By Bernadette Starzee
Covid-19 can impact nearly every organ of the body, including the heart. Here’s a look at how the virus has affected heart health over the past two years.
Inflammation and Blood Clots
A small number of Covid-19 patients develop inflammation of the heart, which is known as myocarditis, according to Dr. Guy Mintz, director of cardiovascular health and lipidology at North Shore University Hospital in Manhasset. Dr. Mintz pointed to a Centers for Disease Control and Prevention (CDC) report indicating a 0.146% incidence of myocarditis among patients diagnosed with Covid-19 during an inpatient or hospital-based outpatient encounter from March 2020 through January 2021 – or about 3 in 2,000 patients. Myocarditis can cause heart failure, hospitalization and, in severe cases, death.
Some patients also experience pericarditis, which refers to inflammation of the sac surrounding the heart. “It’s like having a sunburn around the lining of your heart – it causes a lot of pain,” said Dr. Richard Shlofmitz, chairman of cardiology at St. Francis Hospital, The Heart Center in Roslyn, who noted that pericarditis incidence was more common earlier in the pandemic.
Blood clots are also associated with Covid-19 and have led to serious complications, especially early in the pandemic, according to Dr. Shlofmitz. Clots can form in the legs, coronary arteries, lungs, and elsewhere and can potentially lead to heart attacks, strokes and other life-threatening emergencies.
But for most patients, the heart largely acts as a “bystander” as the body responds to the Covid-19 infection, according to Dr. Ruwanthi Titano, a cardiologist with the Mount Sinai Health System.
The Heart and Long-Haul Syndrome
Mount Sinai founded the first-of-its-kind Center for Post-Covid Care in May 2020 to help patients suffering from Covid-related symptoms long after their acute infection has subsided. Long-haul syndrome, or long Covid, is generally defined as a variety of Covid-related symptoms a month or more after the initial infection. Common symptoms include fatigue, difficulty thinking or concentrating (called “brain fog”), shortness of breath, headache, dizziness when standing, heart palpitations, chest pain, cough, joint or muscle pain, depression and/or anxiety, fever, and loss of taste and/or smell.
Cardiac symptoms are evaluated with echocardiograms, stress tests, and other tests. “But in most cases, there is no structural heart damage or no malignant arrhythmias,” Dr. Titano said. “What happens in a lot of the patients is that they develop dysautonomia, or nervous system dysfunction, which leads to the heart becoming unconditioned.”
According to Dr. Titano, it is not known why dysautonomia develops in some Covid-19 patients, but the symptoms can range from mild to debilitating.
“When the nervous system is dysregulated, hand in hand we get cardiac deconditioning,” she said. “Patients will say, ‘I used to be a runner, but now if I just walk across the room, my heart is beating fast and I’m out breath’ or ‘I get so exhausted just doing household chores.’”
Patients are treated with supportive treatment and rehabilitation.
“We help retrain the body to not have these exaggerated responses to being upright and doing normal activity,” Dr. Titano said. “Normally, blood pressure dips a little when you stand up, so the nervous system releases adrenaline to go to the periphery to get blood back into circulation. This usually happens in a split second. But when patients have dysautonomia, the body may not respond properly.”
Treatments can include increasing fluid and electrolyte intake, medications, and a graduated exercise program to build up the body’s reserves and train it not to have an exaggerated response. “We start with recumbent exercise – with the patient lying down, which is the least stressful on the body,” she said. “We move up to seated exercises, then seated cardio like a stationary bike, and then upright exercises like an elliptical or treadmill.”
Indirect Impacts on Heart Health
The pandemic shone a spotlight on the importance of going to the doctor for things like blood pressure and cholesterol checks and especially for symptoms like chest pain and shortness of breath.
“One of the biggest tragedies of the pandemic was that people were avoiding going to their doctor, even for severe symptoms, and it led to an increase in heart attacks and cardiac deaths from March through June of 2020,” Dr. Mintz said. “Now with the Omicron surge, some people may be avoiding going to doctors’ offices again, but it’s nothing like 2020.”
Many of the risk factors for adverse Covid-19 reactions are similar to those for heart attacks and other cardiac events, and the pandemic may have raised awareness of the importance of taking healthy steps to control these risk factors, Dr. Mintz said. A study published in the Journal of the American Medical Association’s JAMA Network found that in 5,700 people hospitalized in Northwell Health hospitals during the early months of the pandemic, the leading comorbidities [overlaps of different conditions] were hypertension (56.6%), obesity (41.7%) and diabetes (33.8%).
“Controlling high blood pressure and diabetes, exercising, and losing weight if you’re obese can lower your risk factors and improve your cardiac health over time,” Dr. Mintz said.
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