In December 2020, a week before cardiologist Stuart Katz was scheduled to receive his first COVID-19 vaccine, he came down with a fever. He spent the next two weeks wracked with a cough, body aches and chills. After months of helping others to weather the pandemic, Katz, who works at New York University, was having his own first-hand experience of COVID-19.

On Christmas Day, Katz’s acute illness finally subsided. But many symptoms lingered, including some related to the organ he’s built his career around: the heart. Walking up two flights of stairs would leave him breathless, with his heart racing at 120 beats per minute. Over the next several months, he began to feel better, and he’s now back to his normal routine of walking and cycling. But reports about COVID-19’s effects on the cardiovascular system have made him concerned about his long-term health. “I say to myself, ‘Well, is it really over?’” Katz says.

In one study¹ this year, researchers used records from the US Department of Veterans Affairs (VA) to estimate how often COVID-19 leads to cardiovascular problems. They found that people who had had the disease faced substantially increased risks for 20 cardiovascular conditions — including potentially catastrophic problems such as heart attacks and strokes — in the year after infection with the coronavirus SARS-CoV-2. Researchers say that these complications can happen even in people who seem to have completely recovered from a mild infection.

Some smaller studies have mirrored these findings, but others find lower rates of complications. With millions or perhaps even billions of people having been infected with SARS-CoV-2, clinicians are wondering whether the pandemic will be followed by a cardiovascular aftershock. Meanwhile, researchers are trying to understand who is most at risk of these heart-related problems, how long the risk persists and what causes these symptoms.

COMMENTARY:

 The heart and Covid are connected from a variety of angles.

Obese people with high blood fats, diabetes, the metabolic syndrome tend to have atherosclerosis and heart problems, making them more susceptible to severe Covid and long Covid. Covid loves to involve the lining of blood vessels and the heart, the endothelium, where the number of ACE receptors are high.

The respiratory tract and lung are a particular target for Covid, and reduced oxygen from lung involvement can compromise the hard-working heart.

 Heart cells, cardio myocytes, can be directly infected with the virus. Even Covid vaccines can rarely produce myocarditis, raising the possibility that there is some antigenic similarity between the virus and heart cells, similar to the beta hemolytic streptococcus and the heart which sets up rheumatic fever. 

If this similarity is real, the tendency of Covid to compromise the immune system and produce a cytokine storm in severe cases could therefore specifically involve the heart.

The nature article indicates several different varieties of heart problems and is a recommended read. From my personal standpoint, arrhythmias were mentioned, and I already have trouble with a couple of different types, AF and NSVT.

To make definite statements about the likelihood of heart involvement in Covid is problematic. The patients reported on were infected with an earlier strain of Covid, and the present one, BA.5, seems to be milder, and  may not be as hard on the heart as previous strains. Many more people are now immunized, and the most susceptible patients may have passed away. There are medications to take, such as remdesivir, and even select immune globulins, such as an immuno-suppressed friend of mine was given when he contracted Covid recently.

The bottom line for me is that I am 90 years old and have no desire to let Covid have a crack at me, so I avoid big gatherings, and wear a mask whenever I am exposed.

—Dr. C.

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