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Long COVID and Your Heart

Medically Reviewed by James Beckerman, MD, FACC on September 27, 2022

If you’ve had a bout of COVID-19, common symptoms like cough, chills, and shortness of breath might clear up within 1-2 weeks. But if some or all of your symptoms like fatigue, a racing heart rate, chest pain, dizziness, diarrhea, joint pain, or trouble breathing return – or continue for 4 or more weeks after you’ve had COVID – you might have what doctors call “long COVID.”

For some people, the symptoms might carry on for months or even longer. Experts also call it by other names, like long-haul COVID, post-acute COVID-19, post-acute sequelae of SARS-CoV-2 infection (PASC), or chronic COVID, among others.

As research on COVID-19 and its aftereffects continues, experts aren’t exactly sure how long COVID might affect your long-term health. While COVID-19 mostly affects your lungs, studies are starting to show that for a small number of people, long COVID can also affect other organs in your body, including the heart.

How Does Long COVID Affect Your Heart?

When you get long COVID-19, the SARS-CoV-2 virus attacks your body and the cells and muscles in your heart in several ways.

Temporary or permanent heart problems could look like:

Heart issues from lack of oxygen. When the virus takes root in your lungs, it causes inflammation. This then causes air sacs responsible for oxygen exchange to fill with fluid. When this happens, it cuts down the amount of oxygen that can pass into the bloodstream.

To make up for this, the heart has to pump a lot harder to get enough oxygen-rich blood to the rest of your body. This can take a toll on your heart, and it could fail if it’s overworked, especially if you had heart disease before you got a COVID-19 infection.

Or if your body is unable to get enough oxygen, it might cause your cells to die or damage your heart tissue or other organs. Low levels of oxygen in your body can cause symptoms like shortness of breath, dizziness, or chest pain.

Myocarditis.It’s a condition that happens when there’s inflammation in the heart. The SARS-CoV-2 virus can attack the endothelial cells – the cells that line the inner walls of blood vessels like veins and arteries.

This can cause inflammation within the blood vessel, damage very tiny ones, or cause blood clots. This can disrupt blood flow between the heart and the rest of your body.

The virus could also directly infect and damage the heart muscles and tissue and cause inflammation. You can also develop myocarditis because of the immune response your body puts up to fight off COVID-19.

Stress cardiomyopathy.When you’re infected with COVID-19, the virus can stress out your body and flood it with chemicals called catecholamines. This surge can shock your heart and affect its ability to pump properly. But this is usually temporary. Your heart will recover once your infection clears up.

Arrhythmia and atrial fibrillation.The virus can affect your heart rate especially if you have long COVID. It can cause it to beat too fast or too slowly. Or, it can cause it to beat too fast in a specific pattern, known as atrial fibrillation.

POTS (postural orthostatic tachycardia syndrome). New findings about long COVID show that even if you have a mild case of COVID-19, you stand a higher risk of getting POTS. It’s a condition in which your heart starts beating really fast when you stand up after lying on your back. You might feel very tired or dizzy or have trouble breathing. In serious cases, the sudden change in heart rate could cause a fainting spell (called syncope).

POTS is found to be five times more common among women than men.

Heart attack symptoms.Long COVID can cause heart attack-like symptoms such as:

But when your doctor runs a test called an angiogram to check for major blockages in your heart's blood vessels, they might not see anything. Doctors are trying to understand more about this.

If you think you might be having a heart attack, don’t try to wait it out or look for home remedies. Get emergency medical help right away.

How Does Long COVID Cause Heart Problems?

For the most part, COVID-19 attacks the lungs and the respiratory system. But, it’s possible for the virus to damage other organs and tissues within your body to cause long COVID. Experts are still trying to understand exactly how.

When the virus enters your body, your immune system launches an attack on what it believes to be an invader. To mount a defense, it floods your body with a type of protein called cytokine. These cytokines have the ability to communicate with one another and work together to kill the virus.

But in some people, when the immune system releases cytokines, it releases too much. This causes a dangerous surge in inflammation that is likely to overwhelm your body. This is called a “cytokine storm.” This is a serious complication.

Excessive inflammation not only attacks the virus but can also hurt good cells and tissue and damage your organs, including your heart.

A cytokine storm can mess up your heart’s regular rhythm. This can lead to arrhythmias, which could be dangerous for your health. If the arrhythmias in your heart’s ventricles are serious enough, a cytokine storm may be difficult to survive.

Another possible cause that researchers are looking into might have to do with the structure of the virus. The SARS-CoV-2 virus has spike proteins on its surface. The proteins grab onto healthy cells in your body through what are known as “ACE2 receptors.” This allows the virus to get into cells in your body, including heart cells. When it enters a cell, it can destroy it or damage it.

In some cases, the virus can cause cells in the arteries and veins within the heart to die and form blood clots. This could lead to a variety of heart diseases.

Who’s at Risk?

Studies show that as many as three in 10 people with COVID-19 will go on to develop long COVID.

Research shows that you’re more likely to get long COVID if you’ve had a serious case of the virus, especially if you need to be hospitalized or go to the intensive care unit (ICU). You’re also more likely to get it if you’re not vaccinated.

But recent evidence shows that almost anybody who has had COVID-19 can get long COVID and have a higher risk for heart problems up to a year after you test positive. This includes people who:

  • Had a mild or moderate infection
  • Had no symptoms
  • Had other health conditions before COVID-19

Also, researchers have found that you’re also at risk if you were fit, healthy, did not smoke or drink alcoholic beverages, or have any prior medical issues like diabetes, kidney disease, or obesity before you caught the viral infection.

Just as with most other COVID-19 data points, research from the Brookings Institution shows that racial and ethnic minorities are more likely to get long COVID.

This includes Indigenous, African American, and Latino people. This is because they have higher rates of COVID-19 infection and exposure. They’re also most likely to have prior health problems that make them more likely to have symptoms that last a longer time.

Unequal access to proper and timely health care because of where they might live or work can also put ethnic and racial minorities at a higher risk for long COVID-related heart problems.

Long COVID and Your Heart: Symptoms to Watch Out For

If you have long COVID, you may have a wide range of symptoms, have certain ones return, or continue to have some from the time you tested positive.

Long COVID doesn’t affect everyone the same way. It might be hard to know if your symptoms are related to COVID-19 or something else, especially if you didn’t have the problems before you caught the virus.

If you suspect you have long COVID that’s affecting your heart, watch out for symptoms like:

  • Sudden shortness of breath
  • Low oxygen levels
  • Ankle swelling
  • Fatigue
  • Chest pain (mild to serious) after exercise or strenuous movement. This should usually go away in 15 minutes.
  • Nausea
  • Lightheadedness
  • Sweating
  • Racing or irregular heartbeat (palpitations)

If your symptoms like sudden chest pain or palpitations don’t go away in 15 minutes, if your face or lips turn bluish, or if your oxygen levels fall under 92%, get medical help right away. Call 911 or go to the nearest hospital. A heart specialist (called a cardiologist) will need to evaluate you.

If your symptoms are not serious but you’re concerned about how long COVID might be affecting your heart, talk to your primary care doctor.

What Does the Research Say?

To study the link between long COVID and heart problems, researchers took a look at the COVID-19 data from the U.S. Department of Veterans Affairs. This is the largest study done to learn more about the link between long COVID and the heart.

They put together a list of more than 153,000 veterans who tested positive for COVID-19 to see what the long-term effects of the viral infection were at the 1-year mark. They were compared to almost 6 million veterans in a control group who did not get infected.

In this study, after regular follow-ups, they found that people who did get an infection were at a higher risk for several heart problems like abnormal heart rhythms, heart disease from not enough blood flow, myocarditis, heart failure, and blood clot-related heart problems.

To be specific, those who had COVID-19 were more than 70% more likely to have heart failure, over 60% more likely to get a heart attack, and more than 50% more likely to get a stroke than those who never got COVID-19.

Can You Prevent Long COVID-Related Heart Problems?

As experts learn more about the link between COVID-19, long COVID, and the heart problems it might cause, the best way to prevent these issues or protect yourself is to avoid the virus in the first place.

Get fully vaccinated as soon as you’re eligible for the shots and the boosters. This can help prevent a severe infection, which lowers your risk for long COVID.

Research also shows that among those who have breakthrough infections – when you get infected even though you’re fully vaccinated – you’re less likely to get long COVID, compared to those who are not vaccinated.

Show Sources

SOURCES:

Johns Hopkins Medicine: “COVID and the Heart: It Spares No One,” “Coronavirus Diagnosis: What Should I Expect?” “Heart Problems after COVID-19.”

CDC: “Long COVID or Post-COVID Conditions.”

Nature: “Long-term Outcomes of COVID-19.”

JAMA Network: “The COVID Heart – One Year After SARS-CoV-2 Infection, Patients Have an Array of Increased Cardiovascular Risks.”

BMJ: “Covid-19: Even mild infections can cause long term heart problems, large study finds.”

Cleveland Clinic: “Mild COVID-19 Linked to Postural Orthostatic Tachycardia Syndrome.”

Brookings: “Living With COVID-19 Will Not Be Easy for Many Americans Suffering From Long COVID-19, Particularly Those From Diverse Communities.”

American Medical Association: “3 tips for doctors trying to manage long COVID’s cardiac symptoms.”

American Heart Association: “Coronavirus spike protein activated natural immune response, damaged heart muscle cells.”

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