Two studies published Monday provide the strongest evidence thus far that some patients who survive the respiratory ravages of COVID-19 may experience long-term heart problems, the latest indication that the consequences of the pandemic go far beyond body count.
Experts who spoke to The Daily Beast said the twin reports released by Journal of the American Medical Association It should serve as a “wake up call” for patients and doctors who think that the new coronavirus is limited to the lungs.
“These two studies together tell us that beyond COVID-19 pneumonia and all this severe lung damage and injury that can occur, there is an ongoing injury in a proportion of patients that can cause lasting heart damage,” said Gregg Fonarow , a professor of cardiovascular medicine and science at the University of California, Los Angeles, who wrote an opinion piece on the research for Jamaica.
In one of the new studies, scientists at Frankfurt University Hospital discovered through cardiac imaging that patients recovering from COVID-19 continued to have problems with their cardiovascular system weeks and even months after their diagnosis. Out of every 100 German patients, the study found that more than three-quarters, with an average age of 49, showed signs of heart abnormalities. And almost two-thirds had continuous inflammation of the heart muscle. Also, neither your history of hospitalization nor any underlying heart conditions appear to be a factor.
“For me that is troubling because it means you can recover from COVID and have potentially latent heart sensitivity,” Eduardo Marban, executive director of the Smidt Heart Institute in Cedars-Sinai, told The Daily Beast.
“There is potentially more than meets the eye with patients who we think are doing quite well,” said Marban, who was not involved in the research published by JAMA.
The second study, conducted by a team of German doctors, focused on the cause of the inflammation. Observing the autopsies of 39 patients, whose average age was 85 years. The official cause of death for the majority of patients, 35, was pneumonia caused by COVID-19. The document found that in nearly two-thirds of cases, the virus had traveled directly into the tissue surrounding the cells of the heart muscle. In some cases, the virus was found to be actively replicating there.
“These patients clearly have lung involvement, extensive lung involvement, clinically they have died of pneumonia,” Fonarow said. “But there is evidence in these patients of significant heart injury. And that injury, in many of these cases, was not a heart attack … but seemed to be real evidence of infection, active viral infection.
“That damage may have consequences that contribute to the severity of an individual’s illness.”
Jeff, a 63-year-old New Jersey native who did not want his last name used, experienced the effects of the virus on his own heart. He said he had a suspected COVID infection in early March, and then developed a swelling in his legs that his doctor was concerned might be a sign of heart failure.
Although he had a clean medical history, Jeff was admitted to a hospital and diagnosed with pneumonia and an irregular heartbeat known as atrial fibrillation. Months later, he can barely walk half a mile without reaching the point of exhaustion. He faces two more cardiac procedures before he has a chance to overcome the effects of the virus.
“People look at the death rate, and I say, ‘Well, I didn’t die, but my whole life is different,'” he said.
Red Sox pitcher Eduardo Rodríguez was infected with the coronavirus earlier this summer, but was cleared to return to the team after testing negative. However, he was quickly brushed aside and revealed that he suffers from myocarditis or inflammation of the heart as a result of the virus.
Doctors knew that a characteristic of COVID-19 was heart injury and that it was expressed in many deaths. They also knew that existing cardiac patients had an increased risk of serious complications or death. But as Fornarow wrote in his opinion piece, the new studies add a new layer of understanding about the effects on the heart and how long they can last, even in those who have never had heart problems before.
“We see the plot thicken and we are inclined to raise a new and very apparent concern that COVID-19-related cardiomyopathy and heart failure may potentially evolve as the natural history of this infection becomes clear,” he wrote.
Sanjum Sethi, an interventional vascular doctor at Columbia University Medical Center, says the autopsy study could offer a window into a case that has been bothering him for months. Sethi was called to help with a COVID-19 patient who had symptoms of a heart attack and died shortly thereafter. But an autopsy did not show the blood clot typically associated with cardiac arrest.
“We have been conducting special tests for the past month to assess whether there is a direct invasion of the virus responsible,” he said. “What we didn’t know is: Is this a general inflammation that is occurring due to the host, or is the virus really getting there?”
For Marban, similar unanswered questions continue to persist. About a quarter of all patients admitted to New York hospitals have shown biomarker elevation, which means heart damage, but few have exhibited extreme heart events such as heart attacks or arrhythmias. He called it a medical disconnect.
“The elevations of cardiac biomarkers are high, but very few patients get heart disease, so for me this was all smoke and not fire,” he said. “But now, two or three months later, patients may be exhibiting significant abnormalities … It means there is something going on in the long term that we don’t clinically suspect.”
Experts caution that the results of the two studies are just the beginning, and more research is needed to replicate the findings and better understand the links between COVID-19 and the heart. But each new study could affect patient outcomes by offering evidence that anti-inflammatory drugs and anticoagulants are beneficial for coronavirus patients.
“The main findings will have the impact of encouraging further research,” said Fonarow. “I think these studies will be important in informing physicians to potentially look further. While they may have previously thought, you know, we just look for any residual lung damage and stop there.”
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