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Two new studies from Germany paint a sobering picture of the toll that Covid-19 takes on the heart, raising the specter of long-term damage after people recover, even if their illness was not severe enough to require hospitalization.

One study examined the cardiac MRIs of 100 people who had recovered from Covid-19 and compared them to heart images from 100 people who were similar but not infected with the virus. Their average age was 49 and two-thirds of the patients had recovered at home. More than two months later, infected patients were more likely to have troubling cardiac signs than people in the control group: 78 patients showed structural changes to their hearts, 76 had evidence of a biomarker signaling cardiac injury typically found after a heart attack, and 60 had signs of inflammation.

These were relatively young, healthy patients who fell ill in the spring, Valentina Puntmann, who led the MRI study, pointed out in an interview. Many of them had just returned from ski vacations. None of them thought they had anything wrong with their hearts. 

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“The fact that 78% of ‘recovered’ [patients] had evidence of ongoing heart involvement means that the heart is involved in a majority of patients, even if Covid-19 illness does not scream out with the classical heart symptoms, such as anginal chest pain,” she told STAT. She is a cardiologist at University Hospital Frankfurt. “In my view, the relatively clear onset of Covid-19 illness provides an opportunity to take proactive action and to look for heart involvement early.” 

The other study, which analyzed autopsy results from 39 people who died early in the pandemic and whose average age was 85, found high levels of the virus in the hearts of 24 patients. 

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“We see signs of viral replication in those that are heavily infected,” Dirk Westermann, a cardiologist at the University Heart and Vascular Centre in Hamburg, said in an interview. “We don’t know the long-term consequences of the changes in gene expression yet. I know from other diseases that it’s obviously not good to have that increased level of inflammation.”

Taken together, the two studies, published Monday in JAMA Cardiology, suggest that in many patients, Covid-19 could presage heart failure, a chronic, progressive condition in which the heart’s ability to pump blood throughout the body declines. It is too soon to say if the damage in patients recovering from Covid-19 is transient or permanent, but cardiologists are worried.

“These are two studies that both suggest that being infected with Covid-19 carries a high likelihood of having some involvement of the heart. If not answering questions, [they] prompt important questions about what the cardiac aftermath is,” said Matthew Tomey, a cardiologist and assistant professor of medicine at the Icahn School of Medicine at Mount Sinai Health System in New York. He was not involved in either study. 

“The question now is how long these changes persist,” he added. “Are these going to become chronic effects upon the heart or are these — we hope —  temporary effects on cardiac function that will gradually improve over time?”

Since the pandemic began, people with underlying cardiovascular problems such as high blood pressure, coronary artery disease, or heart failure have been known to be at higher risk for infection and death. The connection between Covid-19 and blood clots emerged later, after doctors began connecting the pulmonary embolisms, strokes, and heart attacks they were seeing to the virus.

Cardiac problems in recovering patients could belong to a pattern of lingering symptoms. Tomey sees signs of weakness in patients who had Covid-19 in March or April, when the disease was surging in New York.

“Patients come to my office saying, ‘Hey, I’m a 31-year-old who used to run and be completely unlimited in my exercise, and now I get palpitations walking across the street. Or I get out of breath climbing up to my second-floor apartment,’” he said. “Individuals are exquisitely tuned in to their own capacity for exercise, so I take that very seriously. Our challenge is to understand the why.” 

Marc Pfeffer, a cardiologist at Brigham and Women’s Hospital in Boston, called both the autopsy and MRI studies a sobering warning. He was not involved in either. He’s concerned about relatively young people losing their cardiac health reserves, which typically decrease with age and can set the stage for heart failure.

“We knew that this virus, SARS-CoV-2, doesn’t spare the heart,” he said. “We’re going to get a lot of people through the acute phase [but] I think there’s going to be a long-term price to pay.”

In an editorial about the two studies, Clyde Yancy, a cardiologist at Northwestern’s Feinberg School of Medicine, and Gregg Fonarow, a cardiologist at UCLA’s Geffen School of Medicine, pushed for more research into the problem. 

“If this high rate of risk is confirmed, … then the crisis of COVID-19 will not abate but will instead shift to a new de novo incidence of heart failure and other chronic cardiovascular complications,” they wrote. “We are inclined to raise a new and very evident concern that cardiomyopathy and heart failure related to Covid-19 may potentially evolve as the natural history of this infection becomes clearer.” 

Asked if there is something that can be done for patients now, Mount Sinai’s Tomey said, “I would love to have the answer to that question.”

  • Now days my heart makes funny palpitations once in a while. Sometimes, it’s like forcing blood to flow upwards.

  • I’m 38 years old and 3 months recovered from COVID – able to recover at home. I have a family history of cardiac issues – CHF, MI, palpitations. In the last month, I’ve recently spoken to my PCP regarding lower extremity swelling and heart palpitations (I’ve had palpitations for years, but nothing had ever shown up on EKGs). I had an EKG just last week that showed borderline intraventricular conduction delay, earning me a 48 hour heart monitor, cardiology consult, and echocardiogram. Now that I’m reading about these studies, I’m interested in knowing what is attributed to my history and what is because of COVID.

  • As a person not in the medical field, I’m certainly worried to see doctors worried themselves. However, I wonder, as one comment already suggested, at which extent those documented complications related to COVID-19 are specific to this disease.
    Some experts say there are complications with other viruses too, including cardiac damage.
    I guess my question is, are we finding defects in the body because we’re now looking at them?
    From what it looks like, the main difference is, COVID asymptomatic patients are affected, but not the asymptomatic ones who contracted the flu or other viruses ?
    I sometimes have the feeling we’re now starting to examine the general health of people, which was already quite bad, because of the COVID, and it collects a lot of the blame.
    A lot of questions… we’re all eager to know the answers!

    • I thought I’d be something they’ve had beforehand, but even with prognosis, if a patient comes about & states having heart palpitations/trouble walking up the street after contracting the virus, it’s pretty safe to say that they didn’t have the damage beforehand. Pretty scary virus, I hate that we have to go through this bs rn lol.

  • This article presents fodder worthy of wide-spread media attention: warn the beach & bar crowds that they are risking long-term heart issues. Maybe this will finally curb their obnoxious “cognitive dissonance” behaviour, and get them to finally participate in keeping all of the US much safer and healthier and guess what? more free (of disease !).

  • This article horrifies me. It makes my heart palps worse. I had the virus back in April…thought it was a cold…not a particularly bad cold either. I am 60. My 63 yr old husband got it from me…he was incredibly sick for 6 wks and passed away on May 27th. I of course have been greiving and struggling to get by. The anxiety is debilitating. I have over the past few weeks been feeling a ballooning sensation in my chest, LOTS of heart palps and flutters…which freak me out and make me panic. Other stuff too. So bad I’ve almost went to the ER. I started looking on online about what might be going on…too broke to go to Dr. appt with 80% of our income gone. Now I’m even more worried and scared. OMG !

    • Or Covid uncovers early heart dx previously undiagnosed. Those with asymptomatic exposure having healthier hearts and able to ward off dx.

    • Dear Mrs Hashley, Sorry about your loss and all the carnage this dreaded Evil has brought your family and the rest of our Human families. The human body is a wonderful system in that it has the ability to regain balance.

      The Heart(a muscle) can/has through exercise smarter eating been shown to strengthen so please get on a treadmill,stationary bike or start walking and little by little turn it into a light jog and eventually who knows! perhaps climbing your local mountain. I too have experienced “ballooning” shortness of breath, bad,bad GERD but exercising plus Earthing while getting D from the sun are doing wonders for this 60 year old.
      Notice the above requires near zero $$$$..

    • Please go see your doctor! You could he experiencing panic attacks. You could be having serious cardiac issues. Both require attention to keep you safe and help you live your life. ♥️ Please do not wait and do nothing. I’ve seen too often how that ends up.

  • The study authors noted that while most coronavirus research has focused on short-term respiratory complications, particularly in critically ill patients, mounting evidence suggests that COVID-19 has a significant impact on the cardiovascular system by worsening heart failure in patients with preexisting cardiac diseases.

    In this study, CMR revealed several kinds of heart abnormalities, each of which can be tied to underlying dysfunction and worse outcomes, the authors said.

    • Having 22 years in clinical cardiology I have a hard time believing that structural changes have occurred to the heart from COVID 19. I’d like to see additional information in the form of prior studies that prove there was no evidence of a structural heart abnormality before the images or specific modality had acquired them. In other words we don’t know if it was pre-existing before COVID or not. The term structural abnormality is misleading due to the fact that congestion from the course of the upper respiratory response could result in elevated pulmonary pressures which could induce small benign clinical abnormalities such as pulmonary hypertension, that could cause pulmonic insufficiency. Or long standing systemic hypertension that leads to aortic insufficiency. I don’t doubt or discredit clinical finding by patients that state they have experienced a significant drop in relative VO2 Max and or exertional dyspnea, with documented history of exercise. I just feel that recent findings in young patients with no prior diagnostic cardiac testing can not point to COVID as a clinically established cause.
      Much more research, at the time of diagnosis of COVID and long term diagnostic cardiac testing is the only verifiable way to accurately know the long term outcome of such claims.

  • I think this is why alot of people are mentioning cold extremeties…especially feet and hands. Palpitations…and breathless months later… including myself…thankyou for the truth…

  • While positive with covid 19 I never suffered from any respiratory infection . Although now I suffer from swelling and chest hurts during normal activities .

  • Based on the study it is uncertain what % of subjects had pre-existing endocarditis, myocarditis, or pericarditis. From Table 1, Patient Characteristics, we can only tell that a sizable percentage of subjects had diabetes, hypertension and/or were smokers. The total number (n) who had at least one of these is not disclosed, which is a potential major failing of this study, especially since the control group is heart healthy individuals. In short, we have no idea if we are comparing apples to apples so there is no way to ascertain whether this study was properly designed and therefore whether the study’s conclusion are valid.

    • Yes; our better research tactics and strategies are disrupted as we attempt to plunge into this complicated procedure. Pros and victims all can appreciate the ongoing complexity enhanced by our awkward, feeble, postponed research. 45 did far more harm than even he could guess.

    • Mitch, I agree with you that the study “control group” is not representative of the subjects being evaluated. We need a valid study to draw valid conclusions.

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