Heart Problems After Covid

Does COVID-19 cause heart problems?

Yes. A severe or even mild case of COVID-19 can make you more likely to have heart failure or a heart attack. It’s very rare for the virus that causes COVID-19 to infect your heart muscle. But the virus can cause problems throughout your body that lead to heart damage.

Even if you’ve never had heart issues before, you can have heart problems after COVID. But if you have cardiovascular disease, you face the greatest risk of heart problems. If you have heart disease risk factors like high blood pressure, diabetes, obesity or high cholesterol, you also face a higher risk of serious complications. COVID-19 can impact your heart while you’re sick but also after the virus has left your body.

How does COVID-19 affect your cardiovascular system?

Some heart problems — like injury to your heart muscle — can show up while you have the COVID-19 infection. Myocardial injury, or injury to your heart muscle, causes cells in your heart muscle to die. Sometimes, people with myocardial injury don’t have any heart disease symptoms. Others might have symptoms like chest pain, shortness of breath (dyspnea) or lower extremity swelling. A provider makes a diagnosis through blood tests and cardiac imaging.

Researchers are still learning how many people with COVID-19 experience myocardial injury. Estimates range from 7% to 40%. Myocardial injury is more common among people who need care in the intensive care unit (ICU). If you have heart damage, you face a higher risk of complications as your body tries to fight off the virus.

Inflammation from COVID-19 leads to heart damage

Research suggests inflammation leads to COVID heart damage. When you first get the infection, your body activates your immune system. This leads to the production of inflammatory cells and cytokines. Cytokines are small proteins that activate your immune response. This process of inflammation is necessary and helpful to your body.

But COVID-19 causes too much inflammation in some people. This condition is called cytokine release syndrome (or “cytokine storm”). It often happens in severe COVID-19 cases. Excessive inflammation can harm your cardiovascular system in many different ways, including:

• Arrhythmia. Inflammation can alter your heart’s electrical signals. As a result, your heart can lose its normal rhythm. If you already have arrhythmia, a cytokine storm can make it worse.
• Blood clots. When inflammation affects the lining of your blood vessels (the endothelium), you face a greater risk of blood clots, heart attack or stroke.
• Myocarditis. This is an inflammation of your heart muscle. People with COVID-19 face a higher risk of myocarditis compared with those who aren’t sick.
• Pericarditis. This is inflammation in the membrane around your heart. It can cause chest pain and fluid buildup around your heart.
• Heart failure. This is a condition where excess fluid and swelling (edema) can build up in your lungs and your body.

People with cardiovascular disease or risk factors face higher risks of heart damage

Many people hospitalized for COVID-19 have underlying heart issues. And people with cardiovascular disease are more likely to experience a cytokine storm.

If you have any of the following conditions, you face a higher risk of COVID-19 complications:

• Heart failure.
• Coronary artery disease (CAD).
• Cardiomyopathy.
• Chronic kidney disease (CKD).
• Diabetes.
• Overweight/obesity.
• History of a stroke.
• High blood pressure (hypertension).
• Sickle cell disease.
• Thalassemias.

Does COVID-19 cause a heart attack or stroke?

COVID-19 may increase your risk of a heart attack or stroke, especially if you’re hospitalized. But researchers continue to explore this topic. Inflammation is the main culprit, as it raises your risk of blood clots and prevents your body from getting rid of clots on its own.

Blood clots also prevent oxygen from reaching your organs, including your heart. When this happens, you’re at risk of having a heart attack. This means that your heart isn’t getting enough oxygen-rich blood.

Troponin, an enzyme providers can measure in your blood, may help them diagnose a heart attack.

Don’t delay medical appointments or emergency care

Researchers will continue learning about COVID and heart issues. Meanwhile, heart attacks still happen every day among people who don’t have COVID-19.

During the pandemic, many people avoided doctor’s appointments and hospitals. While it’s normal to worry about catching COVID-19, you shouldn’t delay care. It’s much safer to visit a doctor’s office or hospital than to ignore life-threatening symptoms.

Call 911 (or your local emergency service number) immediately if you have heart attack symptoms. Prompt care is essential to preventing further heart damage. Also, keep up with your regular medical appointments. Tell your healthcare provider about any new symptoms or problems. And if you had COVID, discuss how it affected your body.

Will I have heart issues after COVID-19?

Some people have heart issues after COVID. Your risk is higher if you needed intensive care or were on a ventilator. But even those with mild cases can still experience heart problems down the road.

Such problems can happen if you develop long COVID. This is also known as post-acute coronavirus (COVID-19) syndrome. If you have long COVID, your health isn’t back to where it was before getting sick.

Healthcare providers consider the four-week mark significant. If you’re still having problems four weeks after getting COVID, you have long COVID. This can impact you in several different ways.

New or lingering symptoms

COVID-19 can cause new or lingering symptoms in people who were severely ill. But it can also cause lingering problems in people who had mild or asymptomatic COVID. Fatigue, shortness of breath and “brain fog” are among the most common problems. Symptoms that could be related to your heart include:

• Chest pain that’s worse with deep breaths.
• Heart palpitations.
• Fast heart rate (tachycardia).
• Feeling dizzy or lightheaded.
• Shortness of breath with exercise.

If you have any of these symptoms, call your healthcare provider right away to discuss how you’re feeling. Your provider may want to run some tests to check your heart function. These tests include an electrocardiogram (EKG) or echocardiogram.

Effects on multiple organs

COVID-19 can affect many organs and systems such as your heart, lungs, brain and kidneys.

SARS-CoV-2 attaches its spike protein to proteins in your body called ACE2 receptors. These are proteins that you have throughout your body, including your heart and lungs. The ACE2 receptors are also in the lining of your blood vessels. SARS-CoV-2 can easily attach to your ACE2 receptors. As a result, the virus can spread to many organs and damage them, like your:

• Lungs. COVID-19 can damage your lungs more severely than the flu. Severe COVID-19 cases can cause thickening and scarring in your lung tissue. This is called fibrosis.
• Brain. COVID-19 can harm your brain by preventing it from getting enough oxygen.
• Kidneys. COVID-19 can reduce your kidney function.

COVID-19 can affect your whole body, so it’s important to take precautions to avoid getting the virus. Getting vaccinated is the best way to protect yourself and others. Also, wear a well-fitted mask where required, stay home if you’re sick and wash your hands often.

Effects of treatment and hospitalization

Problems related to treatments and extended hospital care aren’t unique to COVID-19. You might feel very weak and tired. Or you might develop symptoms of post-traumatic stress disorder (PTSD).

Talk with your provider about how you’re feeling. It’s normal not to feel OK for a while after battling COVID-19. Give yourself time to heal and adjust back to your regular routine. You’re definitely not alone. Your provider will work with you to determine how best to support your recovery.

A note from Cleveland Clinic

Getting over a case of COVID-19 is hard enough. But you may also be dealing with heart problems after COVID. This is real and your concerns are valid. Don’t be afraid to ask your healthcare provider questions about what you’re experiencing. Follow up on treatments your provider recommends and be sure to keep all your appointments.