COVID and the heart

February is American Heart Month. As with other medical issues, COVID-19 overshadows even our nation’s leading cause of death – cardiovascular disease. As the pandemic proceeds, we are learning about the adverse effects of COVID on the heart. COVID is more than just a severe respiratory infection; it directly damages the heart. COVID causes incased events including heart attacks, strokes, heart failure and inflammation of the heart (myocarditis). COVID damages the heart by causing severe inflammation throughout the body and by directly attacking heart cells. The primary symptoms to watch for are chest pain and shortness of breath.

There are numerous reports in the medical literature about the increase in cardiovascular events in persons experiencing a COVID infection. COVID patient have a three times greater risk of a heart attack in the first week after their diagnosis than a matched group of persons without COVID. The risk of stroke during hospitalization for COVID is almost eight times higher than the rate seen in patients admitted for other viral infections. The risk of myocarditis (inflammation of the heart muscle) is 16 times higher among patients with COVID. As expected, outcomes of these events were worse in persons with other medical conditions such as diabetes and hypertension.

The increased risk of events is not limited to the time of the acute disease. Significant increases in 20 cardiovascular problems have been reported in the year following a COVID infection. During this time, even a mild case increases the risk of heart failure by 72% and strokes by 52%. The elevation was seen regardless of age, smoking status, obesity or diabetes. Rates are higher among severe cases than mild cases.

COVID causes an extreme inflammatory response throughout the body by producing large amounts of substances known as cytokines. The inflammation produced is much more severe than that caused by other viruses and it involves all tissues of the body. By contrast, the flu only causes inflammation in the lungs. The cytokines attack the virus so aggressively that they damage normal health organs.

The inflammation also damages the cells on the surface of blood vessels that contributes to an increase in blood clotting. Numerous small blood clots occur locally .These clots block small vessels that provide blood to the heart cells. Blood clots in the lung also contribute to the lung symptoms, shortness of breath and a decreased ability to absorb oxygen.

There is also some evidence that the virus may infect the heart causing direct damage.

The COVID vaccines also trigger inflammation of the heart — myocarditis. This effect is especially seen in young persons – 73% of cases were under age 30 and 33% were under age 18. Myocarditis occurred after the second injection (82%) and typically presented within 1 week of the injection. The primary symptoms were chest pain, shortness of breath and palpitations. When it occurs, the American Heart Association recommends close follow-up and avoiding competitive athletics for three to six months. Additional doses of the vaccine are advised only in select cases.