‍COVID-19 and Heart Health: What You Need to Know

January 16, 2023

COVID-19 has had far-reaching implications on the global population, and it is becoming increasingly clear that many of these effects are impacting the cardiovascular system. As researchers uncover more information about the virus, staying informed about how COVID-19 could affect your heart health is important.

What We Know So Far About COVID-19 and Heart Health

Preliminary research by the American Heart Association noted that while the findings need further investigation, there's growing evidence that suggests that anyone who has had COVID-19 may be at an increased risk for new or worsening cardiovascular disease. Initial infection is known to cause serious problems like strokes, heart failure, cardiac arrest, or heart attacks. It is also possible to develop pulmonary embolisms if blood vessels become blocked due to inflammation caused by the virus.

Some studies suggest that the risk of cardiovascular problems remains high many months after a SARS-CoV-2 infection clears up. In a 2022 study, researchers used records from the US Department of Veterans Affairs (VA) to estimate how often COVID-19 leads to cardiovascular problems. They found that individuals who recovered from the virus had an increased risk for 20 cardiovascular conditions in the year after infection — adding that these complications can happen even in people who seem to have completely recovered from a mild infection.

To put it in perspective, as of January 2023, there have been 661 million confirmed cases of people infected with SARS-CoV-2 worldwide —raising the concern that the pandemic will be followed by a COVID aftershock — a secondary global health crisis of long COVID. For this reason, we are trying to understand who is most at risk of these heart-related issues, how long the risk persists, and the mechanisms of cardiovascular injuries.

Potential Causes

Short-term or long-term damage to the heart can be due to several factors:

Cytokine storm. SARS-CoV-2 can hyperactivate and impair the immune system by releasing proinflammatory cytokines and chemokines. This cytokine storm can lead to multiorgan damage and make the blood vessel walls easier to penetrate, resulting in 'leaky' blood vessels.

Endothelial dysfunction. In addition to vascular leakage (compromised endothelial barrier function) a cytokine storm exposes the endothelium to proinflammatory cytokines causing endothelial dysfunction. This dysfunction can produce micro-clots in the blood vessels and compromise the heart and other body systems.

Lack of oxygen. The virus pathogenesis can lead to vascular leakage and pulmonary edema. This condition causes fluid to leak into the air sacs in the lungs, decreasing the amount of oxygen reaching the bloodstream. The lack of oxygen forces the heart to work harder to pump blood throughout the body, which can cause the heart to fail from overwork. Oxygen insufficiency can also cause tissue damage and abnormal cell death in the heart and other organs.

Pericarditis. The virus can cause swelling and irritation of the double-walled sac surrounding the heart (pericardium). Individuals may experience sharp chest pain when irritated layers of the pericardium rub against one another. Fluid buildup, known as pericardial effusion, around the heart and poor heart function can complicate the condition.

Myocarditis. SARS-CoV-2 can infect and damage the heart's muscle tissue. When the heart muscle is inflamed, it can affect the heart's electrical system, resulting in arrhythmia or a rapid or abnormal heartbeat. Myocarditis can cause the heart muscle to weaken and can lead to cardiomyopathy. 

Cardiomyopathy. When cardiomyopathy occurs, the myocardium (heart muscle) can stiffen, thicken and can cause scar tissue. As a result, the heart muscle’s ability to pump blood is reduced, which can lead to irregular heartbeats, the backup of blood into the lungs or rest of the body, and heart failure.

Postural orthostatic tachycardia syndrome (POTS). Studies published in Nature Cardiovascular Research suggest that the virus may trigger POTS, an autonomic nervous system disorder often characterized by a rapid heart rate, low blood pressure, fainting, and lightheadedness. Smidt Heart Institute Researchers show the risk of developing POTS is five times higher after SARS-CoV-2 infection. 

Multisystem inflammatory syndrome in children (MIS-C). MIS-C is a rare condition in children in which the body's immune system overreacts to the virus, resulting in inflammation of multiple organ systems throughout the body. It can affect many systems simultaneously and cause impaired organ function and organ failure.

Stroke. A stroke occurs when something blocks blood supply to part of the brain or when a blood vessel in the brain bursts. A stroke can cause lasting brain damage, long-term disability, or even death. A Nature Medicine study found that between 30 days and a year after recovery from COVID-19, survivors were 52% more likely to have a stroke. This means that over one year, for every 1,000 people who had COVID-19, there would be over four extra strokes. In another study published in the American Heart Association journal Stroke, they found that men and women had twice the risk of a major cardiac event one year after a stroke.

Preventive Measures To Protect Your Heart Health

Given all this information, it's important for everyone—especially those with existing heart conditions—to take preventive measures to protect their cardiovascular health. Make sure you get regular checkups with your healthcare provider so any potential issues can be caught early on and managed appropriately.

Stay informed about new developments so you know how best to protect yourself from experiencing serious side effects of even the mildest case of COVID-19.

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