February is American Heart month, with a focus on hypertension and stroke but with the COVID-19 pandemic happening, healthcare providers are also talking about the effects of the coronavirus on the heart. COVID-19 is a disease that is known to affect the lungs, but this is also a virus that affects many organs of which the heart is one. According to researchers who put out a series of articles about this topic in the Journal of Cardiology in October 2020, they found that about one-quarter of hospitalized patients with COVID-19 developed cardiac complications that included the development of blood clots and arrhythmias. Patients with known heart disease have also experienced more cardiac complications once infected with COVID-19. The stress of inflammation on an already weakened heart can cause the patient to develop other cardiac complications such as myocarditis, an inflammation of the heart muscle.
Who are the patients experiencing cardiac complications? What are their risk factors?
What the current studies are showing so far is that older adults, 65 and older with underlying medical conditions, such as kidney and liver disease are more vulnerable to cardiac complications. In addition to the patient’s underlying diseases, the patient’s immune system response and viral load are also a factor. Once inside the body, the virus can cause disease by either entering the heart muscle or overstimulating the inflammatory response. The heart can also become affected by the body’s nervous system going into overdrive and weakening the heart muscle which can cause cardiac issues.
The risk factors that put patients at high risk for cardiac issues when they have COVID-19 are pre-existing heart conditions such as high blood pressure and high cholesterol. Hypertension was the greatest risk factor with an increase in severity of COVID-19 and increased mortality.
Are younger people having cardiac issues after COVID-19?
Although early findings showed that older people had cardiac complications, recent medical reports are describing this in younger patients. What was particularly concerning in this younger population was that many of them presented with initially no symptoms or just mild disease. This has been seen in young, healthy athletes such as Michael Ojo, 27, a professional basketball player on a Serbian team who tested positive for COVID-19 in July, was cleared to return to the court, and then died from a heart attack in August. A more high profile case in the US involved the professional athlete Eduardo Rodriquez, a young pitcher for the Boston Red Sox, who developed myocarditis after recovering from COVID-19. These cardiac effects of COVID-19 have not only been seen in athletes but the general population as well. A study that was published in July in JAMA Cardiology cited that seventy-eight percent of people who had COVID-19 had heart damage weeks after their recovery, as seen on MRI.
The other population that has demonstrated cardiac complications are patients referred to as “Long Haulers”. These are patients who have developed cardiac complications weeks after their initial infection which include palpitations, extreme fatigue, and a cough.
What cardiac symptoms should a person at home with COVID-19 pay attention to?
For patients who develop mild cases of COVID-19 or who test positive without symptoms, it is important that they are aware of the signs to look for that may indicate cardiac involvement. Patients may think they are getting better, but may suddenly develop subtle changes in stamina or extreme fatigue. According to the Mayo Clinic, signs of heart involvement when someone has COVID-19 are changes in heart rhythm and heart failure. Because of this, patients should be aware of the following signs and symptoms:
Shortness of breath
A persistent cough
Swelling of the feet and ankles
Palpitations
Extreme fatigue
Chest pain
Inability to lay flat
Contact your physician if you are experiencing any of these symptoms to set up an appointment or telemedicine call. Based on your symptoms, your physician may decide to do some diagnostic tests and may treat you with medication to relieve the symptoms. Treatment may include a beta-blocker or diuretic, but this will be decided by your physician after examining you and reviewing test results.
What are some of the lessons learned from the heart effects from COVID-19?
Cardiologists agree that COVID-19 can significantly affect the heart of both people who have pre-existing heart conditions and those that have no history. Researchers are still studying the long-term effects of this virus on the heart since COVID-19 has only been known for a year. The message that everyone should pay attention to is that maintaining good heart health at any age is important! This includes a healthy lifestyle of eating right, exercise, stress reduction, and avoiding alcohol and smoking. Following the current control measures to mitigate contracting COVID-19 should also be done, this would include getting vaccinated for COVID-19, masking, social distancing, avoiding crowds, and handwashing!