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COVID-19 threatens patients’ hearts

Even mild cases can develop serious issues

Beginning nearly a year ago, the coronavirus pandemic gripped the nation, leaving more than 400,000 people dead—a number that continues to climb. Meanwhile, we are learning more about the virus and its unusual presentation, as well as the toll it takes on the human body. 

One particular side effect of the disease is catching our eye. We are seeing more cases where COVID-19 is attacking some patients’ hearts, and it’s not necessarily patients who have a full-blown case of COVID. One of the more concerning aspects is that we are seeing myocarditis cases in patients who had mild symptoms and had already recovered. 

Myocarditis simply is considered inflammation of the heart. It is a well-known, long-standing complication of various viruses and other infectious diseases, and even can be a side effect of some medications. Severe cases of myocarditis can lead to heart failure, abnormal heartbeat and possibly death. 

Patients with myocarditis typically complain of chest pain, shortness of breath, fatigue and palpitations. It is usually diagnosed with clinical features and symptoms, electrocardiogram tracing, blood tests, heart ultrasound testing and most accurately, with a cardiac magnetic resonance imaging (MRI). 

There is limited data so far, and myocarditis in COVID patients is rare enough that the data that does exist is based on a small number of cases. However, a cardiac MRI study from Germany found 30–60% of 100 coronavirus recovery patients had heart muscle inflammation—a much higher number than expected. 

Another troubling factor? The age of an increasing number of myocarditis patients. While there are increases in the 65-79-year-old age group, there also is a steady increase in myocarditis in patients ages 20–29. You also may have heard concerns about myocarditis cases in athletes. While true, all young people are at risk, not just athletes. If an athlete does develop myocarditis, she or he should allow the heart to heal and lower the risk of serious cardiac arrhythmias before returning to competitive action. 

Given the pandemic and case numbers, many patients with COVID-19 will have some degree of heart muscle dysfunction, sometimes without heart symptoms and only abnormal blood tests. Other times patients have many symptoms and abnormal testing, even though the incidence of heart muscle dysfunction as a direct COVID-19 complication may be rare.

DR. VINCENT L. SORRELL is director of advanced cardiovascular imaging at UK HealthCare’s Gill Heart & Vascular Institute. 

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