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COVID-19 And The Heart: What We Now Know

A. Rene Garvey, MD, FACC, FSCAI, Cardiology and Interventional Cardiology at CareMount Medical; Associate Director, Cardiac Catheterization Lab at Northern Westchester Hospital
A. Rene Garvey, MD, FACC, FSCAI, Cardiology and Interventional Cardiology at CareMount Medical; Associate Director, Cardiac Catheterization Lab at Northern Westchester Hospital Photo Credit: CareMount Medical

During the COVID-19 pandemic, cardiovascular health remains a top health priority — with heart disease and stroke continuing to be the #1 and #5 leading causes of death in the U.S. There is a significant relationship between COVID-19 and cardiovascular disease, including more deaths from cardiovascular disease during the pandemic and serious heart conditions associated with an increased risk for severe illness from COVID-19. Nearly a quarter of the people hospitalized with COVID-19 develop myocardial injury or injury to the heart tissue and a significant number of patients have developed thromboembolic disease or blood clots and arrhythmias.

What we now know is that those with preexisting cardiac issues — like hypertension, obesity, high cholesterol, and high blood sugar levels — have a greater risk of experiencing worse outcomes with COVID-19. Imaging tests taken months after recovery from COVID-19 have shown lasting damage to the heart muscle, even in people who experienced only mild COVID-19 symptoms. This can be troubling as inflammation in the heart can lead to long-lasting cardiac disease and failure.

Short Term Effects:

There are many ways COVID-19 can affect the heart during the initial period when someone gets the infection, particularly in the first few weeks. This includes new or worsened problems pumping blood effectively, inflammation of the heart muscle, and inflammation of the membrane around the heart.

My colleagues and I are also seeing a higher incidence of a condition called Takotsubo cardiomyopathy, which is heart dysfunction that occurs when someone is under tremendous stress. These days, stress might be a result of social isolation, from having loved ones fall ill, or from having lost loved ones. So now, more than ever, it is important to partake in activities that reduce stress and keep your mind and body healthy. Try meditation, exercise, a new activity such as learning a language or an online dance class, and keep in touch with family and friends through video calls.

In addition, we are also seeing effects from COVID-19 that may not be directly due to the virus but are related to people not obtaining appropriate medical treatment for a heart problem, often because they have delayed seeking medical care. This has led to serious complications such as heart attacks and potentially deadly conditions, such as weakening of the heart muscle, holes in the heart muscle and tears in the heart valves. These are issues that we haven’t seen in some time and they are ones that may have been prevented because there are such effective treatments available for these heart conditions when detected early.

Long Term Effects:

Your heart muscle is composed of long fibers that contract with every heartbeat. Imaging studies reveal that the COVID-19 virus causes these fibers to break apart into small pieces which can cut off the cells’ ability to beat and may explain lasting cardiac defects in COVID-19 patients. 

JAMA Cardiology study used cardiac MRIs on 100 people who had recovered from COVID-19 within the past two to three months. Researchers found abnormalities in the hearts of 78% of recovered patients and "ongoing myocardial inflammation" in 60%. The same study found high levels of the blood enzyme troponin, an indicator of heart damage, in 76% of patients tested, although heart function appeared to be generally preserved. Most patients in the study had not required hospitalization.

COVID-19 directly or indirectly affects heart muscle cells and other heart tissue, even among patients who did not have signs or symptoms of COVID-19 and patients of all ages. What that means over the long term is not clear. These effects may continue to be subtle — maybe they’ll never lead to symptoms or problems — or they could lead to a change in the way the heart muscle functions.

If you are recovering from COVID-19, take it easy and don’t get back to exercising too early. Stressing your heart could cause further damage. Give yourself a break for at least a couple of weeks. Watch for the following symptoms — and consult with your provider or a cardiologist immediately if you experience:

  • increasing or extreme shortness of breath with exertion
  • chest pain
  • swelling of the ankles
  • heart palpitations or an irregular heartbeat
  • not being able to lie flat without shortness of breath
  • waking up at night short of breath
  • light headedness or dizzy spells

Staying heart-healthy:

If you have a known heart condition, whether high blood pressure or other disease, stay focused on good heart health practices. Be vigilant with hand hygiene, wear a mask always, maintain social distancing, exercise regularly, eat well, stop smoking, reduce your alcohol intake, and build in time to stay connected. It’s very important to maintain social contact, through the internet or phone. Isolation can lead to depression and a host of other serious health conditions. Protect your heart, and in turn, your heart will thank you.

Sources: National Institutes of Health (NIH); American Heart Association (AHA); Centers for Disease Control and Prevention (CDC); Journal of the American Medical Association (JAMA).