Many people recovering from COVID-19 report post-viral symptoms, with heart-related issues like arrhythmias being a notable concern. An arrhythmia is an irregular heartbeat, and its appearance after a COVID-19 infection can be unsettling. Understanding the connection between the virus and these heart rhythm disturbances is the first step toward managing them.
How COVID-19 Affects Heart Rhythm
Heart rhythm disturbances after a COVID-19 infection can be attributed to several biological mechanisms that impact the heart’s electrical system. These effects are not limited to severe infections, as individuals with mild cases can also experience cardiac symptoms.
A primary factor is the systemic inflammation from a COVID-19 infection. The immune system can launch an overwhelming response, known as a “cytokine storm,” releasing a flood of inflammatory proteins. This inflammation can irritate cardiac tissues, disrupting the electrical signals that regulate the heartbeat and making the heart prone to irregular rhythms.
Another mechanism is direct viral injury to the heart muscle. The SARS-CoV-2 virus enters cells by binding to ACE2 receptors present in heart tissue, which can lead to myocarditis, or inflammation of the heart muscle. When these cells are inflamed or damaged, their ability to conduct electrical impulses is compromised, triggering arrhythmias.
The autonomic nervous system, which controls involuntary functions like heart rate, can also be affected. Dysfunction in this system may lead to inappropriate heart rate responses, such as a heart rate that is too fast for the level of activity. This dysregulation contributes to persistent heart rate symptoms long after the infection has resolved.
The physiological stress of the illness itself can also play a part. Factors such as high fever, low oxygen levels (hypoxia), and electrolyte imbalances place strain on the heart. For instance, hypoxia can alter the pH within heart cells and increase extracellular potassium, making the heart more susceptible to arrhythmias.
Types of Post-COVID Arrhythmias
Doctors have observed a range of specific heart rhythm disorders following a COVID-19 infection. These conditions vary in nature and severity, but all represent a deviation from the heart’s normal electrical pattern.
One frequently reported issue is sinus tachycardia, a heart rate that is faster than normal but remains regular. While expected during illness, persistent sinus tachycardia at rest can signal underlying stress on the heart or autonomic nervous system. Patients describe this as a racing or pounding sensation in the chest.
Postural Orthostatic Tachycardia Syndrome (POTS) is another condition linked to post-COVID recovery. POTS is a form of autonomic dysfunction with a significant increase in heart rate upon standing from a sitting or lying position. This can cause dizziness and lightheadedness and is thought to result from the virus’s impact on the nervous system.
Atrial fibrillation (AFib) is an arrhythmia where the heart’s upper chambers, the atria, beat irregularly and out of sync with the lower chambers. Studies show an increased incidence of new-onset AFib in patients after COVID-19. This rhythm can impair the heart’s ability to pump blood effectively and may increase the risk of other cardiovascular events.
Some individuals experience premature contractions, which are extra, early heartbeats from either the atria (PACs) or ventricles (PVCs). These can feel like a flutter, a skipped beat, or a forceful beat. While often benign, a high frequency of these beats can indicate underlying heart irritation or injury.
Symptoms and Diagnostic Process
Recognizing the signs of a potential heart arrhythmia is important for anyone with cardiovascular symptoms after COVID-19. The symptoms can range from subtle to severe, and certain indicators should prompt a conversation with a healthcare provider.
Common symptoms suggesting a post-COVID arrhythmia include heart palpitations, which can feel like a fluttering, racing, or pounding in the chest. Other symptoms are dizziness, lightheadedness, shortness of breath with exertion, and chest pain. The presence of any of these symptoms, along with fainting or near-fainting spells, warrants medical attention.
When a patient presents with these symptoms, a doctor will begin with a physical examination and a review of the patient’s medical history. To assess the heart’s electrical activity, an electrocardiogram (ECG or EKG) is a standard first step. This test provides a snapshot of the heart’s rhythm and can identify many types of arrhythmias.
For intermittent symptoms not captured during a brief office visit, a physician might recommend an ambulatory monitoring device. A Holter monitor is a portable ECG that records the heart’s rhythm continuously for 24 to 48 hours, while an event monitor is worn longer and activated by the patient during symptoms. An echocardiogram, an ultrasound of the heart, may also be performed to assess heart structure and function.
Treatment and Management Strategies
Managing post-COVID arrhythmias is tailored to the specific rhythm disturbance and symptom severity. For many, the issues are temporary and resolve as the body recovers from the infection.
Lifestyle modifications are a foundational component of management. For those with POTS, increasing fluid and salt intake can help maintain blood volume and reduce dizziness. It is also advised to avoid arrhythmia triggers like caffeine and alcohol and to pursue a gradual return to physical activity, as deconditioning can contribute to a rapid heart rate.
If lifestyle changes are not sufficient, medications may be prescribed. Beta-blockers and calcium channel blockers are two classes of drugs used to slow the heart rate and regulate its rhythm. These medications can reduce palpitations and give the heart time to heal. The choice of medication depends on the specific arrhythmia and the patient’s health profile.
For many people, post-COVID heart rhythm disturbances improve over time. As systemic inflammation subsides and the body recovers, the heart’s electrical system can stabilize. This recovery process can take weeks or months, and medical guidance can provide treatment and peace of mind.