COVID-19 Can Wreck Your Heart, Even if You Haven’t Had Any

https://www.scientificamerican.com/article/covid-19-can-wreck-your-heart-even-if-you-havent-had-any-symptoms/?utm_source=newsletter&utm_medium=email&utm_campaign=week-in-science&utm_content=link&utm_term=2020-09-04_featured-this-week&spMailingID=68774971&spUserID=NDU0NDQ2Nzg4OTk5S0&spJobID=1960451501&spReportId=MTk2MDQ1MTUwMQS2



any-symptoms/
Beyond its scientific backing, the notion that a COVID-19 patient might wind up with
long-term lung scarring or breathing issues has the ring of truth. After all, we hear the
stories, right? The virus can leave survivors explaining how they struggled to breathe,
or how it can feel, in the words of actress Alyssa Milano, “like an elephant is sitting on
my chest.”
We’ve also known for a while that some COVID-19 patients’ hearts are taking a
beating, too—but over the past few weeks, the evidence has strengthened that
cardiac damage can happen even among people who have never displayed
symptoms of coronavirus infection. And these frightening findings help explain why
college and professional sports leagues are proceeding with special caution as they
make decisions about whether or not to play.
From an offensive lineman at Indiana University dealing with possible heart issues to
a University of Houston player opting out of the season because of “complications
with my heart,” the news has been coming fast and furiously. More than a dozen
athletes at Power Five conference schools have been identified as having myocardial
injury following coronavirus infection, according to ESPN; two of the
conferences—the Big Ten and the Pac-12—already have announced they are
postponing all competitive sports until 2021. And in Major League Baseball, Boston
Red Sox ace pitcher Eduardo Rodriguez told reporters that he felt “100 years old” as
a result of his bout with COVID, and  of MLB’s shortened season because of
myocarditis—an inflammation of the heart muscle, often triggered by a virus. Said
Rodriguez: “That’s [the heart is] the most important part of your body, so when you
hear that … I was kind of scared a little. Now that I know what it is, it’s still scary.”
Why are these athletes (and their leagues and conferences) taking such extreme
precautions? It’s because of the stakes. Though it often resolves without incident,
myocarditis can lead to severe complications such as abnormal heart rhythms,
chronic heart failure and even sudden death. Just a few weeks ago, a former Florida
State basketball player, Michael Ojo, died of suspected heart complications just after
recovering from a bout of COVID-19 in Serbia, where he was playing pro ball.
Here’s the background: Myocarditis appears to result from the direct infection of the
virus attacking the heart, or possibly as a consequence of the inflammation triggered
by the body’s overly aggressive immune response. And it is not age-specific: In The
Lancet, doctors recently reported on an 11-year-old child with multisystem
inflammatory syndrome (MIS-C)—a rare illness—who died of myocarditis and heart


failure. At autopsy, pathologists were able to identify coronavirus particles present in
the child’s cardiac tissue, helping to explain the virus’ direct involvement in her death.
In fact, researchers are reporting the presence of viral protein in the actual heart
muscle, of six deceased patients. Of note is the fact that these patients were
documented to have died of lung failure, having had neither clinical signs of heart
involvement, nor a prior history of cardiac disease.
Ossama Samuel, associate chief of cardiology at Mount Sinai Beth Israel in New
York, told me about a cluster of younger adults developing myocarditis, some of them
a month or so after they had recovered from COVID-19. One patient, who developed
myocarditis four weeks after believing he had recovered from the virus, responded to
a course of steroid treatment only to develop a recurrence in the form of pericarditis
(an inflammation of the sac surrounding the heart). A second patient, in her 40s, now
has reduced heart function from myocarditis, and a third—an athletic man in his
40s—is experiencing recurring and dangerous ventricular heart rhythms,
necessitating that he wear a LifeVest defibrillator for protection. His MRI also
demonstrates fibrosis and scarring of his heart muscle, which may be permanent,
and he may ultimately require placement of a permanent defibrillator.
This is an incredibly tricky diagnosis. Patients with myocarditis often experience
symptoms like shortness of breath, chest pain, fever and fatigue—while some have
no symptoms at all. J.N., a health care provider who asked that his full name not be
used, told me that COVID-19 symptoms first appeared in his case in late March. He
ultimately was hospitalized at Mount Sinai Medical Center after developing
unrelenting fevers spiking to 104 degrees, chest tightness, nausea, vomiting and
diarrhea.
“Even the Advil and acetaminophen wouldn’t help my fevers,” said J.N. Just 34 years
old, he was diagnosed with COVID-induced myocarditis and severe heart failure.
Doctors admitted him to the intensive care unit and placed him on a lifesaving intra-
aortic balloon pump due to the very poor function of his heart. He spent two weeks in
the hospital, has suffered recurrences since his discharge, and now says, “I’m very
careful. I’m very concerned about the length of time I’ve been feeling sick, and if
these symptoms are lifelong or will go away anytime soon.” J.N. said that everyday
activities, like carrying his one-year-old daughter up a flight of stairs, leave him
feeling winded and fatigued. He has been unable to work since March.
According to some reports, as many as 7 percent of deaths from COVID-19 may
result from myocarditis. (Others feel that estimate is too high.) The arrhythmia that
sometimes accompanies it is also worrisome, and researchers have found that to be
fairly common among COVID-19 patients. In J.N.’s case, he noticed his heart racing
on several occasions into the 130 beats per minute range. And while the prevalence
of this in virus patients is not known exactly, a study published recently in the Journal
of the American College of Cardiology found that some type of ventricular
arrhythmias occurred in 78 percent of patients without COVID. Up to 30 percent of
the full study group, meanwhile, experienced serious arrhythmias 27 months later. 
Experts estimate that half of myocarditis cases resolve without a chronic
complication, but several studies suggest that COVID-19 patients show signs of the
condition months after contracting the virus. One non–peer reviewed study, involving
139 health care workers who developed coronavirus infection and recovered, found
that about 10 weeks after their initial symptoms, 37 percent of them were diagnosed


with myocarditis or myopericarditis—and fewer than half of those had showed
symptoms at the time of their scans.
Any such cardiac sequelae lingering weeks to months after the fact is clearly
concerning, and we’re seeing more evidence of it. A German study found that 78
percent of recovered COVID-19 patients, the majority of whom had only mild to
moderate symptoms, demonstrated cardiac involvement more than two months after
their initial diagnoses. Six in 10 were found to have persistent myocardial
inflammation. While emphasizing that individual patients need not be nervous, lead
investigator Elike Nagel added in an e-mail, “My personal take is that COVID will
increase the incidence of heart failure over the next decades.”
Taking on myocarditis is a chore. Thankfully, some acute cases resolve on their own,
requiring only hospital monitoring and possibly some heart medications. We’ve
learned that steroids and immunoglobulins—useful elsewhere—aren’t effective in
acute viral myocarditis, although Samuel said there may be a role for steroids in
younger COVID-19 patients who seem to present with more of an autoimmune type
of the condition. And, of course, an effective vaccine could help prevent cases in the
first place.
Samuel called it “extremely dangerous” for athletes diagnosed with myocarditis to
play competitive sports for at least three to six months, because of the risk of serious
arrhythmia or sudden death, and several athletes already have made the decision to
heed those dire warnings. We’ll likely see more such decisions in the very near
future, as each sport enters its peak season.
And for the rest of us? Wear a mask, social distance, avoid large gatherings, and
spend more time in the great outdoors. I would echo the advice of J.N.: “Be careful.
Just don’t get the virus in the beginning.” As of today, it’s still the best defense we’ve
got.