Autopsies reveal surprising cardiac changes in COVID-19 patients

Date:
July 21, 2020
Source:
Louisiana State University Health Sciences Center
Summary:
A series of autopsies conducted by LSU Health New Orleans
pathologists shows the damage to the hearts of COVID-19 patients
is not the expected typical inflammation of the heart muscle
associated with myocarditis, but rather a unique pattern of cell
death in scattered individual heart muscle cells.



FULL STORY ==========================================================================
A series of autopsies conducted by LSU Health New Orleans pathologists
shows the damage to the hearts of COVID-19 patients is not the expected
typical inflammation of the heart muscle associated with myocarditis,
but rather a unique pattern of cell death in scattered individual heart
muscle cells. They report the findings of a detailed study of hearts
from 22 deaths confirmed due to COVID-19 in a Research Letter published
in Circulation, available here.


==========================================================================
"We identified key gross and microscopic changes that challenge the notion
that typical myocarditis is present in severe SARS-CoV-2 infection," says Richard Vander Heide, M.D., Ph.D., Professor and Director of Pathology
Research at LSU Health New Orleans School of Medicine. "While the
mechanism of cardiac injury in COVID-19 is unknown, we propose several
theories that bear further investigation that will lead to greater understanding and potential treatment interventions." The team of LSU
Health pathologists led by Dr. Vander Heide, an experienced cardiovascular pathologist, also found that unlike the first SARS coronavirus, SARS-CoV-2
was not present in heart muscle cells. Nor were there occluding blood
clots in the coronary arteries.

Their previously reported results revealed diffuse alveolar damage (DAD)
- - damage to the small airspaces of the lung where gas exchange occurs
-- along with blood clots and bleeding in the small blood vessels and capillaries of the lung, were the major contributors to death.

"These findings, along with severely enlarged right ventricles, may
indicate extreme stress on the heart secondary to acute pulmonary
disease," adds Sharon Fox, MD, PhD, Associate Director of Research and Development in the Department of Pathology at LSU Health New Orleans
School of Medicine.

The autopsies, believed to be some of the first reported from the US,
were conducted on 22 patients who died of COVID-19 at University Medical
Center in New Orleans. The majority were African American. The ten male
and twelve female patients ranged in age from 44-79. Although there
were other underlying conditions, the majority had high blood pressure,
half had insulin-treated type 2 diabetes, and about 41% had obesity.

The LSU Health New Orleans pathologists, as have others, also found
viral infection of some of the cells in the lining of the smaller blood
vessels (endothelium). Although at low levels, it may be enough to cause dysfunction leading to individual cell death. The effects of the so-called "cytokine storm" (severe overreaction of the immune system cells fighting
the infection) associated with COVID may also play a role.

"Given that inflammatory cells can pass through the heart without being
present in the tissue proper, a role for cytokine-induced endothelial
damage cannot be ruled out," says Dr. Vander Heide.

In addition to Drs. Vander Heide and Fox, the LSU Health New Orleans team included Pathology residents Aibek Akmatbekov, MD; Fernanda S. Lameira,
MD; and Jack L. Harbert, MD. Guang Li, and J. Quincy Brown from Tulane,
also participated.


========================================================================== Story Source: Materials provided by Louisiana_State_University_Health_Sciences_Center. Note: Content may be
edited for style and length.


========================================================================== Journal Reference:
1. Sharon E. Fox, Guang Li, Aibek Akmatbekov, Jack L. Harbert,
Fernanda S.

Lameira, J. Quincy Brown, Richard S. Vander Heide. Unexpected
Features of Cardiac Pathology in COVID-19 Infection. Circulation,
2020; DOI: 10.1161/ CIRCULATIONAHA.120.049465 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/07/200721114722.htm

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