Can COVID-19 damage the heart?
Cardiologist Erin Michos, M.D., M.H.S. says, Yes: Although COVID-19 — the disease caused by the coronavirus that’s led to the global pandemic — is primarily a respiratory or lung disease, the heart can also suffer.
Early reports coming out of China and Italy, two areas where COVID-19 took hold earlier in the pandemic, show that up to 1 in 5 patients with the illness end up with heart damage. Heart failure has been the cause of death in COVID-19 patients, even those without severe breathing problems such as acute respiratory distress syndrome, or ARDS.
Not all heart problems related to this coronavirus — officially called SARS-CoV-2—are alike, however. Cardiologist Erin Michos, M.D., M.H.S., explains the different ways the virus — and the body’s response to it — can cause heart damage.
Michos explains that cells in the lung and heart are both covered with protein molecules called angiotensin-converting enzyme 2, or ACE-2. The ACE-2 protein is the doorway that the new coronavirus uses to enter cells and multiply.
ACE-2 normally plays a favorable role in protecting tissue by being anti-inflammatory. But if the new coronavirus somehow disables those molecules, these cells may be left unprotected when the immune system springs into action.
“There are multiple mechanisms for heart damage in COVID-19, and not everyone is the same,” Michos says. Temporary or lasting damage to heart tissue can be due to several factors:
Lack of oxygen. As the virus causes inflammation and fluid to fill up the air sacs in the lungs, less oxygen can reach the bloodstream. The heart has to work harder to pump blood through the body, which can be dangerous in people with pre-existing heart disease. The heart can fail from overwork, or insufficient oxygen can cause cell death and tissue damage in the heart and other organs.
Myocarditis: inflammation of the heart. The coronavirus may infect and damage the heart’s muscle tissue directly, as is possible with other viral infections, including some strains of the flu. The heart may also become damaged and inflamed indirectly by the body’s own immune system response.
Stress cardiomyopathy. Viral infections can cause cardiomyopathy, a heart muscle disorder that affects the heart’s ability to pump blood effectively. When attacked by a virus, the body undergoes stress and releases a surge of chemicals called catecholamines that can stun the heart. “Once the infection resolves, the stressor has ended and the heart can recover,” Michos says.
People with pre-existing heart conditions are at an increased risk of heart damage from COVID-19. However, even people with healthy hearts can develop heart damage from COVID-19.
Symptoms of heart damage from COVID-19 can include:
- Chest pain
- Shortness of breath
- Fatigue
- Palpitations (feeling like the heart is racing or skipping beats)
- Lightheadedness or dizziness
- Fainting
If you experience any of these symptoms after having COVID-19, it is important to see a doctor right away.
The best way to protect yourself from heart damage from COVID-19 is to get vaccinated and boosted against COVID-19. You should also wear a mask in public indoor settings and avoid crowded areas. If you have pre-existing heart conditions, it is important to work with your doctor to manage your condition and reduce your risk of complications from COVID-19.