Mike Camilleri, a firefighter and paramedic, once had no difficulty carrying large equipment up ladders. Now suffering from long-term COVID, he cautiously steps onto a treadmill to determine how his heart reacts to a basic walk. Physical therapist Beth Hughes of Washington University in St. Louis cautioned, “This is not a test for tough guys, so don’t fake it.”
A moderate case of COVID-19 somehow triggered a chain reaction that left Camilleri with dangerously high blood pressure, a heartbeat that accelerated with mild exertion, and episodes of severe chest discomfort. Doctors were at a loss until Camilleri located a cardiologist at Washington University who had treated patients with identical post-COVID cardiac problems. “Finally a turn in the right direction,” said Camilleri, 43 years old.
He was beginning to recover, but a recent reinfection brought him back down to earth. The extent of COVID-19’s impact on the nation’s cardiac health is just beginning to manifest well into the fourth year of the pandemic. Dr. Susan Cheng, a cardiologist at Cedars-Sinai Medical Center in Los Angeles, stated, “We are observing effects on the heart and vascular system that significantly outnumber effects on other organ systems.”
Even if they initially appear to recover normally, for up to a year following a COVID-19 infection, individuals may be at increased risk of developing a new heart-related condition, such as blood clotting, irregular heartbeats, or a heart attack.
Who is most likely to experience these after effects? is one of the unknowns. Are they reversible, or are they an indicator of future cardiac disease?
“We’re about to emerge from this pandemic as an even sicker nation,” said Dr. Ziyad Al-Aly of Washington University, who helped raise the alarm about lingering health concerns. He added that the consequences “will likely reverberate for generations.”
Heart disease has long been the leading cause of death in both the United States and the rest of the world. But in the United States, heart-related mortality rates reached record lows in 2019, just prior to the outbreak of the pandemic.
Cheng stated that COVID-19 erased a decade of this progress.
Every time a virus outbreak occurred, heart attack-related fatalities increased. Cheng’s research revealed a nearly 30% increase in heart attack fatalities among 25- to 44-year-olds during the first two years of the pandemic, despite the fact that heart attacks in young individuals are not expected. A portent that the trouble may persist: High blood pressure is one of the greatest risk factors for heart disease, and “people’s blood pressure has actually increased significantly during the pandemic,” she said.
Some of these patients have long COVID, an umbrella term for scores of symptoms that frequently include fatigue and cognitive fog. The National Institutes of Health is initiating limited studies of a few potential treatments for certain long-lasting COVID symptoms, such as an irregular pulse. However, according to Dr. Cheng, both patients and physicians must be aware that cardiovascular issues are sometimes the first or primary sign of harm caused by the coronavirus.
“These are people who wouldn’t necessarily tell their physician, ‘I have long COVID,'” she explained.
After contracting COVID-19 in late 2020, Camilleri initially manifested shortness of breath, followed by a variety of heart-related and other symptoms. Until he ended up at Washington University’s COVID clinic, he had unsuccessfully attempted various treatments from multiple physicians. There, he saw Dr. Amanda Verma for his worsening blood pressure and cardiac condition. Verma is a member of a cardiology team that examined a small group of patients with cardiac symptoms similar to Camilleri’s and discovered that abnormalities in blood flow may be a contributing factor.
How? Blood flow increases during movement and decreases during relaxation. Verma explained that the fight-or-flight system, which regulates stress responses, remains activated in some long-term COVID patients, preventing them from experiencing a sufficient decrease in cortisol during repose. She added that some individuals have problems with the lining of their small blood vessels not dilatation and constriction appropriately to circulate blood.
In the hope that this helped to explain some of Camilleri’s symptoms, Dr. Verma prescribed cardiac medications that dilate blood vessels as well as medications to suppress the fight-or-flight response.After the treadmill test revealed erratic heart rate fluctuations in Camilleri, Hughes, a physical therapist who works with long-term COVID patients, devised a thorough rehabilitation plan.
“We’d see worse if you weren’t on Dr. Verma’s medications,” Hughes said as he demonstrated exercises for Camilleri to perform while lying down and monitored his pulse rate. “We need to rewire your system” in order to normalize the fight-or-flight response. Camilleri stated that as Verma combined and matched prescriptions based on his reactions, he began to feel better. Then, after a second recurrence of COVID-19 in the spring, he developed additional health issues, which forced him to retire.
What is the post-COVID cardiac risk?
To determine this, Al-Aly analyzed massive database of Veterans Administration medical records. People who had survived COVID-19 early in the pandemic were more likely than the uninfected to experience aberrant heartbeats, blood clotting, chest pain and palpitations, and even heart attacks and strokes a year later. This includes even middle-aged individuals with no history of cardiac disease.
Based on these findings, Al-Aly estimated that, one year after recuperating from COVID-19, 4 out of every 100 persons will require treatment for heart-related symptoms.
That is a low risk per individual. However, he stated that the pandemic’s overwhelming magnitude meant that millions were left with at least one cardiovascular symptom. Al-Aly is currently examining whether the overall risk has decreased as a result of vaccination and the development of benign coronavirus strains, despite the fact that reinfections may still be problematic.
Recent research affirms the necessity of better comprehending and treating cardiac repercussions. This spring, an analysis of a large U.S. insurance database revealed that long-term COVID patients were approximately twice as likely to seek treatment for cardiovascular problems, such as blood clots, aberrant heartbeats, or stroke, in the year following infection, compared to comparable patients who had avoided COVID-19.
Verma noted that a post-infection link to cardiac injury is not all that surprising. She cited rheumatic fever, an inflammatory response to untreated strep throat – notably prior to the widespread use of antibiotics – that damages the heart valves.
“Will this become the next case of rheumatic heart disease? “We have no idea,” she said.
Al-Aly asserts, however, that there is a straightforward take-home message: You cannot alter your history of COVID-19 infections, but if you have neglected other cardiac risks – such as elevated cholesterol or blood pressure, poorly controlled diabetes, or smoking – now is the time to change that. “These are the ones we can intervene in. And I believe that they are more significant now than they were in 2019,” he said.