers [60]. This current anxiety-provoking crisis may create triggers for smoking

relapse and continued smoking behaviors, but there are also opportunities to make strides in

tobacco cessation (Khera, et al., 2020). As stated in Khera et al (2020) smoking relapse may be a

possible coping mechanism of the possible respondents. Anxiety can affect people and like this

possible instance we cannot deny it may be possible. Although the studies have a point, we still

lack concrete information. The possible respondents may have other coping mechanisms to add

once we engage in online interviews.

References

Abbasi, J. (2021, February 10). Researchers Investigate What COVID-19 Does to the

HeartJennifer Abbasi. Retrieved from JAMA Network:

https://jamanetwork.com/journals/jama/fullarticle/2776538

Al-Aly, Z., Bowe, B., Xie, Y., & Xu, E. (2021, October 5). One-year Risks and Burdens of

Incident Cardiovascular Disease in COVID-19: Cardiovascular Manifestations of Long

COVID. Retrieved from Research Square: https://assets.researchsquare.com/files/rs-

940278/v1/5380295d-8158-4b36-af69-210bf1e66fc1.pdf?c=1634087293

Flouda, E., Stefanatou, A., & Apergi, T. (2020). Intervention Options: Depression &

Cardiovascular Disease during Covid-19. Retrieved from Research Gate:

https://www.researchgate.net/profile/Athena-

Stefanatou/publication/354372384_Intervention_Options_Depression_Cardiovascular_Di

sease_during_Covid-19/links/6134994638818c2eaf8227fe/Intervention-Options-

Depression-Cardiovascular-Disease-during-Covid-19.pdf

Khera, A., Baum, S. J., Gluckman, T. J., Gulati, M., Martin, S. S., Michos, E. D., . . . Shapiro, M.

D. (2020, May 1). Continuity of care and outpatient management for patients with and at

high risk for cardiovascular disease during the COVID-19 pandemic: A scientific

statement from the American Society for Preventive Cardiology. Retrieved from Elsevier:

https://www.sciencedirect.com/science/article/pii/S266666772030009X

Naz, A., & Billah, M. (2021, April 7). COVID-19 and Coronary Heart Disease. Retrieved from

Encyclopedia: https://www.mdpi.com/2673-8392/1/2/28/htm
World Life Expectancy. (n.d.). PHILIPPINES: CORONARY HEART DISEASE. Retrieved from

World Health Rankings: https://www.worldlifeexpectancy.com/philippines-coronary-

heart-disease