As 2020 came to a close, the coronavirus surpassed heart disease as the leading cause of death in the U.S. — a sobering reminder of the toll the virus continues to take.
We have learned a lot about Covid-19 over the past 10 months. Importantly, we know now that it isn’t just a lung and respiratory issue, as was thought early on. It is a systemic inflammatory disease that may affect many organs in the body, and when it comes to the heart, it can be especially serious.
Covid-19 infection certainly does not affect everyone’s heart, but it turns out that you don’t even need to have significant symptoms to have heart-related issues. The most direct, and at times the most complicated, impact of the virus on the heart is muscle inflammation, a condition called myocarditis. This can result in a variety of cardiac issues, including muscle weakness and rhythm disturbances.
It is well known that other viruses — as well as some medications, chemotherapies and other medical conditions — can also affect the heart in similar ways.
In addition to direct toxic effects on the heart muscle, Covid-19 may cause blood clots, which can impact the heart, lungs and the brain, resulting in heart attacks, pulmonary emboli and stroke. We learn more every day, but it remains unclear whether traditional approaches to heart disease are applicable to patients with long-term complications of the coronavirus, like heart damage.
While many patients are asymptomatic or mildly symptomatic, others may become very ill, and some even succumb to the disease. We don’t know the exact number of Covid-19 patients with myocarditis, because some patients may have cardiac involvement without even knowing it.
Some of the symptoms of myocarditis include chest pain; shortness of breath; heart palpitations or irregular heartbeat; lightheadedness, dizzy spells or loss of consciousness, and extremity swelling.
The lingering effects of Covid-19 on the heart, particularly myocarditis, have been a hot topic in the sports community. Several college and pro athletes with the virus have done the right thing by staying off the field this season — not only because of the risk of virus transmission, but because their doctors saw evidence of myocarditis on an MRI.
The heart needs time to heal. We know that active inflammation of the heart can cause serious problems, even in highly trained athletes. And, during recovery, athletes should refrain from heavy exertion until they are assessed by a cardiologist.
And if an athlete can get asymptomatic, or subclinical, effects of the heart, so can we all.
Given new and emerging data, the exact risks and treatment protocols for Covid-related cardiac issues remain unclear. Who should undergo MRI testing of the heart — the best way to detect myocarditis — is a question that has not been definitively answered.
As things stand now, a coronavirus infection alone does not warrant an extensive cardiac evaluation. If, however, patients are highly symptomatic and have abnormalities in specific laboratory tests, like electrocardiograms or echocardiograms, then highly specialized tests, like MRIs, might be warranted.
As the pandemic continues, as at all other times, it is important to recognize cardiac warning signs, which can be very similar to Covid symptoms. Addressing cardiac risk factors, including cholesterol, blood sugar levels, blood pressure, sleep hygiene and obesity — is always prudent. In addition to improving quality and quantity of life, it is widely recognized that controlling cardiac risk factors can affect the course of Covid-19.
Jeffrey T. Kuvin, M.D., is the de Roulet professor and chair of the Department of Cardiology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He is the senior vice president of cardiology for Northwell Health’s Central and Eastern regions, chair of the Department of Cardiology at Long Island Jewish Medical Center and North Shore University Hospital, and co-director of the Sandra Atlas Bass Heart Hospital.