How does COVID-19 affect the heart?

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• A new study takes a close look at the incidence of heart problems after COVID-19.
• The researchers find evidence of a wide range of heart issues for up to 1 year after recovery.
• Experts recommend that people who have had COVID-19 remain alert for symptoms of heart issues, promptly consulting a doctor if these occur.

Scientists are confident that COVID-19 can cause heart damage. Based on an analysis of national healthcare databases from the United States Department of Veterans Affairs, a new study offers a more detailed look at common post-COVID-19 cardiac issues.

The study found that people who have recovered from COVID-19 are at an elevated risk of developing heart problems within the first year after the disease.

University of Southern California cardiologist Dr. Gregg C. Fonarow — who was not involved in the study — told Medical News Today, “There was a large spectrum of cardiovascular injury and risks documented.”

The study comes from researchers at Washington University School of Medicine in St. Louis and the Veterans Affairs (VA) St. Louis Health Care System.

The senior investigator is Dr. Ziyad Al-Aly, chief of research and development service at the VA St. Louis Health Care System and clinical epidemiologist at Washington University.

“What we’re seeing isn’t good,” Dr. Al-Aly says. “COVID-19 can lead to serious cardiovascular complications and death. The heart does not regenerate or easily mend after heart damage. These are diseases that will affect people for a lifetime.”

Dr. Richard C. Becker, director of and physician-in-chief at the University of Cincinnati Heart, Lung and Vascular Institute — also not involved in the study — told MNT:

“The observations from the [VA Health System] underscore what is less well appreciated in both the medical community and lay community — that is, the long-term cardiovascular effects that can be serious and even life threatening. The important message is ‘awareness’ and having a well-established follow-up plan in place.”

The study appears in Nature Medicine.

Dr. Al-Aly described to MNT the types of heart damage known to occur after a SARS-CoV-2 infection:

“A broad array of cardiovascular diseases, including cerebrovascular disease, dysrhythmias, ischemic and nonischemic heart disease, pericarditis, myocarditis, heart failure, and thromboembolic disease. The risks were evident even in people who had mild COVID-19 and did not need to be hospitalized during the acute phase of the ​disease.”

It also appears to be the case, Dr. Al-Aly observes, that COVID-19 does not play favorites when it comes to who might experience postinfection heart problems,

“I would also add that the risks were evident in young [people and older adults], females and males, white people and Black people, people who smoke and people who do not, people with comorbidities — diabetes, hypertension, kidney disease — and people without.”

“COVID-19 is behaving like an equal opportunity offender,” said Dr. Al-Aly.

Dr. Becker explained what might be the cause of so much heart damage,

“The medical community knows that [SARS-CoV-2] infection during its initial or acute phase can cause inflammation of the heart (myocarditis); inflammation of the heart’s covering (pericarditis); heart attacks (myocardial infarction) stemming from the stress of infection, low blood oxygen levels, or blood clots forming in the coronary arteries; and heart failure.”

Those blood clots may provide an important clue, Dr. Becker noted:

“There is reason to believe that blood clots, [or thrombosis], causing heart attacks and strokes in COVID-19 have unique and distinct characteristics. Specifically, they include a much higher proportion of specific subsets of white blood cells than would be seen in other settings. The COVID-19 blood clot theory is starting to take shape. Research is ongoing to understand a specific cause and optimal prevention and treatment.”

“Our observation is that COVID-19-associated pericarditis can be more difficult to treat compared with other virus-associated pericarditis, and recurrence appears to be more common,” Dr. Becker added.

He also noted, “Further research is needed to better understand the mechanism(s) responsible and possibly to alter the approach to treatment for some patients.”

The best strategy — at least until more information is available — is for people who have recovered from COVID-19 to remain watchful for signs of cardiac issues.

Dr. Becker said,

“Patients with COVID-19, including those with even mild symptoms initially, should not hesitate to speak with their primary care [doctor] for lingering or new symptoms, including fatigue, exercise intolerance, chest pain, shortness of breath, palpitations, [and] fainting spells.”