Can Coronavirus Cause Heart Damage?

Can COVID-19 damage the heart? 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 and vascular system can also be damaged.

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.

How can COVID-19 damage your heart?

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. However, if the new virus can disable 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. Temporary or lasting damage to heart tissue can be due to several factors:

Lack of sufficient 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 being overworked, or insufficient oxygen can cause cell death and tissue damage in the heart and other organs.

Myocarditis: inflammation of the heart. COVID-19 may infect and damage the heart’s muscle tissue directly, as is possible with other viral infections, including various 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, and it is clear that the stressor has ended, the heart can recover.

Cytokine Storm: A Potentially Lethal Coronavirus Complication

Most serious of all is the possibility of the immune system launching an attack on the invading virus that is so severe that it destroys healthy tissues.

When responding to infection with the new coronavirus, the body releases a flood of proteins called cytokines that help cells communicate with one another and fight the invaders.

In some people this normal defensive event is exaggerated, leaving them vulnerable to a cytokine storm. In a cytokine storm, the immune system’s response causes inflammation that can overwhelm the body, destroying healthy tissue and damaging organs such as the kidneys, liver and heart.

A cytokine storm and its resulting heart damage can also affect the heart’s rhythm.

A cytokine storm is difficult to survive. Current research is exploring the possible benefit of using immune-suppressing drugs to treat patients with COVID-19 who experience this serious complication.

COVID-19 symptoms can mimic a heart attack

People with COVID-19 can have symptoms similar to those of a heart attack, including chest pain, shortness of breath and changes on their echocardiogram (ultrasound of the heart), or EKG. “In many of these COVID-19 cases when these patients are given an angiogram, there is no evidence of a major blockage in the heart’s blood vessels, which would indicate a heart attack in progress,” she says.

She notes that before the coronavirus pandemic, patients with these signs and symptoms might go directly to the catheterization lab for treatment.

But now, emergency room doctors and cardiologists have to consider these COVID-19 “mimickers” first and perform additional testing such as EKGs. Performing a heart catheterization on a patient with symptoms caused solely by COVID-19 doesn’t address the underlying problem and puts both the patient and health care practitioners at risk.

Even in the pandemic, real heart attacks can still occur, and patients with signs and symptoms of a heart attack should still seek urgent medical attention and not manage these symptoms at home. There is growing concern that people are delaying receiving prompt care for heart attacks due to fear of contracting COVID-19 at the hospital, and untreated heart attacks can lead to long-term serious complications.

Should I see a cardiologist?

Yes, people living with heart disease should stay in close touch with their cardiologist during the pandemic and take care to comply with medication to manage their heart condition. If they catch COVID-19, they should request a follow-up examination after they recover to detect any further heart damage from the virus.

Patients without known heart disease who get COVID-19 may still wish to have a cardiologist screen or test them given their specialized knowledge. Tests may be recommended if symptoms such as weakness, shortness of breath or chest pain persist after recovery, since these problems could be due to damage caused to the heart as a result of coronavirus.

About the Author

Azadeh Beheshtian

Azadeh Beheshtian is board certified in cardiovascular disease and internal medicine by the American Board of Internal Medicine. She specializes in interventional cardiology and peripheral artery disease, with a focus on women’s heart health.