If COVID-19 wasn’t scary enough, we have something new to worry about regarding this damn virus. Many people have assumed that once patients recover from COVID-19, they get on with their lives with no residual complications. Two German studies from JAMA Cardiology (July 27, 2020) contradict that belief. Now we may have to be concerned about the long-lasting cardiac effects of COVID-19.
Studying the Coronavirus and the Heart:
In one of the German studies researchers analyzed MRIs of the hearts of 200 people (JAMA Cardiology, July 27, 2020). Half of them had recovered from COVID-19 and the other half were matched for age and sex but had not been infected.
They were young adults to middle-aged. The average age was 49. These were relatively healthy people. Many of the COVID patients had caught the infection while on ski vacations. So, these were not sick old folks with a ton of serious health conditions.
Of the 100 people infected with the coronavirus, 67 recovered at home. A third required hospitalization and only two required mechanical ventilation. 18 patients had no symptoms and 49 had “minor to moderate symptoms.”
What Were the Cardiac Effects of COVID-19?
The researchers found that more than three quarters of the recovered patients had structural changes in their hearts after infection. These cardiac effects of COVID-19 included:
“…myocardial inflammation (defined as abnormal native T1 and T2 measures), detected in 60 patients recently recovered from COVID-19 (60%), followed by regional scar and pericardial enhancement. Findings on classic parameters, such as volumes and ejection fractions, were mildly abnormal.”
In addition to cardiac inflammation, many infected patients also had elevated levels of troponin, a biomarker used to detect cardiac damage from a heart attack.
The authors note:
“…our findings reveal that significant cardiac involvement occurs independently of the severity of original presentation and persists beyond the period of acute presentation, with no significant trend toward reduction of imaging or serological findings during the recovery period.”
What that means is that patients who were not all that sick from the coronavirus experienced heart damage. And the heart inflammation persisted after recovery from the infection. Many of these “recovered” patients experienced unusual chest pain, palpitations, shortness of breath and general exhaustion. When the ejection fraction of the heart muscle is reduced, the heart is no longer pumping blood as efficiently as possible.
The Cardiac effects of COVID-19 After Death:
Another study, also published in JAMA Cardiology (July 27, 2020), looked at heart tissue in older people who had died from COVID-19. More than half had high levels of the coronavirus in their heart tissue. It appears that the virus can set up housekeeping in the heart and start replicating itself.
An editorial in the same issue of JAMA Cardiology suggests that:
“These new findings provide intriguing evidence that COVID-19 is associated with at least some component of myocardial injury, perhaps as the result of direct viral infection of the heart.”
These cardiologists go on to express concern that the kinds of damage seen in these two German studies could foretell “new-onset heart failure and other cardiovascular complications.”
They state that:
“…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.”
What is the Future of Cardiac Effects of COVID-19?
At last count, roughly 17 million people around the world have tested positive for COVID-19. The US has had over 4 million cases and that is probably a substantial undercount. If the research published in JAMA Cardiology holds up, millions of people could have some degree of heart damage. That’s even if they were not that very sick from the coronavirus.
What we don’t know is whether the inflammation is temporary or long lasting. That will only be revealed over the coming months and years.
What Do You Think About the Cardiac Effects of COVID-19?
Many Americans believe that the coronavirus is not much worse than a case of flu. There is a sentiment that the overwhelming majority of people recover from COVID-19 without any lasting harm. This new research suggests otherwise. Many of the recovered patients did not realize that they had heart inflammation or damage until they were tested by cardiologists and sophisticated imaging.
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