Covid and your heart

How COVID-19 Affects Your Heart — Even After Recovery

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Sreenivas Gudimetla, M.D., Cardiology

While COVID-19 can affect the entire body in profound ways, a recent study finds that it may leave lasting damage on your heart, which could lead to a heart attack or stroke. Additionally, if you have an underlying heart issue, the coronavirus can be especially serious. That’s why we spoke with Sreenivas Gudimetla, M.D., a cardiologist and physician on the medical staff at Texas Health Southwest Fort Worth and at Consultants in Cardiology, a Texas Health Physicians Group practice, to discuss everything you need to know about COVID and your heart health. 

 

How Viruses Affect Your Heart

The coronavirus isn’t the only virus that may affect the heart. Many viruses, even the flu, can impact our hearts for a variety of reasons. According to the American Heart Association, nearly one-fourth of those hospitalized with COVID-19 have been diagnosed with cardiovascular complications, which have been shown to contribute to roughly 40% of all COVID-19-related deaths.

Three of the most common reasons with COVID-19 are due to low blood oxygen levels, arrhythmias possibly caused by a “cytokine storm,” and an inflammatory heart condition called myocarditis.

Low Blood Oxygen

When you have COVID-related pneumonia, which is common, your blood oxygen levels are low because of pneumonia and lung damage that took place. When you have low blood oxygen levels, fewer nutrients can make their way to the heart muscle which can cause a heart-related injury.

One way to look for signs of damage is by checking the troponin levels in your blood. 

“Troponin is an enzyme that is released by the heart when damage occurs,” says Gudimetla. “For instance, we would check troponins in probable heart attack victims to see if there’s evidence that an event occurred. If you have heart damage related to a COVID infection, your troponin levels will be abnormal.” 

Arrhythmias & Cytokine Storms

Another common heart condition during or after a COVID infection is heart arrhythmia, or an abnormal heartbeat. 

“The most common arrhythmia we see is atrial fibrillation (Afib),” Gudimetla adds. “Afib typically occurs in an older population of patients who have underlying risk factors such as diabetes or hypertension. And this is the very population that tends to do worse when they have COVID.” 

But abnormal heart rhythms aren’t just affecting older populations. In fact, Gudimetla says younger populations sometimes suffer from low heart rate as a response to the infection, or bradycardia. It’s believed this is caused by inflammatory cytokines, which regulate inflammation and repair in the body. But when your body produces too many cytokines in response to an infection, the inflammatory response can lead to heart damage.  

Myocarditis

This leads us to myocarditis, but Gudimetla notes that it’s a bit harder to correlate. 

“Myocarditis is the inflammation of the heart, usually caused by a viral infection,” he explains. “This inflammation of the heart muscle can cause weakening of the pump function of the heart and potentially cause heart failure. But that’s not something you can really prove cause and effect, other than someone saying their heart was fine before COVID and now it’s not.”

That being said, most of these issues are seen during the acute phase of infection, or when you’re actively sick. Gudimetla adds that most people tend to recover without too many long-term effects as a result of the infection. 

“Obviously, there’s not a lot of long-term data on this, but most people that I’ve seen after they had COVID, most actually have normal heart function overall,” he explains. 

 

Risky Business — Even for Healthy Individuals

The heart issues listed above can cause trouble for anyone, even previously healthy individuals. But they’re also why developing COVID-19 can be more serious, and potentially deadly, for those with pre-existing conditions, such as diabetes, heart conditions, chronic lung diseases, and obesity in which the body is already dealing with inflammation or damage. 

But that being said, Gudimetla says one of the biggest frustrations with the disease is that there is really no way of knowing how any one person’s body will react to the virus, meaning even healthy people with no underlying conditions aren’t always completely out of the woods when it comes to adverse events. 

“You have people who are completely asymptomatic and don’t even know they have the virus, then some people are minimally ill, and then some people get hospitalized and very sick, and then we have people who get so sick they pass away,” Gudimetla explains. “While people with underlying conditions are at a higher risk of a bad outcome, there are way too many people with COVID who do not have any diagnosed underlying conditions that do poorly, and we can’t predict ahead of time how you’re going to do. That’s what caused the widespread panic in the beginning. We almost have no control over how a patient’s outcome is going to go. In most health conditions we can give them a pretty good idea of what to expect, but with COVID you can’t.” 

 

What to Be on the Lookout For

That being said, what should you be on the lookout for if you’re currently sick with COVID-19 or recently recovered that may signal your heart is in trouble? 

“Primarily we look for shortness of breath. I’m talking about a clear increase in a shortness of breath in which you can’t do your normal activities; clear increase in shortness of breath where you’re unable to lay down in bed because you can’t comfortably breathe,” says Gudimetla. 

Another thing to be mindful of is increased fluid buildup, such as swelling in the legs and abdomen, as well as lightheadedness or dizzy spells. 

From an arrhythmia standpoint, if you feel as if you have palpitations, a rapid heart rate, or a rapid irregular heart rate, then that’s a sign of potential arrhythmias associated with an infection. 

“Sometimes, if you have heart failure, whether you realize it or not, you can develop a dangerous arrhythmia, and you could either pass out and wake up not knowing what happened or you could pass out and have sudden cardiac death. So it’s important that you don’t wait to get care if you think your heart is in trouble.”  

And if you’re worried about heading to the hospital because you’re afraid you may catch the coronavirus, Gudimetla says the risk of contracting the virus at a hospital is considerably lower compared to other public places you may go, such as the grocery store. 

“Hospitals have very strict protocols in place to screen everybody who walks in that door,” he explains. “The COVID patients are in strict units without access to the general population. Everybody is also required to wear a mask. You cannot enter the building without wearing a mask, and everybody gets temperature checks. If you need medical attention, don’t let the fear of contracting COVID deter you from getting the attention you need because greater harm can be done if you don’t.”

 

The Takeaway 

As vaccines continue to rollout and more places start loosening restrictions, it can feel more and more like the pandemic is a distant memory, but the risk of contracting the virus is still considered high, especially as variants start traveling around the globe. While older individuals or those with preexisting conditions have been predicted to fair worse if they contract the disease caused by the coronavirus, many relatively young and healthy patients get severely ill or pass away from the disease, making it a serious matter for everyone. And now as we are gaining more insight on the disease, it seems more and more people are walking away from a COVID-19 infection with some indication of heart damage. 

That’s why maintaining precautionary social measures such as wearing a mask, frequent hand washing and/or use of hand sanitizer, and social distancing is still just as important as ever before. And if you have the opportunity to get one of the COVID-19 vaccines, doing so can help us get back to “normal” sooner while protecting those who can’t get the vaccine or are still waiting. 

“Not only will the vaccine save your life but it will potentially save someone else’s life as well, and I think that’s equally important,” Gudimetla adds. “And as far as heart damage is concerned, anybody who has symptoms suggestive of heart disease, such as chest pain and shortness of breath, you should seek medical attention before permanent damage to the heart occurs.”

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