Anyone can become sick with COVID-19 (coronavirus), but some people are more affected than others. While we're learning more about the virus every day, we do know that people with heart conditions have a higher risk for severe illness. We talked with Ronald Freudenberger, MD, Physician in Chief with Lehigh Valley Heart Institute to find out more about COVID-19 and the heart.
How does COVID-19 affect people with preexisting heart conditions?
Many of the people who have been affected the most severely have preexisting heart conditions. This could be because people who have congestive heart failure or heart disease have less of a cardiac reserve to be able to withstand the stress of pneumonia and low oxygen levels.
We are seeing reports of the direct effects of the virus on the heart. When someone has COVID-19, the heart muscle can become inflamed, causing a condition called myocarditis (inflammation of the heart muscle). There are also many reports coming out that have demonstrated an increased clotting in patients with COVID-19. This can happen in other overwhelming infections as well.
All that being said, many people who have preexisting heart conditions survive COVID-19 infections without hospitalization. It’s important to stay in contact with your provider about treating the symptoms of coronavirus.
High blood pressure does increase the risk for complications of COVID-19, so it's important to continue the regimen laid out for you by your physician. These medications do not increase your risk for contracting COVID-19.
What if I have symptoms of COVID-19 (fever, dry cough, chest tightness)?
If you think you may have a COVID-19 infection and you’re experiencing minor symptoms, you can reach out to a health care professional:
If your COVID-19 symptoms need emergency care, call 1390 and let them know you have COVID-19. Try to put on a mask before medical professionals arrive. Symptoms requiring emergency attention include:
Difficulty breathing or shortness of breath
Persistent pain or pressure in the chest
New confusion or inability to arouse
Bluish lips or face
This list is not all inclusive. Please consult a medical provider for any other symptoms that are severe or concerning.
If someone is experiencing chest pain, shortness of breath or persistent heart racing, what should they do?
If you are experiencing heart attack symptoms like these, call 1990 immediately. This does not change during a pandemic. During a heart attack, time is muscle; the sooner patients are treated, the greater the chance of survival and full recovery.
What are your tips to help people stay healthy?
The most important thing is to continue healthy habits, so that means eat a healthy diet, stay active, stay hydrated and continue medications. It’s also important to stay up to date with health guidance, wear a cloth face mask and wash your hands regularly.
Despite the fact that COVID-19 is considered an illness of the lungs, many patients who contract the coronavirus experience cardiac issues.
Early evidence suggests that up to 1 in 5 patients with COVID-19 have signs of heart injury, regardless of whether or not they had respiratory symptoms.
Though a good portion of these patients already had underlying health issues involving the heart, like heart disease or high blood pressure, many otherwise healthy patients have also developed heart problems, including blood vessel injuries, blood clots, arrhythmia, strokes, and heart attacks.
Now, researchers are beginning to understand why the coronavirus causes heart conditions.
According to a new study published in the journal Frontiers in Cardiovascular Medicine, it boils down to a few factors: the widespread inflammation the infection causes, the possibility that the virus directly infects and injures the cardiovascular system, and the overall stress the infection puts on preexisting heart conditions.
Still, more research is needed to confirm exactly how the coronavirus affects heart function, and which patients with COVID-19 are most at risk for running into heart troubles.
One of the key problems associated with COVID-19 is the amount of inflammation the infection causes.
According to health experts, this level of inflammation occurs due to a phenomenon called a “cytokine storm,” in which the immune system produces too big of a response against a virus.
Instead of solely attacking the virus, the immune cells injure healthy cells, too, spurring inflammation.
A big inflammatory response can put a lot of stress on the heart, making the heart work harder to pump blood throughout the body as the body fights off the infection.
“In terms of the heart, when there is a cytokine storm, the excess of cytokines can lead to fulminant myocarditis (inflammation of the heart), with heart muscle cell necrosis or death,” says Dr. Joyce M. Oen-Hsiao, the director of clinical cardiology at Yale Medicine, adding that this can lead to problems with heart function and heart failure.
Those who have a more intense inflammatory response seem more likely to develop serious heart troubles and have a higher risk of dying from COVID-19, the study’s lead author Shuyang Zhang, a cardiology professor at Peking Union Medical College Hospital Beijing, China, said in a statement.
The virus may also directly infect cells in the cardiovascular system.
The coronavirus infects the body via a receptor called the angiotensin converting enzyme 2, or ACE2.
ACE2 receptors are prevalent in the lungs, hence the respiratory symptoms, but they’re in the heart and blood vessels, too.
According to Dr. Jack Wolfson, a board certified cardiologist and a fellow of the American College of Cardiology, the coronavirus appears to enter and infect the heart cells though these ACE2 receptors.
“Once inside the heart cell, damage to the cellular machinery directly from the virus and the human immune cell response leads to cell dysfunction and cellular death,” Wolfson said.
Researchers observed this with SARS (severe acute respiratory syndrome), a coronavirus that struck back in 2002. The SARS virus also attached to ACE2 receptors, and autopsies revealed that viral genetic material was present in heart samples from patients with SARS.
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