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Facing Heart Issues After COVID-19

As survivors are left with cardiac problems like structural damage and rhythm disorders, doctors seek to understand what may, or may not, be lasting damage

spinner image Patients who have survived COVID-19 sometimes have lasting heart problems.
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Ron Thomas, 69, of Clemson, South Carolina, had never been hospitalized before he got COVID-19 in July.

After spending 12 days in the hospital, Thomas developed atrial fibrillation (AF), a rapid and irregular heart rate that causes poor blood flow and can lead to blood clots or even stroke. He needed to go back and forth to the hospital six times for the heart condition — twice in a single night.

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Thomas describes the condition as unsettling and frightening. “I felt shortness of breath and fluttering in my chest because my heart was racing at 150 to 160 beats per minute.” The symptoms sometimes lasted as long as an hour, until he thought he would pass out.

While doctors have gotten the condition under control with medication, Thomas, an avid golfer, says it's affected his lifestyle.

"This slowed me down,” he says. “I was pretty active, but I'm not able to walk the golf course anymore.” He also had to pare back coaching a local teen golf team because the medications that control his AF also make him lethargic.

While such reports of cardiac problems have mounted after nearly a year of the pandemic, experts say some of the issues they see following a COVID-19 infection may resolve on their own. For now, they report, it's difficult to know which COVID survivors should be screened for which heart issues.

What experts do know, however, is that COVID-19 survivors are more susceptible to these heart conditions if they already have cardiovascular risk factors, such as high cholesterol, diabetes and high blood pressure, or are obese or inactive.

Robert Bonow, M.D., the editor of JAMA Cardiology and a professor of medicine at the Northwestern University Feinberg School of Medicine in Chicago, also notes that those over age 50, as well as those who were hospitalized with COVID-19, seem to be at greater risk.

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Studies show that the increase in irregular heart rate is one of the most common post-COVID heart issues. A study published in Circulation in November 2020 reported that 30 of 396 adult patients, or 7.8 percent, hospitalized at Connecticut's Yale New Haven Hospital with COVID-19 between March and June 2020 developed AF for the first time in their lives.

Other recent studies have reported the condition in 19 to 21 percent of all COVID-19 cases and at rates as high as 36 percent in patients who already had cardiac disease.

Teasing out whether the condition is caused by the coronavirus or is more likely a symptom of something else, including advancing age, can also be challenging. AF occurs in about nine in 100 people over age 65, according to the Centers for Disease Control and Prevention.

Blood clots and myocarditis may also occur

Other reported cardiac complications from COVID-19 include myocarditis, an inflammation of the heart muscle that can weaken it and lead to heart failure and, in some cases, sudden death. The good news with this condition, however, is that more recent studies have shown that it might not be as common as previously thought. What's more, Bonow says the myocarditis seen in some COVID-19 survivors is not “true damage to the heart muscle” but rather a temporary inflammatory immune response in and around the heart tissue.

Doctors are having similar problems deciding on the prevalence and lasting effects of a blood circulation disorder called postural orthostatic tachycardia syndrome (POTS) on people who have recovered from COVID-19. The condition, which normally affects 1 to 3 million Americans, can cause a rapid heartbeat and dizziness and fatigue, especially when the sufferer changes position.

Exercising too soon appears to be a real risk

One of the few post-COVID-19 conditions that uniformly concerns experts is the risk of dangerous arrhythmias in those who exercise too soon after recovering from coronavirus.

James de Lemos, M.D., cardiology service chief at Parkland Memorial Hospital in Dallas, stresses that “people should not exercise while they are actively recovering from COVID.” In fact, de Lemos recommends waiting a good two weeks before going back to fitness activities.

As you begin to work out again, talk to your doctor if you feel your heart racing, you get short of breath, or you have palpitations, de Lemos recommends.

Don't rush to extensive testing, doctors say

Ruwanthi Titano, M.D., assistant professor of cardiology at the Mount Sinai Health System in New York City, says that she's seen patients with a wide variety of cardiac issues “ranging from chest pain to shortness of breath, a racing heart, skipped beats, pauses, a higher heart rate than normal, and fatigue.” But the “good news,” she notes, is that the majority of patients, young and old, have “very good or mostly normal” overall cardiac function beyond their symptoms.

While experts say more research is needed, for now many doctors say patients typically shouldn't rush to get tests like MRIs or troponin blood testing immediately after recovering from COVID-19. “You may detect minor things that don't have long-term significance. This can lead to secondary testing and expense or anxiety,” says de Lemos.

Cheryl Platzman Weinstock is a contributing writer who covers health and science research and its impact on society. Her work has appeared in the New York Times, NPR and Kaiser Health News.