Investigating heart damage from the coronavirus
“COVID is such a bizarre virus in that it truly presents a constellation of symptoms with each person having a completely different subset.”
The “What We Have Learned From COVID” file has grown from the discovery of the genetic information of the virus (RNA) to the long-term damages of coronavirus on the heart. We know that nearly one-fourth of people hospitalized with COVID-19 have been diagnosed with cardiovascular complications — inflammation of the heart muscle and reduced heart function are two of the main concerns. Dr. Brion Winston is an interventional cardiologist with Captial Cardiology Associates. As part of his specialty area, he routinely diagnoses and treats cardiovascular disease and structural heart conditions through catheter-based procedures. Since March, Dr. Winston has noted an increase in COVID patients needing cardiac cath lab testing to assess their heart health. “I have had several such cases; really, the most common manifestation is related to the inflammation caused by COVID.”
Inflammation is a natural response initiated as a defense mechanism by our body when a foreign bacteria or toxin is detected. Damaged cells release chemicals that cause blood vessels to swell, acting as a lock to close the infected area from spreading to the rest of the body. We have learned from COVID that the virus is triggering different inflammation response levels from patient to patient. In the cases investigated by Dr. Winston’s team, these patients have similar responses to people with myocardial infarction, a heart attack, or poor/reduced heart function common with congestive heart failure. “COVID appears like myocarditis (an inflammation of the heart muscle), but we also see the general stress response of a variety of conditions when someone is sick where the heart is placed under strain. We call this by different names, including stress cardiomyopathy, to say that the heart is working hard and has some degree of damage.”
the outbreaks COVID is not the first virus that has presented short or long-term damage to the heart muscle or vascular system. The common cold is an example of a rhinovirus, which can develop into a severe form that can sometimes lead to chronic bronchiolitis, pneumonia, or a lower respiratory tract infection. The seasonal flu virus, in extreme cases, can affect the heart muscle, especially for patients at-risk or have heart disease. “In cardiology, we had quite a bit of experience with viral syndromes that could affect the heart; we did anticipate that COVID could bring complications,” added Dr. Winston. This was confirmed in the early reports from outbreaks in China and Italy. Viral myocarditis, along with inflammation, can affect the heart’s ability to pump efficiently or cause abnormal heart rhythms (arrhythmias). These symptoms are problematic because a change to the heart’s electrical system may not present conditions detected by the average person. A heart that beats out of sync presents the opportunity for blood clotting; combine that with people at risk for stroke or heart attack, and this could produce a negative outcome. “We see that people are more prone to forming clots with more severe COVID infections. This can manifest deep vein thrombosis (DVT), blood clots that can form in the leg and migrate to the lungs, or form in the lungs – we see that.” As DVT forms blood clots in the vein, blood circulation decreases, leading to cramping pain, weakness of the area, or discoloration at the clot site.
Long haulers into the future
As COVID survivors have increased this year, they are learning to live with the long-term effects. They call themselves “long haulers,” those who continue to suffer from lingering symptoms from the virus. For some, it’s body aches and fatigue, shortness of breath is common in others. A journalist for The Atlantic shared her experience in an article she penned in September. She recalled how her heart rate rapidly increased when walking up the 53 steps at her apartment in Brooklyn. She thought she had a racing heart that might be connected with aging. After visiting her healthcare provider, she was diagnosed with postural orthostatic tachycardia syndrome or POTS. Dr. Winston noted that this disorder of the heart and nervous system is not typically associated with a viral illness. It is usually a rare issue for young women in their 20’s. However, POTS has become a trend physicians are observing as part of the many cardiac dysfunctions associated with COVID.
For long haulers, there is support in the form of online groups that have increased this year. Survivor Corps is one of the largest and fastest-growing grassroots movements connecting, supporting, educating, motivating, and mobilizing COVID-19 survivors. They have over 100,000 members after beginning with just one case. Diana Berrent describes herself as a “canary in the COVID coalmine.” She was one of the first people in her Long Island community to test positive for the virus. Diana was also Participant #0001 in Columbia University’s clinical trial of volunteers who have recovered from COVID-19 to donate blood to treat others with this virus. While journaling her experience for the New York Post, Diana founded Survivor Corps. This year, Diana has appeared on major news outlets, been featured on social media, promoting her support group, advancing coronavirus research. “COVID is such a bizarre virus in that it truly presents a constellation of symptoms with each person having a completely different subset. I would love for people to read through the stories of people on the Survivor Corps Facebook page. I promise you will change your mind,” Berrent concluded.