Coronavirus (Covid-19) and the heart: What do we know, and what don’t we know?

Filed Under: Costs

Coronavirus is commonly perceived as a respiratory illness, but as both short-term patients and long-haulers can attest, the symptoms can impact almost every part of the  body – including the heart.

In a survey of long-haul patients this summer published by the Indiana University of Medicine and SurvivorCorps, a long-hauler group, “inability to exercise or be active” was the fifth most-commonly reported symptom – 916 of the more than 1,500 respondents reported this symptom.Tachycardia – when a person’s heart rhythm is over 100 beats per minute – and heart palpitations were in the top 20.

What are long-haulers’ experiences with cardiovascular problems, and what does the science say about Covid-19 and the cardiovascular system? Here’s  what you need to know.

WHAT DO CARDIO PROBLEMS FEEL LIKE FOR LONG-HAULERS?

For Netia McCray, a Black long-hauler, her cardiovascular symptoms started four months after she first fell ill – and were serious enough to land her in the hospital. As we wrote in September:

McCray moved to Florida July 8 to be with her family. Three or four days later, she felt the worst she had felt since her battle with Covid-19 began. Worried that she’d been reinfected, she got a Covid test, which was negative. When she got a chest X-ray and EKG, her urgent care doctor told her she had severe heart inflammation and sent her to the emergency room, as her aorta was enlarged — a sign, the doctor said, that either she had had a heart attack or was about to have one.

“The ER doctor comes in and he goes, ‘All you have is chest wall pain. So you need to stop lifting heavy objects.’ I said I was sent over here because I have an enlarged aorta, which is the sign of an upcoming heart attack. He said, ‘An enlarged aorta can be a sign of chest wall pain. So you need to just ice your chest for 2 hours a day and it should disappear within a week or two.’ I was sent home.”

She received a bill for $2,000 and called her insurance company, Blue Cross Blue Shield, to make sure that it was correct, and that she indeed had to pay. They said that they had already paid $20,000.

“I was like wait, I’m sorry, what? So I just paid for a 2018 Toyota Camry to be told I had chest wall pain and to be sent home without even an ice pack? And I’m still unable to breathe?’ And now I have a new symptom, which is poor blood circulation. I could see the tips of my hands and my feet turn blue. And I wasn’t able to walk at some points.”

Read more about McCray’s  experiences here.

Ziah McKinney-Taylor of Stone Mountain, Ga.,  started having tachycardia, along with other symptoms like brain fog and a lack of appetite, in mid-July after she and her daughter Ava, now 16, caught Covid-19 in March. Their doctor thought they might have been re-infected, or that they relapsed — after a difficult summer with a beloved and ailing dog, and then the stress of new schedules as of September.

“Just beating eggs, [my heart will] get up to, like, 122 beats per minute,” Ziah McKinney-Taylor said in a video interview. “I was a professional dancer and teacher. Like – that’s ridiculous.”

Ava, meanwhile, who Ziah McKinney-Taylor said had been doing martial arts three days a week and dance twice a week before the pandemic, has been having difficulty exercising since falling sick.

Post-Covid, “half an hour of light dancing” with an online class made her nauseous, Ava said. “I would have to lay down and just take really deep breaths, so I didn’t end up hurling my guts all over the floor. It was so weird. “

Amanda Finley, 43, an archaeologist from Kansas City, first developed symptoms in early March. She has asthma, and within several days developed symptoms that she recognized as pneumonia. Later,  she feared that she was having a heart attack at one point — she had a “knotting feeling” in her chest that radiated down her arm. Read more about her experiences here. The feeling passed, but she is still not well, experiencing brain fog, fatigue and other symptoms months later.

Laurie LaCross-Wright, a central Florida-based musician, says she first contracted Covid-19 in mid-January. While most science suggests that Covid first became widespread in March, her symptoms — upper respiratory complaints — seem like the common Covid complaints, and she could easily have had some other bug in January and then caught Covid later.

In April, while still dealing with fatigue and coughing, LaCross-Wright had a heart attack. She felt pain in her chest and throat that moved to her shoulder and down her arm in waves. She went to the hospital, where doctors told her she  had a blocked artery. When she suggested  it was connected to coronavirus,  doctors dismissed her concerns — without a positive test, they didn’t believe that she had the disease. Read more about her experiences here. 

WHAT DO THE EXPERTS SAY?

Cardiovascular experts are beginning to consider how long-haulers’ experiences could shape further research into coronavirus. Eric Topol, a cardiologist and professor at The Scripps Research Institute, published a letter in Science in late October detailing observations from Covid-19 patients:

Cardiac involvement in athletes has further elevated the concerns. A 27-year-old professional basketball player, recovered from COVID-19, experienced sudden death during training. Several college athletes have been found to have myocarditis (14), including 4 of 26 (15%) in a prospective study from Ohio State University (15), along with one of major league baseball’s top pitchers. Collectively, these young, healthy individuals had mild COVID-19 but were subsequently found to have unsuspected cardiac pathology. This same demographic group—young and healthy—are the most common to lack symptoms after SARS-CoV-2 infections, which raises the question of how many athletes have occult cardiac disease? Systematic assessment of athletes who test positive for SARS-CoV-2, irrespective of symptoms, with suitable controls through some form of cardiac imaging and arrhythmia screening seems prudent until more is understood.

Topol also laid out questions for researchers to address:

…So far, there have been minimal cardiac imaging studies in people who test positive for SARS-CoV-2 or are seropositive but without symptoms. Furthermore, the time course of resolution or persistence of any organ abnormalities after SARS-CoV-2 infection has not yet been reported. With a high proportion of silent infections despite concurrent evidence of internal organ damage, there is a fundamental and large hole in our knowledge base.

In contrast to people without symptoms, there is a substantial proportion of people who suffer a long-standing, often debilitating illness, called long-COVID. Typical symptoms include fatigue, difficulty in breathing, chest pain, and abnormal heart rhythm. An immunologic basis is likely but has yet to be determined. Nor have such patients undergone systematic cardiovascular assessment for possible myocarditis or other heart abnormalities, such as fibrosis, which could account for some of the enduring symptoms.

The most intriguing question that arises is why do certain individuals have a propensity for heart involvement after SARS-CoV-2 infection? Once recognized a few months into the pandemic, the expectation was that cardiac involvement would chiefly occur in patients with severe COVID-19. Clearly, it is more common than anticipated, but the true incidence is unknown. It is vital to determine what drives this pathogenesis. Whether it represents an individual’s inflammatory response, an autoimmune phenomenon, or some other explanation needs to be clarified. Beyond preventing SARS-CoV-2 infections, the goal of averting cardiovascular involvement is paramount.

Dr. Avindra Nath, who works at the National Institutes of Health studying how viruses and infections impact the nervous system, said in a video interview that patients with other coronaviruses have suffered cardiovascular collapse and sudden death.

“We wonder why they die suddenly,” he said. “Is it possible that the virus went and attacked the brainstem or something? …Those are possibilities of direct viral attack to the brain. But demonstrating that, proving that, is not easy.”

WHAT RESEARCH IS OUT THERE?

Research is slowly beginning to catch up to long-haulers’ experiences. A study of 100 recent Covid-19 patients published in JAMA Cardiology in July found that “cardiac magnetic resonance imaging revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), which was independent of preexisting conditions, severity and overall course of the acute illness, and the time from the original diagnosis.”

More recent results are even more worrying. A study published in JAMA Cardiology in September surveyed a small group of college athletes who had tested positive for coronavirus, finding that 15 percent of the group had inflamed heart muscles after they had otherwise recovered. More worrisome, none of the athletes in the cohort had been severely ill, and many had reported experiencing asymptomatic infections. (Experts told the New York Times that the size of the sample study – only 26 athletes – and the fact that none of the athletes had had baseline cardiovascular scans before their illness means more study is warranted to determine the link between Covid and heart inflammation.)

And another study published at the end of July found that more than half of the hearts of deceased Covid-19 patients, recovered from 39 autopsies performed after their deaths, showed a high viral load. The study authors noted that the “elderly age of the patients might have influenced the results” – but still concluded that the long-term consequences of Covid infection in the heart “needs to be studied.”