Covid-19 and the heart
Can Covid-19 affect the heart? Yes, Covid-19 can affect the heart, and in multiple ways.
It may cause heart problems in people who never had prior cardiac diseases. However, in patients with known cardiovascular problems, the risk of heart (and lung) complications is significantly higher; so is the risk of death.
How does Covid-19 affect the heart?
1. Myocardial injury: not common. It can result from direct infection of the heart muscle (myocardium) by the coronavirus, leading to cell death and heart weakening. In some people, myocardial injury doesn't cause any symptoms and is only diagnosed through medical tests. In others, it may generate chest pain, shortness of breath or heart failure. The prevalence of this type of affliction ranges from 2 per cent in some series, all the way to 50 per cent in some other reports, mostly from intensive care settings.
2. Whole body inflammation: it is the most common scenario of cardiac involvement. When a virus first invades the body, the latter activates a defence mechanism called the immune system. This leads to the production and mobilisation of inflammatory cells and proteins (known as cytokines).
This inflammatory response is needed to fight a given microorganism invasion. However, in the case of Covid-19 infection, too much inflammation can sometimes ensue, leading to a reaction called "cytokine storm". It often happens in severe Covid-19 cases. This out-of-proportion systemic inflammation can harm the heart and vessels in many ways, including:
● Blood clots: inflammation of the inner walls of the blood vessels makes them prone to clot build-up. Depending where these clots develop, one can end up with a stroke (if it is in the brain), pulmonary embolism (in lungs), heart attack (coronaries), and phlebitis (legs).
● Arrhythmia: It results from inflammation of the special electrical system inside the heart, interrupting normal rhythm signals. That can lead to palpitations, fainting, or even sudden death.
● Pericarditis: It is an inflammation of the outer lining of the heart, causing chest pain and fluid accumulation around the heart.
● Heart failure: from weakening of the heart muscle and/or a combination of the above conditions. It is characterised by fluid overload in the whole body and lungs, leading to swelling, shortness of breath and respiratory failure.
What heart conditions can predispose to a higher risk from Covid-19?
● Coronary artery disease.
● Heart failure
● Prior stroke
● Blood cell disorders like thalassaemia and sickle cell disease
● Age above 65 years
● Kidney disease.
It is not very clear why patients with the above conditions develop more of a "cytokine storm". It has been suggested that their immune response is abnormal, allowing the virus invasion to be more devastating to different body systems at the same time, and leading to multi-organ failure.
Others have blamed it to an over-expression of certain proteins like “Angiotensin-2” in cardiac patients, which happen to be the same proteins used by the virus to enter the lungs and heart.
What is the timeline for Covid-19 adverse cardiac effect?
While most patients recover within one to two weeks from catching the infection, cardiac patients could remain sicker for a longer period of time, inside and/or outside the hospital.
In addition, some recent studies suggest that the risk of cardiovascular problems, such as a heart attack or stroke, remains high months after a coronavirus infection clears up. The cause of this worrisome finding is still not defined, though "smouldering" inflammation and irreversible damage to the heart and vessels are likely to blame.
Is the vaccine protective against cardiovascular risk?
Yes! Multiple large analyses showed that compared to people who received incomplete or complete vaccination series, non-vaccinated people infected with Covid-19 – depending on their age and comorbidities – were 10 to 100 times more at risk for developing myocarditis from the virus.
How about vaccine-related cardiac side effects?
Myocarditis and pericarditis have been rarely reported after Covid-19 mRNA vaccination (Pfizer and Moderna). They were mostly seen in young men after the first booster dose, and likely within one to seven days. In fact, their risk has been estimated to occur in approximately 1 in 200,000 doses after the initial dose, 1 in 30,000 doses after the second dose, and 1 in 50,000 doses after booster doses. This risk does not seem to increase with additional booster shots.
What can I do to protect my heart from Covid-19 infection?
1. Wear a mask, especially in closed spaces, and wash hands often.
2. Take the vaccine and recommended boosters.
3. Stay healthy: avoid weight gain, exercise regularly, and check your blood pressure and sugar as recommended by your healthcare provider.
4. If you have heart, kidney or lung problems: make sure you are on optimal medical management.
Joseph Yammine is a consultant cardiologist at the Bermuda Hospitals Board. He is also the director of the outpatient multi-speciality clinics and director of the Cardiac Computed Tomography programme. He received his post graduate training at the Brigham and Women's hospital, Brown University and the State University of New York. Dr Yammine holds five active American board certifications.
The information herein is not intended as medical advice nor as a substitute for professional medical opinion. Always seek the advice of your physician. You should never delay seeking medical advice, disregard medical advice or discontinue treatment because of any information in this article.