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.