Although COVID-19 is a respiratory illness, which means it affects the lungs and other aspects of the respiratory system, it can affect other parts of the body as well, including the heart. Heart problems after COVID-19 are not uncommon among survivors, even if they didn't have heart disease prior to their COVID-19 diagnosis. In addition, people who did have underlying medical issues may be more likely to develop a serious heart-related illness after having COVID-19.
How does COVID-19 affect the heart?
"When someone gets COVID or has been exposed to COVID, there is an increased risk of having a heart attack at that time," says Alison Bailey, MD, chief of cardiology at HCA Healthcare’s Centennial Heart at Parkridge (Chattanooga, TN). Additionally, patients who already have heart disease, have had a prior heart attack, or who have conditions such as diabetes or high blood pressure are at higher risk of experiencing all associated complications due to COVID-19.
There are a few ways COVID-19 can affect the heart. One is myocarditis, which is an inflammation of the heart that can happen after any viral infection, as Dr. Bailey notes. This also includes influenza (the common flu) and pneumonia. Myocarditis could lead to heart failure later on, but most people can have their myocarditis treated with medication. Others may experience "spontaneous recovery," where the condition goes away on its own.
COVID-19 can also affect the heart by increasing the risk of thrombosis, or blood clotting. The exact prevalence of thrombotic events due to COVID-19 infection isn't currently known, but more information in this regard is always emerging thanks to ongoing research. According to QJM: An International Journal of Medicine, differences in the prevalence of thrombotic events will be determined based on the stage of the disease, where the patient was hospitalized and their ethnicity.
Symptoms of heart problems after COVID-19
Some symptoms that people should be aware of after having COVID-19 include chest pain, shortness of breath and heart palpitations. "All of those are alarming symptoms that indicate we should evaluate your heart," says Dr. Bailey.
Patients with healthy hearts may experience complications such as myocarditis after COVID-19, but these cases are typically mild, according to Dr. Bailey. Other patients could develop postural orthostatic tachycardia syndrome (POTS), a condition that causes racing heart rate during physical activity, whether that takes the form of exercising or simply standing up.
Any symptoms should be checked out by a doctor, but the severity of the symptoms will determine where someone should go. "If the symptoms are mild, I would probably go to my primary care doctor to start with. If the symptoms make you feel more significantly impaired, the ER or an urgent care center is probably the more appropriate place," Dr. Bailey says. As a cardiologist, the majority of patients that Dr. Bailey sees are coming from their primary care doctor or the emergency room.
Does COVID-19 cause permanent heart damage?
Doctors are still researching whether or not COVID-19 can cause permanent damage to the heart, as there hasn't been enough time to do long-term studies yet, and information may change once more data is gathered. Dr. Bailey notes that patients can generally recover from myocarditis damage, but if someone has a heart attack due to a thrombotic risk, their chances of recovery will depend more on how long it took for them to get to the hospital and have the artery opened.
A study published in JAMA Cardiology used cardiac MRI to evaluate the presence of myocardial injury in patients who had recently recovered from COVID-19. Of the 100 patients evaluated, researchers found abnormalities in the hearts of 78 and observed "ongoing myocardial inflammation" in 60.
How to reduce the risk of heart problems after COVID-19
Not all of the news in this regard is bleak, according to Dr. Bailey. Although myocarditis in particular has been in the news a lot, it has probably been overstated a bit.
"As we've gone through this last year and a half of COVID, what we've seen is that the minority of individuals have involvement of the heart," Dr. Bailey says. Since patients with comorbidities likes heart disease are more at risk if they contract COVID-19, Dr. Bailey also emphasizes that the COVID-19 vaccines are safe and recommended for all cardiovascular patients. She also recommends that patients stay on top of their health to reduce their risk of getting COVID-19 and therefore lower their risk of developing heart problems.
"There have been several studies that found that the people who have the lowest likelihood of getting COVID are the healthiest people," Dr. Bailey says. "So make sure you get regular exercise, make sure you eat healthy. Make sure that you wash your hands normally and take your medicines to treat your blood pressure and diabetes. Make sure you get enough sleep."
If you believe you may have COVID-19 or are worried about any symptoms or changes to your health following a COVID-19 diagnosis, speak with your doctor.