Some people experience disturbing cardiac sequelae after contracting COVID-19

St.Louis, Missouri, USA—

Firefighter and paramedic Mike Camilleri used to have heavy-duty ladders to move equipment effortlessly. Now, suffering from long-term COVID-19, he carefully climbed onto the treadmill and took a simple walk to understand his heart condition.

“This is not some kind of test for super strong people, so don’t pretend,” warns Beth Hughes, a physical therapist at Washington University in St. Louis.

Somehow, a moderate case of COVID-19 set off a chain reaction that culminated in a dangerous spike in Camilleri’s blood pressure, a rapid heart rate on exertion and bouts of severe chest pain.

He’s far from the only one. The devastation COVID-19 is wreaking on Americans’ heart health is only beginning to be felt, years after the pandemic began.

“Unfortunately, we’re seeing effects on the heart and vascular system that really outweigh the effects on other organ systems,” said Dr. Susan Cheng, a cardiologist at Cedars-Sinai Medical Center in Los Angeles.

This isn’t just a problem for long-term COVID-19 patients like Camilleri. People may be at increased risk of developing new heart-related problems, including blood clots, cardiac arrhythmias and heart attacks, in the year after contracting COVID-19, even if they initially appear to be recovering well..

One of the unknowns is: who is most likely to suffer from these sequelae? Are they reversible, or a warning sign of bigger heart problems later in life?

Dr. Ziyad Al Aly of the University of Washington, who helped sound the alarm about ongoing health problems related to COVID-19, said that because of heart problems associated with the virus, “we are coming out of this pandemic as a much sicker country.” “. The fallout “could affect generations,” he added.

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Heart disease has long been the leading cause of death nationally and worldwide. But in the United States, in 2019, just before the pandemic hit, heart-related deaths had fallen to record levels.

Cheng noted that COVID-19 has erased a decade of these gains.

Heart disease deaths have increased during each coronavirus surge. Worse, young people aren’t supposed to get heart disease, but Cheng’s research documented a nearly 30 percent increase in heart disease deaths among people aged 25 to 44 during the first two years of the pandemic.

Here’s a troubling hint that these problems may be here to stay: High blood pressure is one of the biggest risks for heart disease, “and in fact, during the pandemic, people’s blood pressure went up dramatically,” he added.

The cardiovascular symptoms are part of the so-called long-term coronavirus, a generic term that covers dozens of health problems, including fatigue and brain fog. The National Institutes of Health is starting small studies of some possible treatments for some symptoms of long-term COVID-19, including heart rhythm problems.

But Cheng said both patients and doctors need to know that cardiovascular problems are sometimes the first or main symptom of coronavirus damage.

“These people aren’t necessarily going to the doctor and saying, ‘I’ve had coronavirus for a long time,'” he said.

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In St. Louis, after Camilleri contracted COVID-19 in late 2020, he first developed shortness of breath, followed by a series of heart-related and other symptoms. He tried different treatments from different doctors, but nothing improved until he underwent long-term COVID-19 treatment. Washington University Clinic.

“Finally, we turned in the right direction,” said Camilleri, 43.

There she consulted with Dr Amanda Verma as her blood pressure and heart rate problems worsened. Verma was part of the cardiology team that studied a small group of patients with puzzling heart symptoms like Camilleri’s and found that abnormal blood flow could be part of the problem.

How did this happen? Blood flow increases when people move and decreases when they are resting. But some patients with long-term COVID-19 infections don’t slow down enough while resting because the “fight-or-flight” response system that controls the stress response remains activated, Verma said.

Some people also have problems with the lining of small blood vessels that don’t expand and contract properly to pump blood, he added.

Hoping this helps explain some of Camilleri’s symptoms, Verma prescribed vasodilator heart medications and other medications to calm the “fight or flight” response.

Back in the gym, Hughes, a physical therapist who has long treated COVID-19 patients, laid out a careful recovery plan after a treadmill test revealed erratic spikes in Camilleri’s heart rate.

“If you don’t take Dr. Verma’s medicine, it’s much worse,” Hughes said, showing Camilleri the exercises he performed while lying on the floor and monitoring his pulse. “We need to reconfigure your system” to normalize the “fight or flight” response, he added.

Camilleri said he noticed some improvements after Verma made some changes to the recipe based on the test results. But then a second wave of COVID-19 in the spring caused more health problems, and the disability forced him to retire.

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What is the risk of heart problems after contracting the new coronavirus? To find out, Al Ali pored over medical records in the Veterans Health Administration’s vast database. Compared with people who were not infected, COVID-19 patients who survived the early stages of the pandemic were more likely to experience heart arrhythmias, blood clots, chest pain and palpitations, and even heart attacks and strokes a year later. . This even includes middle-aged adults with no previous signs of heart disease.

Based on these findings, Al Aly estimates that 4 in 100 people will need treatment for some type of heart-related symptom within a year of recovering from COVID-19.

To everyone, it’s a very small risk. But the severity of the pandemic means millions of people are experiencing at least some cardiovascular symptoms, he said. Although reinfection could still cause problems, Al Ali is currently studying whether vaccination and milder coronavirus strains reduce the overall risk.

Recent research confirms the need for better understanding and care of these cardiac sequelae. An analysis this spring of a large database of U.S. insurers found that patients with long-term COVID-19 infections were similarly as likely to seek medical care for cardiovascular problems (including blood clots, arrhythmia or stroke) within a year of infection as untreated patients. Twice as many patients were not infected with COVID-19.

The link with post-infection heart damage isn’t surprising, Verma noted. He mentioned rheumatic fever, an inflammatory response to untreated strep throat — especially before antibiotics were common — that can scar heart valves.

“Will this be the next rheumatic heart disease? We don’t know,” he said.

But Al Aly says there’s a simple takeaway: You can’t change your history of COVID-19 infection, but if you ignore other heart risks — like high cholesterol or high blood pressure, poorly managed diabetes or smoking — now is the time Change that now.

“Those are things we can do something about. I think they’re more important now than they were in 2019,” he said.

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The Associated Press Health and Science Division is supported by the Howard Hughes Medical Institute’s Science and Educational Media Group. The Associated Press is solely responsible for all content.