Nearly two years into the COVID-19 pandemic, there remains a great deal about the disease’s long-term effects that researchers haven’t completely figured out, including the potential impact of COVID-19 on the heart. COVID heart damage is the subject of ongoing research, and over time, we will better understand the relationship between COVID and heart damage.

How does COVID-19 affect the heart?

COVID-19 can affect the heart in a few ways. The virus can invade the heart muscle directly, causing inflammation and even permanent damage in some cases, usually due to muscle cell death or scarring. 

COVID-19 can indirectly lead to heart damage when an infected person’s immune system overreacts to the viral infection and floods the body with cytokines, which in normal amounts help your body fight off inflammation. However, when cytokines are released en masse—known as a cytokine storm—in response to the body being overwhelmed by pathogens, they may cause excessive inflammation and cause blood vessels to become too porous. This may result in low blood pressure and deplete the organs of oxygen, leading to organ failure. 

Inflammation of the blood vessel linings can also lead to blood clot formation. This increases the risk of heart attack, stroke, and pulmonary embolism (blood clot in vessels of the lungs), which can lead to dangerously low blood oxygen levels. Blood clots in the lung affect the heart by causing strain on the right ventricle, resulting in right-sided heart failure that can lead to fluid backing up in the kidneys and liver, and fluid accumulating in the abdomen and legs. 

Can COVID-19 worsen pre-existing heart problems?

Scientists agree that COVID-19 can have detrimental impacts on the heart and the circulatory system as a whole—especially in people with pre-existing heart disease. Any condition that can damage the heart or arteries has high potential to worsen the prognosis of people who have been diagnosed with heart issues. However, people with a pre-existing heart condition who have an asymptomatic or mild case of COVID-19 are unlikely to experience worsened heart health related to the virus. 

Still, the effects of COVID-19 on the heart are still being researched, and most studies done to date have been small. As more, larger studies get underway, it’s important to stay informed about new findings if you have a heart condition and have had COVID.

Can COVID-19 cause new heart problems?

The American Academy of Cardiology identifies myocarditis and pericarditis as possible heart-related complications that may be caused by COVID-19, although more research is needed to determine the extent to which the coronavirus directly infects the myocardium and pericardium and causes these conditions.

Myocarditis is the inflammation of the heart muscle, and pericarditis is the inflammation of the outer lining of the heart. Both conditions can be acute, which means they occur suddenly and don’t last long. But they may also be chronic, which means they develop over time and take time to treat.

Does COVID-19 cause permanent heart damage?

This is where most long-term studies on COVID-19 heart damage are focusing. The ongoing cardiovascular effects of the virus in people suffering from post-COVID conditions also known as “long COVID” can’t be fully understood until the proper studies are done, which takes time.

What is known right now, though, is that enough COVID-19 patients have been found to have ongoing myocarditis, independent of preexisting conditions, to suspect that there is a link between COVID and potential damage to the heart. 

Can pre-existing heart conditions increase the risk of severe illness from COVID-19?

There’s no doubt that COVID-19, like any serious viral infection, can be particularly dangerous for people with heart disease. The CDC notes a variety of heart conditions, including heart failure, high blood pressure, and cardiomyopathies, that can increase the chances that COVID-19 patients will become seriously ill or require hospitalization. 

In a large-cohort Chinese study of case fatality ratio, or CFR, for COVID-19, the overall fatality rate was 2.3 percent of all cases. By contrast, the CFR of people who had underlying cardiovascular disease was 10.5 percent—higher than those for people with diabetes (7.3 percent), chronic respiratory disease (5.6 percent), and cancer (5.6 percent.)

Research over the past year has identified two primary reasons why heart disease worsens the prognosis for people with COVID-19.

First, someone with a weakened heart or vascular system is more susceptible to low blood pressure, low blood oxygen levels, heart rate changes, inflammation, and blood clots. Even the healthiest of hearts must work extra hard to overcome these common COVID-19 complications, but for someone with heart disease, the complications can be severe and deadly.

Secondly, someone with heart disease is likely to have other health conditions such as obesity, high blood pressure, or diabetes. Even people with these conditions who don’t have COVID-19 are at risk for severe complications—obesity causes excessive inflammation in the body, and diabetes increases the risk for developing blood clots. These conditions exacerbate COVID-19 complications. 

How can I tell if I have a heart problem from COVID-19?

The symptoms of myocarditis and pericarditis are similar and usually include chest pain, shortness of breath, and heart palpitations—either an accelerated heart rate or a feeling that your heart is fluttering or pounding in an unusual manner. It’s important to note that some of these symptoms—especially shortness of breath—are common among seriously ill COVID-19 patients in general, so they don’t necessarily mean there is heart damage involved.

As with all symptoms and lingering issues related to COVID-19, it’s important to see your doctor if you’re experiencing any of these heart-related symptoms.

Should I see a cardiologist after having COVID-19?

Simply testing positive for COVID-19 doesn’t necessitate a trip to a heart specialist. Many people contract the coronavirus and never experience any heart issues, particularly in mild cases—which, thankfully, make up the majority of infections.

But if you experience symptoms typically associated with myocarditis and pericarditis—or if you have existing heart disease or common risk factors for it—make an appointment to see your primary care physician to determine the best course of action.

Can the COVID vaccine cause heart problems?

In very rare cases, myocarditis and pericarditis have occurred in people after receiving a COVID-19 vaccine, although those cases have typically been mild and temporary. Current CDC guidance suggests seeking medical care if you experience chest pain or heart palpitations within a week of receiving a dose of any COVID-19 vaccine. 

How can I protect my heart from COVID-19 complications?

If you suspect you’ve suffered heart damage as a result of COVID-19 or the COVID vaccine, talk to your doctor. If you haven’t had COVID but you’re worried about your heart in the event you contract it, consider getting vaccinated and staying up-to-date with vaccinations. Follow mask protocol if you’re at high risk for heart problems or for COVID-19 complications as a result of existing heart disease. 

COVID-19 prevention is a major priority at Forward. Our doctor-led COVID-19 program for members includes symptom assessments, PCR testing, COVID vaccinations, and at-home care and monitoring for those who test positive. Up-to-date expert guidance for COVID issues is at your fingertips with in-app updates—and additional support, including at-home medical and mental health monitoring, helps you stay healthy and connected.
For those with concerns about COVID-19 and their heart health, Forward’s Healthy Heart Program can help with comprehensive testing, monitoring, treatment, and counseling to help assess your risk and develop a personalized plan to maximize your cardiovascular health. Through vigilance, risk management, and education, Forward can help you reduce your chances of COVID-related heart problems and heart-related COVID problems—and improve your overall heart health and wellbeing.

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