The COVID HEART: More Mysterious/Unpredictable Effects

The more we learn about COVID-19, the more we’ve come to appreciate that it’s a virus like no-other due to its unpredictable nature and mysterious effects (see “From Head to Toe“). For example, we initially thought that like other corona (or common-cold like) viruses, once the infection ran its course, then all would return to normal, in otherwise healthy people. While this is true for the majority who are infected, provided that they are not immunocompromised, do not have pre-existing conditions (cancer, diabetes, hypertension, obesity) or have unhealthy habits (cigarette smoking/vaping), a significant caseload has emerged demonstrating the potential for adverse long-term consequences after the acute phase of the infection has resolved.

This was initially demonstrated in children who developed severe inflammation of blood vessels known as multisystem inflammatory syndrome in children (MIS-C) that developed weeks after the initial infection; ironically, many of these children never experienced COVID symptoms! The second has been the persistence of symptoms well after recovery, with fatigue, shortness of breath, joint pain and chest pain as the most common complaints. Now a new study (see #3 below) adds to the growing complexity of COVID-19 and to the list of potential heart related complications that have arisen as a result of the ongoing pandemic.

  1. Broken Heart Syndrome: Also known as Takotsubo or stress cardiomyopathy, prior cases of “Broken Heart Syndrome” have traditionally occurred during times of extreme stress, such as the unexpected death of a loved one. In addition to the first case of stress cardiomyopathy reported with COVID-19, other cases have now surfaced. The basis for the increased number of cases during this pandemic is believed to reflect the inordinate amount of stress, both psychologically and economically, experienced rather than the direct complication of COVID-19, especially since most of the affected cases have tested negative for the virus.
  2. Heart Muscle Injury: Heart muscle injury occurs in severe cases of COVID-19 and is most likely to occur in those with pre-existing heart disease. The virus increases the risk of blood clot formation and vascular inflammation with a number of cases reported among survivors as well as those who have died of COVID.
  3. Lingering Heart-Related Effects: A recent study from Germany found that 60% patients who had “recovered” from lung infections due to COVID-19, exhibited active inflammation in their heart muscle weeks later with associated reduction in heart function. This suggests that a COVID-19 infection may have a lingering effect on the heart- this in turn may produce symptoms such as palpitations, fatigue and shortness of breath. Consequently, COVID-19 survivors who experience such symptoms after their infection has seemingly resolved, should be evaluated by their physician to rule out the possibility of new-onset heart failure.

Michael Miller, MD is Professor of Medicine, Epidemiology & Public Health at the University of Maryland School of Medicine in Baltimore, Maryland USA.  His latest book is  “Heal Your Heart published by Penguin Random House.

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