COVID-19, caused by the SARS-CoV-2 virus, can have lasting effects on the cardiovascular system, even after the initial infection has cleared. Many individuals who recover from the illness report new or persistent heart-related symptoms, underscoring that COVID-19 is not solely a lung disease but can also affect the heart. Recognizing potential cardiac complications that may arise in the weeks or months following a COVID-19 infection is important.
How COVID-19 Impacts the Heart
The SARS-CoV-2 virus can damage the heart and blood vessels through several mechanisms. While direct infection of heart muscle cells is rare, the virus can instigate problems throughout the body that lead to heart damage. The virus primarily targets cells with ACE2 receptors, which are abundant in respiratory epithelial cells but also found in pericytes that wrap around capillaries, potentially leading to widespread effects. A major mechanism of cardiovascular damage involves the body’s overactive immune response, often described as a “cytokine storm.” When the immune system produces an excessive amount of inflammatory cells and cytokines, these small proteins can harm the cardiovascular system in various ways. This widespread inflammation can lead to direct injury to heart muscle cells, causing myocardial injury. Beyond inflammation, the virus can also damage the lining of blood vessels, known as the endothelium. This endothelial dysfunction can increase the risk of blood clots, which may obstruct blood flow to the heart and other organs. The formation of tiny blood clots, or microclots, can further impede circulation within smaller blood vessels in the heart, contributing to heart-related problems.
Common Post-COVID Heart Conditions
Several specific cardiovascular conditions are commonly observed after a COVID-19 infection.
Myocarditis and Pericarditis
Myocarditis involves inflammation of the heart muscle itself, while pericarditis is the inflammation of the sac-like membrane surrounding the heart. Both conditions can result from the body’s inflammatory response to the virus and may occur simultaneously, a condition known as myopericarditis.
Postural Orthostatic Tachycardia Syndrome (POTS)
POTS is another condition that can manifest after COVID-19, characterized by an abnormal increase in heart rate upon standing. This autonomic nervous system disorder can lead to symptoms like dizziness and fatigue as the heart struggles to regulate blood flow when a person changes position.
Arrhythmias
Arrhythmias, or irregular heartbeats, are also frequently reported after COVID-19. These can include tachycardia, a heart rate that is too fast, or palpitations, which are sensations of a fluttering or pounding heart. Inflammation triggered by the virus can alter the heart’s electrical signals, disrupting its normal rhythm.
Heart Failure
In more severe cases, widespread damage from the virus and the inflammatory response can weaken the heart muscle, potentially leading to heart failure. Heart failure is a condition where the heart cannot pump blood efficiently, resulting in symptoms like fluid buildup and swelling. While less common, severe, prolonged inflammation can contribute to the development of this complication.
Recognizing the Warning Signs
Being aware of potential heart-related symptoms after a COVID-19 infection is important for timely medical evaluation.
Chest pain: This can manifest as sharp, dull, or pressure-like sensations. This discomfort might worsen with deep breaths or feel like tightness or heaviness in the chest.
Shortness of breath: Especially with minimal exertion or when lying down, or if you tire more easily than before your illness.
Heart palpitations: Described as a racing, fluttering, or pounding sensation in the chest, neck, or throat. These irregular heartbeats can be particularly noticeable when changing positions, such as standing up.
Dizziness or lightheadedness: Especially upon standing, often accompanies these palpitations and can point to issues with blood pressure regulation or heart rate.
Extreme fatigue: Not relieved by rest and out of proportion to activity levels.
Swelling (edema): In the legs, ankles, or feet, a sign of fluid retention due to compromised heart function.
Any of these symptoms warrant attention, particularly if they are new or worsening after a COVID-19 infection.
Risk Factors and Vulnerable Populations
Certain factors can increase an individual’s likelihood of developing heart complications after a COVID-19 infection.
Severity of Illness
The severity of the initial illness plays a role, with those experiencing severe or critical COVID-19, especially requiring hospitalization or intensive care, facing a higher risk of heart problems. However, even mild or asymptomatic cases can lead to lasting cardiovascular issues.
Pre-existing Medical Conditions
Pre-existing medical conditions significantly contribute to the risk of post-COVID heart complications. Individuals with hypertension (high blood pressure), diabetes, coronary artery disease, and obesity are at a heightened risk of serious complications. Conditions like heart failure and cardiomyopathy also predispose individuals to worse outcomes if they contract COVID-19.
Age
Age is another factor, with older adults generally being more vulnerable to severe COVID-19 and its associated heart complications. While heart issues can affect people of all ages post-COVID, the risk tends to increase with advancing age. The presence of multiple underlying health conditions further compounds this risk.
Vaccination Status
Vaccination status has also been shown to influence outcomes. Widespread vaccination has contributed to a reduction in hospitalizations and deaths from COVID-19. While not a complete guarantee against long-term effects, vaccination reduces the risk of severe illness and, consequently, the likelihood of developing associated post-COVID complications, including heart issues.
When to Seek Medical Attention
Any new or worsening heart-related symptoms experienced after a COVID-19 infection warrant prompt medical evaluation. Ignoring persistent chest pain, shortness of breath, or heart palpitations is not advisable. Contacting a doctor or a cardiologist is the appropriate next step to assess the situation.
During a medical evaluation, healthcare professionals will review a person’s medical history, including their COVID-19 experience and any cardiac symptoms. A physical examination will involve checking vital signs and listening to the heart and lungs. Blood tests may be ordered to look for markers of inflammation or cardiac injury, such as elevated cardiac troponins.
Further diagnostic tests might include an electrocardiogram (ECG or EKG) to assess the heart’s electrical activity and an echocardiogram to visualize the heart’s structure and function. These tests help determine the underlying cause of symptoms and guide appropriate management. Seeking professional diagnosis and care is important for addressing potential post-COVID heart issues effectively.