Over the course of the coronavirus pandemic, scientists have learned that the virus can affect the heart and cardiovascular health in general in the short and long term, and that this impact is not restricted to people who have had severe COVID-19.
“COVID-19 produces inflammation in our body, like any other viral infection,” Dr. Aeshita Dwivedi, a cardiologist at Lenox Hill Hospital in New York City, told Yahoo News. “This inflammation can impact pretty much any organ in your body, and the heart does not get spared,” she added.
When COVID-19 first emerged, it was thought to be a respiratory disease primarily affecting the lungs. But as time went on and the list of its symptoms reported grew longer, scientists learned that the disease can also affect other organs, including the heart.
A recent study conducted by the U.S. Department of Veterans Affairs found that those who recover from a severe case of the disease face significantly higher risks of developing new heart problems and other serious cardiovascular disorders. The study compared rates of new cardiovascular problems in over 150,000 people infected with the coronavirus before vaccines were available, with 5.6 million people who were never infected; they were also compared to a group of 5.9 million people whose data was collected before the pandemic. Researchers found that a year after their recovery, people who had suffered a severe COVID-19 infection had a 63% higher risk for developing heart complications, including heart attacks, heart failure, arrhythmias and stroke, compared to people who were not infected.
The study found that even people who had mild COVID-19 and were not hospitalized appear to be at a higher risk of heart problems a year after infection. People who had a milder form of the disease had a 39% higher risk of developing heart problems compared to those who had never been sick.
COVID-19 can affect the heart in various ways. For some people who fall critically ill with the virus and who need hospitalization, a serious complication called a cytokine storm can occur. This is not caused by the virus but by the body’s response to it. It happens when the immune system launches an attack on the virus that is so severe that it can damage healthy tissues in the body.
Dwivedi said such an event causes significant inflammation. “At that point, it can impact pretty much any part of your heart, including the lining, the heart muscle itself, the arteries of the heart and the rhythm of the heart,” she said.
In some people with severe COVID-19, the massive inflammatory response is also accompanied by severe blood clotting.
“It's the most blood clot-causing disease we've ever encountered,” Dr. Alex Spyropoulos, a thrombosis expert and professor at the Feinstein Institutes for Medical Research, told Yahoo News. “It's a truck going at a 100 miles an hour in terms of what we call a system-wide tendency to have blood clots.” Blood clots, he explains, can block blood flow and reduce oxygenation to the heart, which can damage it.
He said the number of patients who are critically ill and develop these blood clots has fallen over time, probably because many people now have immunity, either from the vaccines or a prior infection, or a combination of both. But also because the virus has mutated into more infectious, but less aggressive forms. However, everyone should continue to exercise caution, he warned, now that COVID-19 cases are on the rise again in many parts of the country.
“Hospitalizations are going up again,” said Spyropoulos, who practices medicine at Northwell Health System in New York. “Thankfully, fewer people are needing critical care, so that's a good sign, but I think once you're sick enough to be in the hospital, the risk of blood clotting is still there.”
New COVID-19 cases have been on the rise nationwide. On Tuesday, New York City’s COVID-19 risk level was upgraded from medium to high, due to an increase in cases and hospitalizations. City officials said more than 10% of its hospital capacity is now occupied by coronavirus patients.
COVID-19 can impact the heart in many different ways, whether an individual has had a severe case of the virus or not. For individuals with underlying heart conditions, COVID-19 can exacerbate the problems, Dwivedi said. She recommends that after contracting COVID-19, people consult a doctor about heart health if they experience any of these symptoms:
Ongoing shortness of breath
Ongoing chest discomfort or pain
Elevated heart rate
Swelling in the legs
Dizziness or lightheadedness with exertion or when changing positions
Some of these heart issues can be temporary, Dwivedi said, and others longer term, but with the proper medical care, they can be rectified. “We do see that with time and appropriate medical care, these can be tackled, in conjunction with your doctor,” she said.
People who have recovered from severe COVID, and even those with milder cases, can also experience lingering COVID-19 heart problems, Dwivedi explained. “Some people may have inflammation of the lining of the heart, which is the sac that the heart sits in, and this is called pericarditis,” she said, adding that this condition can present with chest discomfort and shortness of breath. She said it is relatively benign and can be easily treated.
In some cases, after this condition heals, Dwivedi said it can result in “scarring of the pericardium,” which she compared to the scar from a cut after it heals. Similarly, the inflammation can cause scarring of the pericardium, she explained. In severe cases, this can be problematic, but the cardiologist said that most pericarditis cases she has seen usually resolve after treatment, which involves anti-inflammatory medications.
Body inflammation caused by COVID-19 can also affect the muscle of the heart responsible for pumping blood to the rest of the body. This “less benign presentation," myocarditis, Dwivedi said, can sometimes lead to weakening of the heart muscle and heart failure, which may require immediate medical attention.
A very few cases of myocarditis have been reported after COVID-19 vaccination. "In very rare cases, less than 0.1%, people can get inflammation of the heart muscle," she said, adding that "The good news is that no one [has] had long-term sequelae from vaccine-induced side effects."
Scientists are still studying the long-term effects of infection, known as “long COVID,” which may include heart issues. Dwivedi said some of these patients also complain of palpitations and abnormal heart rhythm, and that their heart rate remains elevated, especially after changing position. She told Yahoo News that these symptoms are due in part to “an imbalance in the homeostasis or the regulation of the blood pressure.” Diagnosing and treating this condition is more challenging, she said, and the treatment options usually “rely on a lot of lifestyle modifications.”
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