Covid-19 and the Heart

The coronavirus 2019 (COVID-19) pandemic is due to a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was first reported in late 2019. This virus has had a massive global impact resulting in the deaths of millions of people. COVID-19 has a broad range of clinical presentations from completely asymptomatic to affecting every organ system of the body.

Based on data collected during the pandemic, we know that individuals with cardiovascular disease are at increased risk of death or severe illness from COVID-19. The virus is dangerous not only to those with preexisting heart disease, but to those with no preexisting medical conditions at all.

COVID-19 can damage the heart muscle in many ways

The virus can either directly damage the heart itself, or it can cause secondary damage due to the inflammatory response caused by the virus affecting other organs in the body. Generally, this secondary damage to the heart is due to increased demands on the heart combined with limited oxygen availability to the heart. In order for the heart to pump blood effectively, it needs to be supplied with enough oxygen.

When the heart is not supplied with the amount of oxygen it needs to perform the work that is required of it, damage to the heart muscle occurs. This oxygen supply and demand mismatch is what leads to the various types of heart attacks.

Additionally, damage can result from inflammation in the heart due to an inappropriate immune system response to the infection. It has become increasingly clear that this inflammatory immune response to the infection is responsible for some of the devastating consequences of the COVID-19 infection.

What tests can be used to detect heart muscle damage?

There have been many studies looking at blood tests and imaging studies to detect damage to the heart caused by COVID-19. Though the field of evidence is still growing, it is well known that individuals who become severely ill with COVID-19, or who have to be hospitalized, are at a relatively high risk of having damage to the heart.

Blood levels of troponin, a heart muscle enzyme, can be used to detect damage to the heart muscle. In addition to blood test, ultrasound imaging of the heart or computed tomography or magnetic resonance imaging of the heart can be used to detect the inflammation or damage caused by the infection.

How does a virus affect the heart?

There are multiple possible ways that viral infections such as influenza or COVID-19 can affect the heart. One of the most common forms of heart muscle damage from viral infections is myocarditis, or inflammation of the heart muscle. This has been well described in individuals who have viral infections such as COVID-19 and the symptoms that occur are variable.

Some individuals are asymptomatic, while others become severely ill and require hospitalization. In addition to direct viral infection and damage to the heart, cardiac damage from COVID-19 and other viral infections can be due to the systemic inflammation that often occurs.

Specifically for COVID-19, based on the risk of heart muscle damage from symptomatic infection, it has been recommended that those individuals who develop severe symptoms such as chest pain or shortness of breath be evaluated for cardiac risk stratification to determine whether any damage has occurred, and to ensure that it is safe to resume regular activity.

What symptoms might I have if COVID-19 has affected my heart?

Symptoms can range in severity from none at all to severe chest pain and shortness of breath. For individuals who are having shortness of breath, chest pain, or signs of low oxygen levels, it is important to seek medical attention so a physician can provide supportive care and determine if additional therapies are needed.

When should I see a doctor to make sure my heart is healthy after COVID-19, and when can I return to exercise?

You should see a doctor for a cardiac evaluation if you had moderate to severe COVID-19, are age 65 or older, or experienced any cardiovascular symptoms. It recommended that individuals quarantine for a 10-day period after initial diagnosis of infection.

For athletes, even if asymptomatic, it is recommended to abstain from exercise for 10 days before gradual supervised resumption.

For those who had moderate to severe symptoms, those with pre-existing cardiovascular conditions, those with prolonged symptoms (>10 days), and those older than 65, it is reasonable to undergo cardiovascular risk stratification to ensure it is safe to resume exercise.

If cardiac involvement is diagnosed during the post COVID-19 infection period, then return to physical activity should be delayed until determined to be safe from a physician.

Protecting Hearts. Saving Lives.

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Protecting Hearts. Saving Lives.

Powered by Hopeworks Technology Solutions

Jake Berman

“I attended a heart screening at Colonial Middle School when I was ten. I was in the marching band and liked to hike and rock climb. I was diagnosed with Wolff Parkinson White Syndrome. After my procedure, I kept doing the same things.”

Whitney Jones

Whitney’s commitment to heart health advocacy began at 10 years old when she and her mother, Rayna, were diagnosed with Long QT Syndrome during a Simon’s Heart screening at Downingtown West High School. Despite the diagnosis, Whitney pursued her passion for cheerleading and continued to thrive in the sport through her college years at St. Joseph’s University. After graduating, Whitney joined Stryker Instruments as the Senior Specialist for Off-Site Meeting and Events, where she skillfully orchestrates events that promote health and medical innovation. Further extending her impact, Whitney is an active member of the Simon’s Heart Young Professionals Committee, while her mother Rayna contributes her expertise on the Board of Directors.

Katie Asper

“I attended a heart screening at Upper Dublin High School when I was ten. I played soccer. I was diagnosed with Wolff Parkinson White Syndrome and had an ablation to fix the problem. I attend Temple University.”

Matthew Green

“I attended a heart screening in Mason, Ohio, when I was ten. I participated in baseball, basketball, and diving. I was diagnosed with an atrial septal defect. I had surgery to repair the hole and started wearing a protective shirt during activity. I am graduating from Miami University.”

Valerie Krawitz

“I attended a heart screening at Colonial Middle School when I was ten. I played baseball, soccer, and track. I was diagnosed with Long QT Syndrome and an atrial septal defect. I had heart surgery to repair the hole and I take medicine for the Long QT. I can’t play competitive sports like I once did, but found other activities. Next year, I’m attending Penn State University.”

Drew Harrington

“I attended a heart screening at Radnor High School when I was ten. I played lacrosse, tennis, and basketball. I was diagnosed with Wolff Parkinson White Syndrome. I used to feel my heart beat really fast, but just assumed it was fine. Coincidentally, on Simon’s 7th birthday, I had a procedure called an ablation. Today, my heart is fine and I attend the University of Richmond.”

Alaysia Keeley

“I attended a heart screening at Norristown High School when I was ten. I played softball and enjoyed going to the mall with my friends. I was diagnosed with Long QT Syndrome. I had to stop playing sports and drinking soda. Now, I take medication and live a normal life.”

Kyle McCabe

“I attended a heart screening at Norristown High School when I was ten. I played baseball, basketball, and football. I was diagnosed with Long QT Syndrome. I stopped playing sports to protect my heart, but I still manage to have fun.”

Melissa Fair

“I attended a heart screening at Colonial Middle School when I was ten. I loved dancing and hanging out with my friends. I was diagnosed with Partial Anomolous Pulmonary Venous Return and Atrial Septal Defect. The doctor told me that my life would have been cut short if I hadn’t found out. I’m graduating from Penn State University this year.”

Zach Steffens

“I attended a heart screening at Stillman Elementary School in Tenafly, N.J., when I was fourteen years old. I love running, Tae Kwon Do, and Armenian cultural dancing. I was diagnosed with a rare congenital defect called ALCAPA (Anomalous Left Coronary Artery from the Pulmonary Artery). I had open-heart surgery and recovered well. One month later, I suffered a cardiac arrest and an automated external defibrillator (AED) saved my life. I now have an implantable cardioverter defibrillator (ICD) and am healthier than ever. I will be attending The College of New Jersey and majoring in biomedical engineering.”

Annie FitzPatrick

“I went into sudden cardiac arrest at a local convenience store when I was 19 years old. My heart stopped and the only reason I am alive today is because an AED was readily available. I was diagnosed with Long QT Syndrome shortly after and was introduced to Darren and Phyllis with Simon’s Heart. I have been an active volunteer ever since. I went on to graduate Cum Laude from Drexel University with a double major in Business Analytics and Marketing and now work at a leading chemical company.”

Maeve Quinn

"I had a sudden cardiac arrest during softball tryouts at my high school. I was 15 years old. Thanks to the quick thinking of my coach and athletic trainer, they started doing CPR and using an AED immediately. This helped save my life. I had an implantable defibrillator surgically placed in case this happens again. I volunteer to educate people on the importance of screenings, learning CPR and the use of AEDs. Anyone can save a life like mine! I am planning on going to college for nursing."