Over the course of the COVID-19 pandemic, doctors and researchers have been carefully studying the novel coronavirus to learn as much as they can about the illness, including how it transmits and how it attacks the body. Six months into this global health crisis, we have learned much more about the COVID-19 infection. What was once thought to primarily affect the lungs and respiratory system is now understood to directly affect other major organs of the body. One of these organs is the heart, and researchers are now concerned that coronavirus heart damage may impact recovered patients for years to come, or perhaps for the rest of their lives.
Two Studies, One Conclusion
Two new studies from Germany examining the effects of COVID-19 on the heart have indicated that the infectious disease can leave lasting heart damage, even in patients who were considered healthy prior to becoming sick.
“The patients and ourselves were both surprised by the intensity and prevalence of these findings, and that they were still very pronounced even though the original illness had been by then already a few weeks away,” said study co-author Dr. Valentina Puntmann .
Puntmann explained that the team found evidence of ongoing inflammation in the heart muscle as well as the heart’s lining, which are consistent with myocarditis and pericarditis, two potentially dangerous heart conditions.
Myocarditis is inflammation of the heart muscle, which can reduce the heart’s ability to pump and potentially cause irregular heartbeats. Severe myocarditis weakens your heart so that the rest of your body doesn’t get enough blood. This can cause blood clots in your heart, which can lead to a stroke or heart attack [2,3].
Pericarditis occurs when the protective tissues (the pericardium) surrounding the heart become inflamed, which can cause pain. This pain can be quite sharp as the irritated layers of the pericardium rub against each other. It typically begins suddenly and doesn’t last long, but can become chronic [2,4].
The study participants ranged in age between 45 and 53 years old, had all recovered from COVID-19, and underwent the MRI evaluation two to three months after being diagnosed with the virus.
Two-thirds of the participants had recovered at home, and eighteen percent were asymptomatic. About half of them, however, had mild to moderate COVID-19 symptoms. Sixty percent of participants showed evidence of ongoing heart inflammation that was not associated with any preexisting condition .
The second study analyzed autopsy results from 39 COVID-19 victims, whose average age was 85 years old and who died in the early stages of the pandemic. Of those 39 patients, 24 of them were found to have high levels of the virus in their hearts .
Coronavirus Heart Damage: A Warning Sign
These two studies taken together suggest that coronavirus heart damage could be a new risk factor for heart failure, which is a chronic condition that progressively reduces the heart’s ability to pump blood throughout the body. Cardiologists are not sure yet whether or not this damage will be permanent, but they are very concerned.
“These are two studies that both suggest that being infected with Covid-19 carries a high likelihood of having some involvement of the heart. If not answering questions, [they] prompt important questions about what the cardiac aftermath is,” said Matthew Tomey, a cardiologist and assistant professor of medicine at the Icahn School of Medicine at Mount Sinai Health System in New York .
It is still too early to say whether or not these changes will be long-lasting, or if these temporary effects will improve over time.
“We don’t know the long-term consequences of the changes in gene expression yet. I know from other diseases that it’s obviously not good to have that increased level of inflammation,” said Dirk Westermann, a cardiologist at the University Heart and Vascular Centre in Hamburg .
Tomey says that he has been seeing many recovering patients in his office who were sick at the beginning of the pandemic complaining about heart problems like palpitations and weakness.
“Patients come to my office saying, ‘Hey, I’m a 31-year-old who used to run and be completely unlimited in my exercise, and now I get palpitations walking across the street. Or I get out of breath climbing up to my second-floor apartment,’” he said. “Individuals are exquisitely tuned in to their own capacity for exercise, so I take that very seriously. Our challenge is to understand the why.” 
Many cardiologists are now concerned that the COVID-19 crisis will not end when the number of cases fall, but will instead shift to a new incidence of heart failure and chronic cardiovascular conditions, particularly among younger populations.
As the natural history of the COVID-19 pandemic unfolds, we are likely going to be seeing a significant number of relatively young people losing their cardiac health reserves, which under normal circumstances decrease with age. This, in turn, could set the stage for heart failure.
“We knew that this virus, SARS-CoV-2, doesn’t spare the heart,” said Marc Pfeffer, a cardiologist at Brigham and Women’s Hospital in Boston. “We’re going to get a lot of people through the acute phase [but] I think there’s going to be a long-term price to pay.” 
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