COVID-19 and your heart

Posted on 1 September 2021

Although most people think of COVID-19 as a respiratory disease that affects the lungs, this virus is just as likely to cause damage to your heart. A specialist explains why.

COVID-19 commonly presents with a cough and shortness of breath, so it’s often thought of as a respiratory disease only. In fact, says Dr Nivesh Sewlall, a pulmonologist at Mediclinic Morningside, the virus affects the entire body, and is capable of causing damage to multiple organs.

“The virus enters the body through ACE (angiotensin-converting) receptors – [a specific protein that allows the virus to infect a wide range of human cells], and so it can be found in any organ where these receptors are present,” Dr Sewlall explains. “These include the brain, gut, pancreas, blood vessels, kidneys, and the lining of the nose and mouth. Wherever the virus can gain entry, it can also cause damage. That’s why patients suffering from long COVID tend to experience such a wide array of symptoms.”

When it comes to the heart, this damage takes the form of scar tissue that forms on the muscles of the organ. The virus can also cause blood clots in the vessels around the heart, and can lead to a cytokine storm; a condition where the immune system overreacts to the presence of a bacterium, virus, or other microorganism (all known as pathogens), which causes inflammation. This can disrupt the proper functioning of the organ, leading to an arrhythmia, where the heart pumps either too quickly or too slowly. Both conditions are dangerous, Dr Sewlall warns. Damage caused by the virus can also lead to a heart attack or stroke.

Cardiac issues among COVID-19 patients are more common than you may think. According to the American Heart Association, around 25% of US COVID-19 patients admitted to hospital have experienced cardiac complications, and even recovered patients have presented with abnormalities in the heart. Symptoms of these conditions include chest pain, shortness of breath, as well as palpitations if the heart rate has increased. Conversely, if the heart rate slows, the patient may faint.

Even if patients don’t experience damage to the heart at the time of infection, some of the virus’s effects on the heart, such as myocarditis or inflammation of the heart muscle, can put them at risk for heart failure in years to come.

Although some of these conditions can be reversed, it’s also possible that some damage may be permanent – especially in cases where there’s scar tissue that affects the heart’s functioning.

So, when should you worry about your heart? Dr Sewlall says if you’ve entered the recovery phase of infection, but are still experiencing symptoms such as shortness of breath and fatigue that aren’t lessening as time passes, further investigation may be required.

Your first step is to consult your GP, who will conduct tests such as an ECG to check for any damage to the lungs and heart. If necessary, your doctor will refer you on to a specialist for treatment.