Doctor wearing a mask consulting with a patient in a hospital bed

The Potential Negative Effect of COVID-19 on Heart Health

In the early months of the COVID-19 crisis, original thinking was that the only organ system with possible long-term effects was the lungs.  Now, after many months, clinicians are realizing that this coronavirus can negatively affect the heart too. In fact, a study published in September 2020 found that nearly one in four people hospitalized with COVID-19 develop some damage to their heart tissue.

Similar research found a significant number of COVID-19 patients have developed abnormal heart rhythms, and others have developed blood clots. What makes COVID-19 different from other viruses is that multiple blood clots have been found within the heart’s capillaries, or tiny blood vessels, within the heart muscle and in many cases, these clots can go to the lungs, which can be fatal.

People who have pre-existing issues such as high blood pressure, high cholesterol, diabetes or obesity have a greater risk for worse outcomes from COVID. However, lingering heart effects can occur in people who had no issues before getting COVID-19.

Consider the recent incident where Keyontae Johnson, a University of Florida basketball player, collapsed during a game in December. At the hospital after the collapse, Johnson, who contracted COVID-19 last August, was diagnosed with acute myocarditis – inflammation of the heart muscle. While it’s not definitive that his condition was caused by his earlier bout with COVID-19, myocarditis can be triggered by the coronavirus. In general, myocarditis is caused by a viral infection. But some researchers are looking into ways that the myocarditis after COVID-19 differs from myocarditis seen after other viruses.

Usually, myocarditis causes inflammation in the heart muscle, which weakens the heart and makes it harder to pump blood. This can also cause blood clots to form, which can cause strokes, heart attacks or travel to the lungs causing sudden death. But some studies from autopsies of people who died from COVID-19 found inflammation in the blood vessels of the heart, rather than the heart muscle. Additional research is needed to better understand the cause and effect.

As the medical community learns more about the ways COVID-19 affects the heart, it’s a good idea for those who have had COVID-19 to remain in contact with their doctors for ongoing follow-up. This is particularly important for those who had more severe cases and who may have been hospitalized. Lingering side effects seem to be more common with more severe cases.

For those with moderate or severe cases, it’s also important to get a thorough medical evaluation before starting or returning to physical exercise or athletic activity. Individuals should also talk with their doctor about the need for a cardiac screening. And even when people are cleared for exercise, it’s a good idea to slowly work back up to prior exercise levels.

Post-COVID exercisers should be on the lookout for the following warning signs and if experienced, stop exercising and talk with a physician:

  • Chest pain
  • Shortness of breath
  • Abnormal heart rhythm
  • Fatigue

 James D. Grant, M.D., is senior vice president and chief medical officer at Blue Cross Blue Shield of Michigan.

Photo credit: Tempura

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