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Six-fold monthly rise in heart attacks in Mumbai in 2021 over previous years: BMC data – The Indian Express

Mumbai witnessed an over six-fold rise in monthly deaths related to heart attack in the first six months of 2021 compared to previous years. Between January and June 2021, as many as 3,000 people lost their lives to heart attacks every month in the city, compared to 500 in 2020.

According to data provided by the Brihanmumbai Municipal Corporation (BMC), a total of 5,849 patients lost their lives to heart attacks in Mumbai in 2019. This dropped by 3.6 per cent when 5,633 patients succumbed to the disease in 2020. But between January and June 2021, a total of 17,880 succumbed to heart attacks in the city — a surge of 217 per cent over the previous year, according to a reply to an RTI request filed by activist Chetan Kothari.

“Pre-pandemic, cancer was the biggest killer. But last year, although deaths due to cancer subsided, heart attacks surged significantly,” said a civic official.

Dr Avinash Supe, in-charge of the Covid-19 death committee, said there are three major reasons for the surge in deaths related to heart attack — possibility of development of thrombosis among recovered Covid-19 patients, delay in diagnosis of patients during the pandemic and better recording of data.

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“Globally it has been witnessed that heart attack-related deaths increased during the pandemic, so it is not a new phenomenon that has only been observed in Mumbai. Secondly, since the start of the pandemic, medical practitioners are more conscious of segregation and bifurcation of types of deaths, so it has possibly helped maintain better data pertaining to heart attacks,” said Supe.

It has been observed that SARS-Cov-2 injures the heart and blood vessels in infected patients, which leads to the development of clots, heart inflammation, arrhythmias and heart failure. In August 2021, The Lancet reported that the risk of a first heart attack increased by three to eight times in the week after a Covid-19 diagnosis.

Dr Kedar Todaskar, director of critical care at Wockhardt Hospital and member of Maharashtra Covid-19 Task Force, said though there is no proven cause and effect relationship, the data suggests that Covid-19 infection was a risk factor for thrombosis, not only arterial but venous thrombosis, which included deep vein thrombosis and pulmonary thromboembolism, too, apart from acute coronary syndromes.

“This is related to the virus interacting with the ACE2  receptors in the host body. So, all the organs with a predominance of ACE2 receptors are involved, which includes the endothelium. The endothelium is the inner lining of all vascular structures in the body, which includes the arterial and venous system. Covid-19 typically causes inflammation of the endothelium, which is coined as Covid endotheliitis. This endotheliitis is the cause of increased thrombotic events, thereby leading to increase in the cardiac mortality and morbidity seen in the second wave,” he said.

Also during the second wave, many patients avoided hospitals due to fear of contracting Covid-19, which further delayed life-saving treatment. Dr Prafulla Kerkar, interventional cardiologist, chairman of Guidelines Committee of Cardiological Society of India (CSI), said, “It has been blamed on the pandemic when people with heart attack symptoms reached hospital late, which pushed up the mortality rate. reperfusion therapies like Thrombolytic therapy (that dissolve clots) and timely interventions like angioplasty.”

He also said there is a possibility that patients who died of preexisting heart conditions like decompensated heart disease or heart failure (the heart doesn’t pump blood as well as it should) were categorised as heart attacks without necessary investigation at a time the health system was overwhelmed with Covid-19. “A patient with heart failure is not identified as having a heart attack until it is shown in the ECG and and cardiac enzyme levels are elevated. So, there is a possibility that the data also includes cases of heart failure,” he said.

To better understand the trend, doctors say there is a need for better investigation into the deaths and verbal autopsy of the deceased patients. “But if these patients had no history of past or present Covid-19 infection and died of cardiac complications, then the causes could be major lifestyle changes, additional distress or any new clinical anomaly yet to be analysed. So, it’s advisable to read the data in conjunction with associated risk factors for cardiac complications,” said Dr Abdul Samad Ansari, director, Critical Care Services, Nanavati Hospital.

Source: https://indianexpress.com/article/cities/mumbai/six-fold-monthly-rise-heart-attacks-mumbai-2021-bmc-data-7980763/