Covid-19 can cause heart damage, even if you are asymptomatic

Much has been written about “long haul” – patients who have tested positive for SARS-Cov-2, the virus that causes Covid-19, who continue to have persistent symptoms such as fatigue, muscle pain, palpitations and breathing difficulties for months after their initial diagnosis.

Long-acting carriers have drawn attention to complaints about the lungs and respiratory system as some of the important systemic effects of the virus, but it is also of growing concern that the extent of its effects on the heart hasn’t received as much attention.

And while SARS-CoV-2 can cause overt heart symptoms such as chest pain or shortness of breath leading to heart attacks and blood clots, it’s also possible that the virus could cause significant heart damage and inflammation, but without producing or more noticeable cardiac symptoms.

This concern was addressed in the results of a new study published in JAMA last month, showing that even if you are not aware of having symptoms after recovering from Covid-19, it is possible that the virus causes heart damage or inflammation which could put you at risk for complications such as heart arrhythmias, heart failure, and sudden heart death.

The study looked at 100 patients (median age just 49) who recently recovered from Covid-19, most of whom were asymptomatic or had just mild symptoms. The researchers, who performed an MRI of their heart an average of 2 months after the initial diagnosis of Covid-19, found disturbing results: 78% of patients had ongoing heart abnormalities and 60% had myocarditis, an inflammation of the heart. heart muscle. More worryingly, the extent of myocarditis was not related to the severity of the initial disease or the general course of the disease.

Although the study had some limitations and its overall importance is not yet apparent, it does demonstrate that it is relatively common for the heart to be affected in young adults and middle-aged people who have successfully recovered. virus. The magnitude of this damage may be just the tip of the iceberg. The study, if any, argues the need for continued monitoring of the long-term cardiac effects of Covid-19. It also emphasizes the importance of continuous testing in the general population so that we can follow up and monitor asymptomatic patients who test positive for SARS-CoV-2 for long-term cardiac effects after their initial diagnosis.

Researchers are still trying to determine exactly how SARs-CoV-2 leads to myocarditis. They believe it may be a combination of 2 mechanisms: heart damage caused by the virus itself, as well as the after-effects of the immune response it triggers. In fact, the effectiveness of some potent anti-inflammatory drugs such as dexamethasone to help reduce mortality in some of the sicker patients could potentially be linked to its anti-inflammatory effects on the heart. However, even with aggressive treatment, more severe cases of myocarditis due to Covid-19 can lead to permanent heart damage, leading to continued heart failure and sudden death.

“The new coronavirus can affect the heart both directly and indirectly: it can invade heart muscle cells causing inflammation or ‘myocarditis’ which can reduce the heart’s pumping ability and make it vulnerable to arrhythmias,” said Holly S. Andersen, MD, attending cardiologist. , Associate Professor of Medicine, Director of Education and Outreach, The Ronald O. Perelman Heart Institute, The New York Presbyterian Hospital, Weill Cornell Medical Center. “Many cases of stress-induced cardiomyopathy (Takotsubo) have been reported and it can lead to transient heart failure and sudden death.”

Andersen also explained that “the virus is also known to cause damage by forming blood clots in small blood vessels in organs, including the heart, can lead to severe lung disease which can put great strain on the heart, and in some patients causes a “cytokine storm” where the body’s immune system causes organ damage. “

The recent diagnosis of Covid-19 associated myocarditis in the Boston Red Sox’s first launcher also illustrates how the virus can affect young, healthy people. Eduardo Rodriguez was set to start this season when the 27-year-old tested positive for Covd-19. His symptoms progressed after his initial diagnosis – to the point where he didn’t have enough energy to throw even 20 throws. He was told to stop and rest. Mr. Rodriguez is now out for the season.

Some patients with myocarditis are asymptomatic, while others may sometimes have mild symptoms, including occasional chest pain or difficulty breathing. But Rodriguez is not alone: ​​There have been multiple reports of myocarditis among college football players, putting the season in jeopardy. Already the Mid-American, PAC-12 and Big 10 have canceled or delayed the start of the fall season.

Brian Hainline, the NCAA chief medical officer, said in a press call last week that 1-2% of NCAA school athletes have tested positive for Covid-19 and at least 12 college athletes had been diagnosed with Covid-19-associated myocarditis. As we know, college and professional athletes have better access to more frequent Covid-19 testing and monitoring to be on the lookout for signs of myocarditis which include fatigue, chest pain, and difficulty breathing.

But what about amateur athletes or regular people who want to get back to exercise after recovering from Covid-19? The short answer is that we don’t know the extent of risk for those recovering from Covid-19 who want to exercise regularly or occasionally at that time – we need more studies to better determine the ongoing risk.

That said, even if only a small percentage of Covid-19 cases result in heart complications, the pandemic will increase the risk for millions of people who exercise regularly. As an example, the study indicated that patients with only mild symptoms of Covid-19 developed myocarditis as often as those who were hospitalized, increasing the risk of those who did not know they had Covid. -19 are also at risk.

This is relevant because athletes with myocarditis must stop all strenuous activity and training for several weeks, or even months, until the inflammation in the heart subsides. The risks of not reducing activities can lead to dangerous arrhythmias, heart failure, and death (cardiac arrest).

But amateur athletes may not benefit from close monitoring by coaches and athletic physicians to assess for signs of myocarditis, which can be quite subtle. In some people, only mild fatigue, dizziness, slight shortness of breath, or chest discomfort may be symptoms of myocarditis. Unless the initial stages of the assessment such as assessment of cardiac markers (troponin) and an echocardiogram are performed, the diagnosis may be missed. It is this window of opportunity that is essential for heart monitoring and comprehensive assessment to continue.

Needless to say, as we learn more about the varied effects of SARS-CoV-2, we need to be alert to the heart symptoms it presents to everyone. Vigilance regarding symptoms is essential, especially in people recently diagnosed with Covid-19 who recover and subsequently develop chest pain, fatigue and difficulty breathing. More generally, we need to broaden our thinking about the fact that Covid-19 is a disease that primarily affects the lungs to a disease that can affect any part of the body, including the heart.

At the same time, the importance of not delaying emergency medical care for fear of Covid-19 – especially in the case of chest pain or stroke-like symptoms – is paramount. The American Heart Association’s (AHA) “Don’t Die of Doubt” campaign was launched to address the significant drop in 911 calls for symptoms of stroke and heart attack.

“The incidence of out-of-hospital cardiac arrests (OHCA) increased by 400% in the first week of April in New York compared to the same time last year, so we know that some patients are dying from their disease. heart at home. to avoid emergencies for fear of contracting the virus, ”Andersen explained.

In addition to the AHA campaign, the Myocarditis Foundation helps raise awareness and also offers research grants to help better understand this devastating disease.

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