COVID-19 is primarily an infection of the lungs, but there is a close relationship between the virus and the cardiovascular system. The relationship is complex in some ways, and our understanding is continuing to evolve. Dr Simon Pearse, Consultant Cardiologist at New Victoria Hospital, tells you all you need to know about Covid-19 and heart health.
How does COVID-19 affect the heart?
We know that if a person has a pre-existing cardiovascular disease, such as high blood pressure, heart failure, coronary artery disease, angina or a previous heart attack, or associated conditions such as diabetes or obesity, they are at increased risk of getting a severe illness with COVID-19. These risk factors are very common amongst patients requiring intensive care treatment for COVID-19.
How Acute and Long Covid can impact the heart and the cardiovascular system
The COVID-19 virus can also affect the heart and circulation, directly and indirectly.
Acute Covid and the heart
In some people with severe COVID-19 infection, we see a condition called myocarditis, in which there is inflammation of the heart muscle. This may be due to the virus invading the heart muscle cells, or as part of the generalised inflammatory state that the body is in as a result of the infection.
There is also an increased risk of having a heart attack with acute COVID-19 infection and a higher risk of blood clots forming in the blood vessels, typically in the lungs, causing a condition called pulmonary embolism that puts strain on the heart and breathing.
COVID-19 also increases the risk of heart rhythm abnormalities, most of which are safe but some require emergency treatment. The end result of these processes in some severe cases is that the heart muscle can become weakened and function less well as a pump.
It is important to stress that these potentially serious consequences happen only in a minority of people who get COVID-19 infections. The majority make a good recovery without any of these complications.
What about Long Covid and the heart?
Long Covid, formally called ‘post-acute COVID’, refers to symptoms that persist more than 4 weeks after the initial COVID infection.
In those who had COVID severe enough to need hospitalisation, persistent symptoms may be seen in more than half of people one to two months later. Amongst those with milder COVID-19 not requiring admission to hospital, more than one in ten people will still have symptoms after one month. It is more common in those with underlying health problems, as well as women and older people.
In the UK, the Office for National Statistics estimates that about 1.1 million people were suffering from Long Covid at the beginning of March 2021.
What are the most common Long Covid symptoms?
The most common symptoms from which people suffer in Long-COVID include:
- fatigue
- breathlessness
- joint pains
- chest pains
- palpitations
- dizziness
- cough
- persistent loss of sense of smell
Whilst any organ in the body can be affected by Long Covid, notably the lungs, the symptoms of breathlessness, chest pains, palpitations and dizziness may indicate involvement of the heart and require further investigation and treatment.
Chest pain in Long Covid may be caused by ongoing inflammation in the heart or maybe due to irritation of the lungs and airways or blood clots on the lung or simply muscular or bone pain due to coughing and the general ache of the viral infection. It may also be that COVID infection has unmasked coronary artery disease and angina. Palpitations and dizziness may just be part of the recovery from severe infection, but in some people, COVID affects the way that the body automatically regulates heart rate and blood pressure, particularly on standing. This can result in the heart racing on standing up and/or dizziness. Breathlessness in Long Covid might be due to ongoing inflammation in the lungs, but can also be a sign of heart failure, weakness of the heart from COVID.
What can you do if you have Long Covid symptoms affecting your cardiovascular health?
If you experience symptoms of Long Covid, you should talk to your GP or book an appointment with a Consultant Cardiologists. Examinations that can be useful to investigate any heart conditions include:
- ECG
- chest X-ray
- oxygen saturation in the blood at rest and on walking
- blood pressure and heart rate lying down and standing
More detailed tests such as an echocardiogram to assess the strength of the heart, a CT scan of the chest, more prolonged ECG monitoring or a tilt table test to assess changes in heart rate and blood pressure with posture can also be done by your Cardiologist.
Certain blood tests are also useful.
Depending on the symptoms and the results of the tests, treatment may involve tablet therapy, rehabilitation or exercise classes and lifestyle modifications.
Whilst COVID-19 is a new illness, we have experience of treating similar conditions in the past, and there are usually several things that we can do to improve symptoms and quality of life.
If someone is acutely unwell with COVID-19 symptoms, the advice remains to isolate and call NHS 111 for advice or an ambulance via 999 if severely ill.
For Long Covid symptoms, anything that is causing distress and is not settling after the acute infection should be checked by a doctor.
Chest pain and breathlessness in particular, are worthy of further investigation, but anything that is affecting the quality of life is worth assessment as there may be treatments to improve things.
Our understanding of COVID-19 is evolving rapidly and new treatments are becoming available that will help relieve the suffering of those affected by the illness.
If you are concerned about any persisting Covid symptoms or would like to have your cardiovascular health checked by a Cardiologist, you can call our Outpatient Department on 020 8949 9020 or:
New Victoria Hospital offers a Cardiac Screening service dedicated not only to people suffering from Long Covid but to any adult who would like to have a cardiology check-up to detect undiagnosed cardiac conditions or prevent life-impacting or threatening diseases such as heart attacks or cardiac arrests.
