COVID-19: Doctors in Singapore advised to watch for heart issues in patients

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SINGAPORE: Doctors in Singapore have been advised to be “watchful” for cardiovascular symptoms in COVID-19 patients, with “emerging data” globally about the increased risks of blood clots and heart disease in such patients. 

Health Minister Gan Kim Yong said in a written answer to Parliament on Thursday (Jun 6) that the Ministry of Health (MOH) had issued a guidance to all doctors on May 20 to highlight the data coming from around the world.

The advisory also asked doctors to look out for cardiovascular symptoms in patients with the coronavirus, and to also provide guidance on evaluating and managing such patients.

Mr Gan was responding to Non-constituency Member of Parliament Leon Perera, who asked if COVID-19 patients in Singapore have experienced “above-average” rates of blood clots and heart disease, as reported in other countries.

In May, four COVID-19 cases who died were not added to the official death toll because they died of heart issues, rather than the disease, MOH said. These four men died in the first two weeks of May.

READ: COVID-19: Why 3 positive cases who died from heart issues were not added to Singapore’s official death toll

“Only cases where the attending doctor or pathologist attributes the primary or underlying cause of death as due to COVID-19 infection will be added to the COVID-19 death count. This is consistent with international practice for classifying deaths,” MOH said on May 12, when the fourth man’s death was reported.

Mr Gan said on Thursday that about one in 1,000 COVID-19 cases in Singapore experienced “cardiovascular events, such as heart attacks and blood clots”.

“Due to the small numbers, we are unable to definitively conclude whether this is higher than average compared to non-COVID patients here in Singapore,” the health minister said.

“This is an ongoing area of research and MOH will continue to support studies on this issue.”

READ: 2 COVID-19 cases’ deaths not attributed to coronavirus: MOH

BLOOD THINNERS USED TO PREVENT BLOOD CLOTS

COVID-19 patients who are admitted to the intensive care unit are at higher risk because they are “immobile for prolonged periods and may have multiple co-mordidities”, said Mr Gan, citing international data.

For such cases, doctors in Singapore take “extra precautions”, including monitoring the patients’ coagulation status or the propensity for the blood to clot.

In some cases, blood thinners are used to prevent blood clots from forming.

“However, use of anti-coagulants must be weighed against the risk of bleeding, and our doctors will decide on a case by case basis,” Mr Gan said.

“As COVID-19 is a new disease, we are learning more about it as we go along. MOH will continue to monitor the emerging evidence, and work with our clinical experts to ensure the best possible care and outcomes for our COVID-19 patients,” he added.

READ: Mysterious blood clots are COVID-19’s latest lethal surprise

4 DEATHS IN COVID-19 CASES NOT LINKED TO DISEASE

The cause of death in four COVID-19 cases in May was not attributed to the coronavirus.

A 47-year-old Bangladeshi national, Case 17410, died on May 1. He was confirmed to have COVID-19 after his demise, MOH reported on May 2.

A day later, the health ministry said the cause of his death was ischaemic heart disease.

On May 5, a 44-year-old Bangladeshi national – Case 16370 – died of acute myocardial infarction. 

He had been admitted to Khoo Teck Puat Hospital on Apr 29 and treated for a heart attack, MOH said. He tested positive for the coronavirus on the same day he was admitted to hospital.

On May 9, a 53-year-old man died of a heart attack due to a blood clot. He was confirmed to have COVID-19 a day after his death.

The Indian national had been taken to the emergency department of Sengkang General Hospital on May 9 after suffering a cardiac arrest.

“The cause of death is ruptured myocardial infarction due to coronary thrombosis,” the health ministry said.

READ: Man dies of heart attack caused by blood clot; confirmed to have COVID-19 after death

And on May 10, a 31-year-old Indian national died after he had collapsed, complaining of chest pain, while he was at his dormitory. The health ministry said he tested positive for COVID-19 on May 11 and the cause of death was coronary thrombosis.

Ischaemic heart disease, also known as coronary artery disease, is when the coronary arteries are narrowed. This can cause chest discomfort, breathlessness and tiredness because of inadequate blood flow to the heart.

These narrowings happen when cholesterol and fat in layers accumulate along the lining of the coronary vessels.

When any of the three arteries gets suddenly blocked, a heart attack occurs. According to the SingHealth website, this may happen because a blood clot suddenly forms over the narrowed portion, or a fat-filled plaque bursts or ruptures.

Acute myocardial infarction is the medical term for heart attack.

Coronary thrombosis is the formation of a blood clot inside a blood vessel of the heart, restricting blood flow. 

“In the dormitories, community care facilities and community recovery facilities, we have been educating workers and patients on preventive measures for cardiovascular complications, such as good hydration, staying active, smoking cessation, and early recognition of symptoms. They are advised to seek medical attention immediately if they feel unwell,” Mr Gan said on Thursday.

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