I remember a patient, let’s call her Sarah, who came in a few weeks after a “mild” bout of COVID. “I just don’t feel right, Doc,” she said, her hand instinctively going to her chest. “My heart sometimes feels like it’s doing a little tap dance, and I get winded just walking to the mailbox.” Sarah’s story isn’t unique. We’ve seen that even if you’ve never had heart issues before, you can, unfortunately, develop heart problems after COVID. It’s a real concern, and something we’re still learning more about every day.
It’s pretty rare for the virus itself, SARS-CoV-2, to directly infect your heart muscle. But what we do see is the virus causing a ruckus elsewhere in your body, and your heart can get caught in the crossfire. If you already have a heart condition, or risk factors like high blood pressure, diabetes, or obesity, you’re at a higher risk for these complications. But truly, anyone can be affected.
How COVID-19 Can Affect Your Heart
So, what’s actually happening? Often, it boils down to inflammation.
When you get an infection, your immune system jumps into action. It sends out inflammatory cells and tiny proteins called cytokines to fight off the invader. This is a good thing! But sometimes, especially with COVID-19, this response can go into overdrive. We call this a cytokine release syndrome, or a “cytokine storm.” It’s like the body’s defense system becomes a bit too enthusiastic, and that intense inflammation can harm your cardiovascular system.
This inflammation can lead to a few different heart issues:
- Myocardial injury: This means damage to your heart muscle cells. It’s more common if you were very sick with COVID, perhaps needing ICU care. Estimates vary, but some studies suggest it happens in 7% to 40% of COVID patients. Sometimes there are no symptoms, but you might feel chest pain, shortness of breath (what we call dyspnea), or notice swelling in your legs. We can check for this with blood tests and heart imaging.
- Myocarditis: This is an inflammation specifically of the heart muscle.
- Pericarditis: This is when the sac around your heart gets inflamed, sometimes causing sharp chest pain and fluid buildup.
- Arrhythmia: Inflammation can mess with your heart’s electrical signals, making it beat too fast, too slow, or irregularly. If you already have an arrhythmia, COVID can make it worse.
- Blood clots: Inflammation can damage the lining of your blood vessels (the endothelium), making clots more likely. This can increase the risk of a heart attack or stroke. A blood test for an enzyme called troponin can help us see if a heart attack has occurred.
- Heart failure: This is a serious condition where your heart can’t pump blood as well as it should, leading to fluid buildup in your lungs and body.
Who’s at Higher Risk for Heart Problems After COVID?
While anyone can experience these issues, your risk is higher if you have:
- Existing heart failure
- Coronary artery disease (CAD)
- Cardiomyopathy (a disease of the heart muscle)
- Chronic kidney disease (CKD)
- Diabetes
- Overweight/obesity
- A history of stroke
- High blood pressure (hypertension)
- Sickle cell disease
- Thalassemias
It’s worth noting that many folks hospitalized for COVID-19 already have some of these underlying conditions.
Lingering Symptoms: When COVID Just Won’t Quit (Long COVID)
We’re also seeing people with what’s called “long COVID” or post-acute coronavirus (COVID-19) syndrome. This is when you’re still not back to your old self four weeks or more after the initial infection. It can happen even if your COVID case was mild.
Some heart-related symptoms that might pop up with long COVID include:
- Chest pain, especially if it feels worse when you take a deep breath.
- Heart palpitations (that fluttering or racing feeling).
- A persistently fast heart rate (we call this tachycardia).
- Feeling dizzy or lightheaded.
- Shortness of breath, particularly when you exert yourself.
If you’re experiencing any of these, please don’t just brush them off. Give us a call. We might want to run a few tests, like an electrocardiogram (EKG) to check your heart’s electrical activity, or an echocardiogram, which is an ultrasound of your heart.
It’s not just the heart, either. COVID-19 can affect multiple organs. The virus uses something called ACE2 receptors to get into our cells. These receptors are all over our body – in our lungs, blood vessels, kidneys, and yes, our heart. This is why the virus can cause such widespread issues, from lung scarring (fibrosis) to kidney problems.
And a quick but important word: Please don’t delay medical care, whether it’s for a new symptom or a routine check-up. During the height of the pandemic, a lot of folks stayed away from clinics and hospitals. But ignoring potentially serious symptoms is far riskier. If you think you’re having a heart attack, call emergency services immediately. Every minute counts.
Take-Home Message: Protecting Your Heart Post-COVID
Here’s what I really want you to remember about heart problems after COVID:
- COVID-19 can indeed lead to heart issues, even if you were previously healthy.
- Inflammation is a major culprit, potentially causing conditions like myocarditis, pericarditis, or arrhythmias.
- If you have existing heart conditions or risk factors, your chances of complications are higher.
- Be aware of “long COVID” symptoms like palpitations, chest pain, or persistent shortness of breath.
- Don’t ignore new or worsening symptoms. Reach out to your doctor.
- Prevention is key – vaccination remains your best defense against severe COVID and its complications.
It can be unsettling, I know. Especially when you thought you were over the illness and then something new crops up. Give yourself time to heal. And remember, we’re here to help you navigate this.
You’re not alone in this. We’ll figure it out together.
