By Moses Osoro, M.D.
There has been a lot of discussion about the lasting effects of COVID-19 on the lungs and respiratory system, but what many may not be aware of are the possible short- and long-term effects the virus could have on cardiovascular health.
Early on in the pandemic, there was indication that many of those hospitalized with COVID-19 were showing signs of cardiac injury. It seemed at that point that most patients who did experience cardiac effects had pre-existing cardiovascular disease.
Recently, however, evidence has emerged that even those who have had the virus without hospitalization and who have otherwise healthy hearts are also at risk for some type of cardiac damage.
Additionally, there’s strong indication that those who do already have heart disease are at high risk for contracting COVID-19 and for experiencing cardiac complications from the virus.
These developments have healthcare experts concerned about a potential overall increase in heart disease and heart failure.
Pre-Existing Heart Conditions Increase the Risk of Severe Symptoms
Cardiovascular disease has been a major predictor of the severity and outcomes of COVID-19. Patients with cardiovascular disease are twice as likely to have severe symptoms of COVID-19 than the general population.
Researchers and experts are now finding that pre-existing heart conditions, like damaged heart muscle or blocked heart arteries, make it more difficult for the body to survive the stress brought on by the virus. Someone with a weaker heart is more likely to have serious reactions to the fever, low oxygen levels, unstable blood pressure, and blood clotting disorders that tend to accompany COVID-19.
It’s also possible that the poor underlying metabolic health common in people with heart disease could increase the risk of severe complications from COVID-19. The symptoms of metabolic syndrome, which can cause heart disease, include inflammation and possible blood clots, which could compound the effects of the virus.
Elevated levels of the troponin enzyme in the bloodstream, an indicator of heart injury, has been detected in about a fourth of patients hospitalized with COVID. Of these patients, about a third had existing cardiovascular disease.
Even with a Healthy Heart, Long-Term Damage Is a Possibility
Most people who contract COVID-19 will experience mild to moderate symptoms and fully recover. For those who had a healthy heart prior to having the virus, cardiac injury is unlikely. However, if severe symptoms develop, the body’s immune system overreacts to the infection by releasing inflammatory molecules called cytokines into the bloodstream. An influx of cytokines can damage the heart and other organs.
The virus can also inflame the heart muscle (a condition called myocarditis) or throw off the balance between oxygen supply and demand. This increases the risk of developing heart disease in the future. Additionally, COVID-19 has been associated with causing a hypercoagulable state, an increased tendency to develop blood clots, which can result in heart attack, stroke, deep vein thrombosis, or pulmonary embolism.
A study by The Journal of the American Medical Association (JAMA) looked at cardiac MRIs of 100 people who had recovered from COVID-19 within the previous two to three months. Of these, 78% showed heart abnormalities and 60% showed ongoing myocarditis. In 76% of patients studied, there were high levels of troponin, which indicates some level of heart damage, although there did not appear to be any effect on heart function. Most of the study patients had not been hospitalized due to COVID.
Of the people who have been hospitalized with COVID, nearly a fourth have been diagnosed with cardiovascular complications, even if their hearts were healthy prior to contracting the virus.
Look for the Danger Signs
It’s normal to feel tired and easily winded when you’re recovering from COVID-19 and for some time after. In most cases, if you haven’t had severe coronavirus symptoms, this is due to the virus’ impact on your lungs.
However, if you’re experiencing any of the following symptoms and did not experience them prior to COVID, you should talk to your physician or a cardiologist as soon as possible:
- Extreme shortness of breath with physical exertion
- Chest pain
- Swelling of the ankles
- Heart palpitations or irregular heartbeat
- Shortness of breath when lying flat on your back
- Waking up with shortness of breath or gasping for air
- Lightheadedness or dizzy spells
If you have any concerns about your heart health after contracting COVID-19, even if you’re not experiencing symptoms, you should discuss them with your doctor.
Dr. Osoro is a cardiologist who cares for patients at Kelsey-Seybold’s Kingwood Clinic and The Woodlands Clinic. His clinical interests include the treatment and prevention of coronary artery disease, treatment and management of valvular disease, and diagnosis and treatment of arrhythmias.