The disease may damage cardiac muscle even in those who never displayed symptoms.

NISHA PARIKH, MD Cardiologist Nisha Parikh, MD, MPH, discusses what we know so far about COVID-19’s impact on the body’s cardiovascular system, from affecting the heart’s rhythm to impairing its ability to pump blood throughout the body.


We used to think of COVID-19 as just a lung disease. What were the first signs that this view wasn’t quite accurate?

One of the first indications that this virus affected the cardiovascular system was an early report about how SARS- CoV-2, the virus that causes COVID-19, enters a cell using the receptor involved in the system that regulates the body’s blood pressure and level of water and salts, which is known as the renin-angiotensin-aldosterone system. That article definitely got my attention and the attention of my colleagues.

This receptor is called the ACE2 receptor, and its involvement might be behind why people with obesity, diabetes, and high blood pressure tend to get more severe forms of COVID-19. Although we haven’t quite unraveled that story, I think we are going to learn more.


What do we know so far about how COVID-19 affects the heart in the short term?

There are many ways COVID-19 can affect the heart during the initial period when someone gets the infection, particularly in the first few weeks. These effects can include new or worsened problems pumping blood effectively, inflammation of the heart muscle, and inflammation of the membrane around the heart.

It should be noted that other viruses also can cause these conditions. We determined this based on deaths from COVID-19 that we know about. But there’s also been a spike in deaths occurring outside the hospital nationwide since this spring, including people being found dead at home from unknown causes.
It makes you wonder how many of these out-of-hospital deaths were really COVID-19-related cardiovascular deaths.

Finally, we are also seeing effects from COVID-19 that may not be directly due to the virus but are related to people not obtaining appropriate medical treatment for a heart problem, often because they have delayed seeking medical care for hours, days, or even weeks after potential heart attack symptoms began.
This has led to some really serious complications we hadn’t seen in some time because we now have such good treatments for heart attacks that are detected early enough.

These issues include potentially deadly problems such as holes in the heart muscle and tears in the heart valves. The other thing my colleagues and I have seen when caring for patients admitted to the hospital is a higher incidence of a condition called Takotsubo cardiomyopathy, which is heart dysfunction that occurs when someone is under tremendous stress.

These days, that stress might be from social isolation, from having loved ones fall ill, or from having lost loved ones. But that trend is anecdotal; we don’t really know the scope of the problem yet.


What symptoms are you seeing among people who had COVID-19 in the past?

We are starting to see more patients with cardiovascular symptoms ranging from chest pain to palpitations to presyncope or syncope – which is feeling lightheaded, like you’re going to faint – that are often accompanied by neurologic symptoms such as brain fogginess, headaches, numbness, or other sensations in various parts of the body.

These are part of a constellation of symptoms that folks in this so-called COVID-19 long-hauler category are experiencing. Many of the symptoms seem to be tied to the nervous system and in many ways may share similarities with cardiovascular diseases we have known about for some time, such as postural orthostatic tachycardia syndrome.

POTS, as it’s known, is characterized by an abnormal increase in heart rate when standing up and can lead to dizziness, fainting, and other debilitating symptoms. We would like to look further into whether this collection of COVID symptoms we are seeing is POTS.


Are signs of heart problems showing up in people of all ages?

Yes, we have seen young, middle-aged, and older adults develop heart issues. Of the two main studies of heart function among patients who’d had COVID-19 – including infections that were asymptomatic – the average age of participants in one was 49 years old; the other was a study of competitive college athletes who were an average of 19.5 years old.

Everyone working to answer questions related to heart function and COVID-19 agrees that we should be taking these studies as preliminary and certainly not definitive; more work needs to be done...

SOURCE: UCSF Magazine - University of California, San Francisco - Allison Bond, MD UCSF Magazine