By Dr Marwan Jumean,

Interventional Cardiology & Cardiovascular Disease Specialist

Although the symptoms of COVID-19 are mostly mild and involve the upper respiratory tract and the lungs, we now know that the virus, and the widespread inflammation that occurs, can ravage the body. It can also have many direct and indirect effects on the heart and vascular systems.

Those harmful effects are more common for people with pre-existing heart and lung conditions but can impact healthy individuals as well.

Inflammation of the heart muscle

COVID-19 patients may develop inflammation of the heart muscle either due to the virus directly attacking the heart muscle or as a result of the body’s overactive immune system that damages the heart muscle when it’s activated to kill the virus. This condition may hinder the heart’s ability to pump blood and, in severe cases, cause circulatory collapse. Circulatory collapse can also happen when the right side of the heart struggles to pump blood to the lungs that are severely injured by COVID-19.

When the heart muscle is inflamed, its ability to send electrical signals becomes damaged, and this can lead to all kinds of irregular beatings of the heart (arrhythmias), some of which may be life-threatening.

A cytokine storm

Some patients who come into the emergency room with COVID-19 pneumonia can develop what’s called a cytokine storm; an immune response where the body produces proteins called cytokines to fight off the virus, but ends up attacking its own cells and healthy tissues as well. The heart is very vulnerable to a cytokine storm, which causes blood pressure to plummet, the heartbeat to become irregular, the pumping function of the heart to decrease and the heart to eventually fail.

Mimicking a heart attack

Some people may experience heart damage that mimics a heart attack injury even if their arteries lack the blockages known to cause classic heart attacks. This can happen when oxygen levels in the blood are dangerously low because of the severe lung injury and the heart muscle becomes starved of oxygen.

Blood clots

The virus also affects the sticky cells in the blood, the platelets, and causes inflammation of the inner lining of blood vessels. Clots then form all over the body, mostly in the lung vessels, but can also develop in the veins and arteries of other organs, including the heart.

Our understanding of COVID-19 during this pandemic has evolved tremendously based on studies from across the globe; however, it is still far from perfect.   

Protecting the heart and body

These are stressful times with increasing psychological and social anxiety. Fear of what could happen to loved ones can be overwhelming, especially when social distancing makes one feel helpless, isolated and lonely. Perseverance is key to staying healthy in this pandemic. Until we have an effective vaccine or a definitive cure, the best way to prevent an infection is to continue to take the simple steps to avoid being infected by:

Maintaining social distancing

Avoiding touching the  face

Handwashing with soap and water (or using a hand sanitiser that has at least 60% alcohol)

Wearing a face mask

Covering coughs and sneezes

Disinfecting frequently touched surfaces

What are the signs?

If infected with COVID-19, check with your doctor regularly. While there is no specific sign or symptom that would suggest that the heart is affected, contacting a doctor is recommended when experiencing:

Extreme fatigue

Trouble breathing

Chest pain

Dizziness or passing out

Unexplained weight gain or swelling of the legs