COVID-19, caused by the SARS-CoV-2 virus, primarily affects the respiratory system but can also impact the heart. Atrial fibrillation (A-fib) is an irregular and often rapid heart rate that can lead to poor blood flow. For individuals with A-fib or new cardiac concerns, understanding the potential connection between COVID-19 and heart rhythm is important.
Understanding Atrial Fibrillation
Atrial fibrillation is a common heart rhythm disorder characterized by a chaotic and irregular beating of the heart’s upper chambers, called the atria. Instead of contracting effectively, the atria quiver, leading to inefficient blood pumping and a rapid, erratic heart rate.
Normal heart rhythm involves synchronized electrical signals, ensuring blood flows from the atria to the ventricles and body. In A-fib, these electrical signals distort, leading to disorganization. Common symptoms include heart palpitations, shortness of breath, fatigue, and dizziness. Untreated, A-fib can result in serious complications like blood clots, increasing stroke risk, and contributing to heart failure.
How COVID-19 Can Affect Heart Rhythm
COVID-19 can influence heart rhythm through several mechanisms, potentially worsening existing A-fib or leading to its new onset. The body’s widespread inflammatory response to the virus is a significant factor. This systemic inflammation, sometimes called a “cytokine storm,” can directly affect heart tissue and its electrical pathways, contributing to arrhythmias like A-fib.
The SARS-CoV-2 virus may also directly infect heart cells, a condition known as myocarditis. This direct viral entry can lead to electrical instability and rhythm disturbances. The overall stress of COVID-19 illness, including fever, low oxygen levels (hypoxia), and increased metabolic demands, can strain the heart. This stress can trigger or exacerbate A-fib.
Electrolyte imbalances, such as abnormal levels of potassium or magnesium, can arise from severe illness or treatments for COVID-19. These electrolytes maintain stable heart rhythms, and their disruption can contribute to A-fib. Some medications used to treat COVID-19 can also have cardiac side effects or interact with existing A-fib medications. Certain antiviral drugs and antibiotics have been linked to QT prolongation, increasing arrhythmia risk.
The autonomic nervous system, which controls heart rate and rhythm, can also be affected by COVID-19. Dysfunction in this system, often observed in “long COVID,” can manifest as persistent changes in heart rate and rhythm, including palpitations. This disruption can contribute to irregular heartbeats.
Recognizing Worsening Symptoms and When to Seek Medical Attention
Recognizing symptom changes is important for individuals with existing A-fib or new heart concerns during or after a COVID-19 infection. Signs of worsening A-fib can include an increased frequency or intensity of heart palpitations, new or worsening chest pain, or severe shortness of breath. Other indicators include dizziness, lightheadedness, fainting episodes, or extreme fatigue.
Some individuals may experience A-fib for the first time during or after COVID-19. Symptoms such as a rapid, pounding, or fluttering heartbeat, unusual fatigue, or unexplained shortness of breath should prompt a medical evaluation. Communicate any new or worsening symptoms to a healthcare provider.
Certain symptoms warrant immediate medical attention. These “red flags” include sudden severe chest pain that does not subside, significant difficulty breathing, or sudden weakness or numbness on one side of the body. Such symptoms could indicate a serious cardiac event or a stroke, requiring prompt emergency care.
Managing Atrial Fibrillation Post-COVID-19
Following a COVID-19 infection, especially if cardiac symptoms were present, consistent follow-up care with a cardiologist or healthcare provider is important. Regular monitoring helps assess heart health and adjust management strategies as needed. Adherence to prescribed A-fib medications, such as anticoagulants to prevent blood clots or drugs to control heart rate and rhythm, remains important.
Lifestyle modifications can also support heart health and A-fib management. This includes maintaining a balanced diet, engaging in regular physical activity as tolerated, managing stress, and avoiding triggers like excessive caffeine or alcohol. Monitoring heart rhythm at home using personal heart rate monitors, smartwatches, or blood pressure cuffs can provide valuable information for healthcare providers.
COVID-19 vaccination and booster doses are recommended for individuals with underlying heart conditions. Vaccination helps reduce the risk of severe illness from COVID-19, which in turn can lessen the likelihood of cardiac complications. For those who have experienced significant cardiac impact from COVID-19, cardiac rehabilitation programs can offer structured support. These programs often include supervised exercise training, dietary counseling, and education to improve physical function and overall well-being.