Alert

How COVID-19 may affect the heart

By Joe Moore, M.D., FACC

Interventional cardiologist

Pardee Cardiology Associates

Early in 2020 the medical community recognized that COVID-19 may cause significant heart and vascular complications, even in otherwise young and healthy individuals. Physicians also recognized that patients with certain risk factors such as cardiovascular (heart and blood vessels) disease were more likely to experience severe illness and worse outcomes.

Can COVID-19 cause heart damage in healthy people?

In some people, infection with the SARS-CoV-2 virus results in systemic (the entire body) inflammation and disruption of blood clotting resulting in large and small clots forming. These clots can cause heart attack, pulmonary embolism, and stroke. We can also see heart rhythm abnormalities, heart muscle inflammation, and heart failure.

An increasing number of studies are showing that COVID-19 may result in unrecognized heart damage in some young and otherwise healthy individuals. For example, a study in JAMA Cardiology reviewed cardiac MRIs of 100 people who had recovered from COVID-19. Even though most of these people were not hospitalized for their illness 78% had heart abnormalities and 60% had ongoing inflammation in the heart. This is the reason most cardiologists recommend screening studies for young athletes prior to return to competitive sports.

Cardiovascular disease increases risk of COVID-19 complications.

While most people who get COVID-19 will have mild symptoms and fully recover, those with cardiovascular disease are at higher risk of severe complications and death. About 40% of all COVID-19-related deaths have been in people with cardiovascular complications.

  • Pre-existing conditions. Pre-existing heart conditions not only make it harder for the body to withstand the stress of COVID-19 illness but also make it more likely that low oxygen levels, blood clotting problems, and unstable blood pressures will result in significant cardiac complications. People with poor metabolic health, such as type 2 diabetes, prediabetes and obesity, also have a higher risk of blood clots and inflammation in the body.

  • Immune system response. In severe forms of COVID-19 illness, the body’s immune system overreacts, releasing cytokines (inflammatory molecules) into the bloodstream. This immune response can damage many organs, including the heart. Myocarditis (inflammation of the heart muscle) can occur because of the body’s immune response or if the virus directly attacks the heart.
  • Problems with clots. Inflammation caused by COVID-19 can provoke clot formation (which is why these patients require blood thinners) and trigger heart attacks causing heart damage, blood clots in the lungs, and many of the difficulties with maintaining blood oxygen levels.

  • Blood pressure fluctuations. In COVID-19 patients with severe infection, the inflammation and fever can result in shock which is characterized by increase heart rate and blood pressure fluctuations which can cause further heart damage, especially in people who already have cardiovascular disease.

What can you do to protect your heart health?

The COVID-19 pandemic is yet another reason to protect your heart health. If you have cardiovascular disease, you can strengthen your immune system by making healthy lifestyle choices. This includes exercising regularly, eating healthy meals, managing stress and monitoring your blood pressure at home. There is also evidence to suggest that supplements such as Vitamin D, zinc, and antioxidants may help prevent or reduce the effects of COVID-19 infection. Always check with your doctor before you start exercising, add supplements or make changes to your diet.

Most importantly, do not delay medical care because you are worried about contracting the virus. If you have chest pain or signs of a heart attack or stroke, call 911 right away. See your doctor regularly and take your medications as prescribed.

Maintain important social measures: wear a mask in public; practice social distancing; regularly wash your hands; and get vaccinated as soon as a vaccine is available to you.

Contact your health care provider if you have concerns about your heart health. To find a provider near you, visit www.pardeehospital.org.

Dr. Moore is a board-certified interventional cardiologist at Pardee Cardiology Associates.

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