We won’t know the full impact that COVID-19 has on our health for a long time, but it’s clear that, for many people, symptoms are intense and even linger for months — if not years.
One of the things COVID-19 can affect in major ways is your cardiovascular system. Research and doctors’ day-to-day work show that the coronavirus and long COVID can cause everything from small problems that clear up on their own to major heart issues.
And why the latter happens to some people is not totally known.
“The exact mechanisms for how COVID affects the heart are unclear. Some of the possible theories involve increased inflammation of the heart and arteries. ... Low oxygen levels may also play a role,” said Dr. Jim Liu, a cardiologist at Ohio State University’s Wexner Medical Center.
While it’s a mystery why this occurs, it’s clear that it does happen. Below, doctors explain the impact a COVID-19 infection can have on your heart and how you can protect yourself:
Most COVID infections won’t cause heart issues, but some groups are at higher risk.
“Thankfully, the more severe complications are very uncommon in mild disease and in previously healthy people,” said Dr. Allison Zielinski, a cardiologist at Northwestern Medicine in Illinois.
“But the risk of these complications goes up with severe disease, particularly if hospitalized or intubated,” she added. Those who do experience these side effects while hospitalized will be tested and monitored by their doctor, too.
Additionally, older people, people who are immunosuppressed or who have preexisting cardiovascular disease, or who have other medical conditions like high blood pressure, obesity and diabetes are also at heightened risk, according to Zielinski.
For those who do experience heart issues, it could lead to one (or a few) cardiovascular problems.
For those who do experience heart issues during or after a COVID-19 infection, the range of symptoms is vast. Here are the cardiovascular problems people experience.
“One of the main complications can be inflammation of the heart muscle itself, which is called myocarditis, or around the heart, which is called pericarditis,” said Zielinski.
While this sounds scary, Liu said, myocarditis usually resolves without any long-term complications. “In the most severe cases, myocarditis can result in heart failure where the heart is unable to pump effectively,” Liu said.
In some cases, Liu said, irregular heartbeat — also known as arrhythmias — can occur in people with severe COVID-19 infections.
“Arrhythmias can also be associated with myocarditis, some of which can make the heart beat so fast that it can’t pump blood effectively and can be fatal if untreated,” he said.
“The biggest thing I tend to see as a consequence of having ... long COVID ... from a cardiovascular standpoint, is what we call POTS, or postural orthostatic tachycardia syndrome,” said Dr. Martha Gulati, the director of preventive cardiology at Cedars-Sinai in California.
According to the Cleveland Clinic, POTS is a syndrome that can result in dizziness, increased heart rate and fatigue when you go from lying down to standing up.
Gulati said POTS is more common in women, and while some folks do recover on their own, symptoms continue to linger for many people. And there are things that doctors can do to manage the disorder, but those management techniques don’t work for all people.
Heart attack complications
A study led by Gulati and other Cedars-Sinai researchers found that people who had COVID-19 at the time they had a heart attack had a higher risk of death.
“We saw that they had a higher hospital mortality, almost three times more likely to die in that hospitalization than somebody who was just having a heart attack without COVID,” Gulati said.
Additionally, people with a COVID-19 infection and a heart attack were more likely to end up on a ventilator and receive hemodialysis. As for why, Gulati said it’s a bit of a chicken or the egg question.
“Did they have the heart attack and COVID was incidentally there ... or was it that they had COVID and they got a heart attack? Unfortunately, in our database, we can’t tell which one. We just know that they had COVID [at the time of the heart attack].”
Gulati noted that the respiratory effects of COVID-19 can put stress on the heart.
“It’s certainly a possibility that just by having COVID, there was a greater chance of developing a [heart attack], but it is a little bit hard with this particular study when we’re looking at big data from across the entire country,” she said.
Disparities were evident, too: Black, Asian, Hispanic and Pacific Islander patients saw worse outcomes and received lower levels of care, the study found.
“The increased mortality, increased complications, disparity in our approach of caring for patients, just highlighted a lot of the things that we knew exist within our cardiology community even pre-pandemic, but certainly the pandemic just [highlighted] the disparities in our care in a very profound way,” Gulati said.
Beyond this, long COVID can present a host of additional heart issues.
According to Zielinski, some of the same issues mentioned above can occur in someone who suffers from long COVID.
“These effects can be separated into two categories. So, the first is cardiovascular disease, and so these are the labeled diseases like myocarditis, pericarditis that have objective abnormalities on cardiac testing,” Zielinski said.
The second category is cardiovascular symptoms, she said. These symptoms “don’t have any clear objective abnormalities on testing but still affect patients, and for that reason may be dismissed by health care providers,” Zielinski said.
Common long COVID cardiovascular symptoms include heart palpitations, chest pain, shortness of breath, exercise intolerance and an exaggerated heart rate, she said.
The same risk factors Zielinski mentioned above are relevant for long COVID too, she said, but the condition can also affect people seemingly at random.
“Many of the people that experience these symptoms may have had only a mild infection and may have been previously healthy and active,” she said.
It’s estimated that 6% of adults have long COVID, according to a recent Centers for Disease Control and Prevention report. And Zielinski pointed out that just a fraction of people with long COVID will have cardiovascular symptoms. But if you do notice any of the above symptoms after a COVID infection, you should get in touch with your doctor to figure out what is going on.
There are proactive steps you can take to protect your heart.
While no one thing can guarantee that you won’t end up with cardiovascular impacts from a COVID-19 or long COVID infection, maintaining your heart health can be a good practice.
Certain cardiovascular risk factors — like high blood pressure, diabetes and obesity — put you at higher risk for severe COVID-19 infections and negative cardiovascular outcomes. Gulati said it’s important to prioritize your heart health so you can be as prepared as possible for any infection that may come your way.
According to the American Heart Association, there are some clear ways to do this including eating meals with lean protein, fruits and veggies, getting two and a half hours of moderate exercise each week, managing cholesterol and blood pressure, and quitting smoking.
“An infection is a stress to the heart, so the more we can keep our heart healthy, I think the better we are equipped to face any illness,” Gulati said.