Covid-19 outbreak and arrhythmias
Currently, little is known about the psychological impact and mental
health of the general public during the peak of the COVID-19 epidemic.1,2,3 This is especially pertinent with the
uncertainty surrounding an outbreak of such unparalleled magnitude.
Wang and coworkers analyzed the psychological impact of COVID 19
epidemic in China and suggest that with respect to the initial
psychological responses of the general public between 31 January and 2
February 2020, just two weeks into the country’s outbreak of COVID-19
and one day after the WHO declared a public health emergency of
international concern, 53.8% of respondents rated the psychological
impact of the outbreak as moderate or severe; 16.5% of respondents
reported moderate to severe depressive symptoms; 28.8% of respondents
reported moderate to severe anxiety symptoms; and 8.1% reported
moderate to severe stress levels. 7
Varshney M and coworkers reported a lower psychological impact of
COVID-19. They found that 33.2% of respondents to the questionnaire
showed significant (mild / moderate /severe) psychological impact
regarding COVID-19. However, as these results were registered during the
initial phase of the COVID-19 epidemic in the country, it is likely that
they may have changed over time and should therefore be interpreted
accordingly. 8
Depression, anxiety and post-traumatic stress symptoms are known risk
factors for adverse events in patients with chronic heart disease.
Interestingly, much less is known about the effect of stress on the
incidence and course of arrhythmias.
Baldi and coworkers found an increased number of out of hospital cardiac
arrests in northern Italy that matched the same geographical areas most
harshly affected by the pandemia. [9] A significant increase in SCD
events (58%) was reported in this region and these investigators
attribute this spike to late complications of myocardial infract or
ischemia, as patients were more likely to remain at home and avoid
hospitalization for fear of COVID-19 infection. 9
Similarly, a significant reductions in the overall number of hospital
admissions in patients presenting with acute coronary syndromes has been
reported. 10,11
The responses to chronic stress also include a number of modifying
lifestyle behaviors such as increased alcohol consumption, heavier
smoking, and diet high in sugar and fat. 2,12 Together
with sedentary lifestyle these unhealthy changes in diet contribute to
excess energy intakes and weight gain. Unhealthy lifestyle increases
oxidative stress and inflammation. 2,12 When subjects
respond to stress by eating more, substantial anecdotal evidence
suggests the foods selected are typically high in sugar and fat. This
phenomenon has been described as “Food craving”. Food craving has been
defined as a multidimensional experience since it includes cognitive
(e.g., thinking about food), emotional (e.g., desire to eat), behavioral
(e.g., seeking and consuming food), and physiological (e.g., salivation)
aspects. 12,13 Food craving can be associated with a
reduced intake of fruit and vegetables. However, a plant-based diet,
rich in anti-inflammatory and anti-oxidative components, has been shown
to significantly affect the most common cardiovascular risk factors in a
positive way.
Sedentary life also contributes to an increase in cardiovascular risk.
While the positive effects of exercise are well studied also in the
elderly less attention was dedicated to the impact of detraining in the
elderly, although the worsening of dynamic balance found in patients
aged 75 as a consequence of a 3-month period of detraining may have an
impact not only on quality of life but also on exercise-induced
cardiovascular adaptations and probably stress-induced arrhythmogenesis.2,14
We expect an increase in arrhythmic phenomena following quarantine due
to higher stress levels and an unhealthy lifestyle that heightens the
overall cardiovascular risk factor. In addition, stress related to
quarantine induces a change in lifestyle and nutritional habits:, which
is mainly due to reduced availability of goods, limited access to food,
and reduction of outdoor physical activity. (figure 1)