Cardiovascular problems are common among people who experience severe illness from COVID-19.
This is a connection that medical experts noticed early in the pandemic and have been studying for nearly two years, said Dr. Swetha Alluri, a cardiologist with Winchester Cardiology and Vascular Medicine who also sees patients at Shenandoah Memorial Hospital in Woodstock.
But the reasons for cardiovascular problems are less clear, she said.
Early in the pandemic, when tests were coming from COVID patients in China, doctors noticed that based on blood tests “there was some indicator of heart damage,” Alluri said.
Two years into the pandemic, she said it’s unclear whether that’s because the virus is damaging to the heart or because organ damage is to be expected in someone who is critically ill.
There’s still more study required to better understand the reasons, she said, but it’s clear that heart health is greatly affected by the virus.
“Now we’re starting to appreciate that there’s actually longer-term complications, cardiovascular complications specifically,” Alluri said.
Sharing the story of a patient in her 30s suffering from post-COVID complications, Alluri said the patient’s case was particular because of how much the virus has affected her life.
The patient had been a college athlete who maintained a high level of physical activity until the pandemic. Then she contracted COVID, and since recovering has noticed she still can barely walk down a hallway at home without experiencing fatigue and shortness of breath.
Tests that Alluri ran to locate any heart-related issues all came back normal. This happens with a lot of COVID patients, she said.
There’s no objective data that COVID did anything to their heart, Alluri said.
“But you can’t ignore these symptoms because there’s definitely a physical decline in these patients,” she said.
One suggestion for why COVID affects the heart was posed in the early days of the pandemic.
In looking for a reason why the virus can have such sweeping effects on the body, scientists focused on the ACE2 receptor, an enzyme that is present throughout the body.
In a video at heart.org/en/coronavirus, Dr. Mitch Elkind, president of the American Heart Association and a stroke neurologist at Columbia University, explains how the virus can impact the whole body, including the heart and brain.
“We thought we were dealing with a lung disease, and it turns out that it’s much more than that,” he says.
The virus gets into the body by binding with the ACE2 receptor within the lungs.
“That same enzyme is present on the heart, it’s present in the gastrointestinal system … it’s also present in some of the nerve cells, which is why we see some neurological problems from it.”
Worse, though, is that it’s present in the lining of the blood vessels, he says.
The virus can bind to the enzyme on the blood vessel lining “and then it can set off blood clotting,” he says.
“It’s not just a lung disease … it’s just that it gets into the body through the lungs,” he says.
Alluri said that science is leaning away from this hypothesis as a catch-all explanation because it doesn’t explain as many COVID-related heart issues as it seemed to in the beginning.
Inflammation has shown to be a bigger factor in the sweeping health concerns of COVID patients.
With COVID, “the whole body’s under a state of inflammation,” she said.
“And we know that inflammation is bad for heart disease,” Alluri said. “There’s a higher risk of plaque rupturing in your vessels because of that, which can cause a heart attack.”
Furthermore, COVID-19 can damage heart muscle and affect heart function, Johns Hopkins says at its website, hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/heart-problems-after-covid19.
Coronavirus infection “can cause blood vessel inflammation, damage to very small vessels and blood clots, all of which can compromise blood flow to the heart or other parts of the body,” it says.
Signs of a problem to watch for:
* Palpitations and feeling your heartbeat rapidly or irregularly in your chest
* Feeling lightheaded or dizzy, especially upon standing
* Chest discomfort
It’s important to follow up with your primary care physician if you’ve had COVID-19, Alluri said.
And if you’re continuing to see symptoms, she said, that’s “another reason to follow up with your doctor and take it seriously.”
One interesting comparison she’s noticed among younger adults showing long-term effects from COVID is that their symptoms are very similar to those of postural orthostatic tachycardia syndrome (POTS), which often presents in young women and exhibits as severe or unusual dizziness and heart palpitations provoked by an intolerance to changes in position.
The best way to prevent getting COVID is to get vaccinated and follow up with a booster shot.
Beyond that, to keep the heart healthy, Alluri recommends regular hydration and physical activity.
During the pandemic, many people have been less active either because they aren’t leaving the house as much or aren’t being as sociable as they were. That, combined with the mental strain of isolation, takes a big toll on the heart, she said.
“People gained a lot of weight during the pandemic,” she said. “It’s a vicious cycle.”
Those who have had COVID probably have it worse, she said, because experiencing shortness of breath and fatigue would make them less physically active, which causes weight gain, which makes them less inclined to try to be active, which in turn can lead to more weight gain.
“A year out from COVID diagnosis, there’s a higher incidence of heart attack, stroke and arrhythmia,” Alluri said. “Again, we don’t know why.”
That’s particularly concerning, she said.
“A lot of people have been infected with COVID,” Alluri said. “It’s alarming for a lot of people.”