A Keck Medicine of USC cardiologist shares why you have a higher risk of cardiovascular disease after COVID-19 and how you can improve your heart health.
Three years after COVID-19 first appeared, over 750 million people in the world have been infected with the coronavirus disease. Recent research has shown that some of these people are more likely to experience cardiovascular issues, such as an irregular heartbeat, stroke and heart failure. Importantly, this higher risk of heart disease was shown even in people who only had a mild case of COVID-19 and were not hospitalized. The risk exists regardless of demographic characteristics, like age, race or sex, or existence of prior conditions, like obesity or hypertension.
“We have seen a myriad of different issues with COVID-19,” says Antreas Hindoyan, MD, a cardiologist at Keck Medicine of USC. “When people come in with heart issues after having COVID-19 now we have to differentiate, is this something that was previously there or do they now have heightened cardiac issues?”
While research on how COVID-19 exactly works is ongoing, doctors do have some idea of what’s going on.
“The reason why you see heightened levels of cardiovascular problems is because you become pro-thrombotic — your blood clots a little thicker with a COVID-19 infection and the inflammatory response that follows,” Dr. Hindoyan says. “These clots can go up to the brain and cause an ischemic stroke or cause a heart attack by compromising the blood flow in the heart arteries.”
Anyone who was infected with COVID-19 is at a higher risk of heart problems. But there are things you can do to improve your heart health after COVID-19 and decrease your risk of cardiovascular disease.
Tests to check for irregular heart health after COVID-19
One of the most important things to do after you have had COVID-19 is to get a follow-up exam with your primary care physician to make sure you are recovering properly. If you suspect you are having issues with your heart after a COVID-19 infection, here are some tests Dr. Hindoyan recommends.
- Routine lab work and blood pressure: “Checking someone’s cholesterol, blood sugar, thyroid function and kidney function are all important routine things to check in any patient, not just people who have had COVID-19,” Dr. Hindoyan says. “You need a comprehensive laboratory panel to have a good idea about someone’s heart health.”
- Electrocardiograms (EKG or ECG): This is a good way to test for an irregular heartbeat, or arrhythmia, by reading the electrical signals in your heart.
- Echocardiogram: This test can detect problems with the chambers in your heart by using sound waves to produce images of the heart and its chambers. “I would start with this, and if the patient has other cardiomyopathy seen, that’s when I would consider an MRI,” Dr. Hindoyan says.
- MRI: Magnetic resonance imaging (MRI) creates advanced images of the soft tissues of your heart, and can show the extent of scarring, inflammation and other damage to the tissue.
- BNP: B-type natriuretic peptide (BNP) signifies if there’s fluid overload, and if the heart isn’t able to move blood efficiently forward.
- High-sensitivity C-reactive protein (CRP) test: High-sensitivity CRP is a risk factor for coronary heart disease and inflammatory response.
- Exercise stress test: This test shows how the heart works during physical activity.
“All of these tests help assess someone’s risk factors,” Dr. Hindoyan says. But there’s still a lot that doctors don’t know. The research, tests and treatments are still in the experimental stages.
“We don’t have one definitive cause for all the symptoms that people have,” Hindoyan says. “It’s more accurate to say that a person has severe deconditioning due to COVID-19.”
How to improve your heart health after a COVID-19 infection
It’s important to take a broad-based approach when improving your heart health after a COVID-19 infection, especially if the infection period was severe and involved a lot of heavy coughing. If you feel that your heart is beating abnormally, or you’re more out of breath than usual, it might be time to see a doctor. People who exercise will also be best off easing back into their normal workout routine.
“From a medical standpoint, we want to rule out any structural abnormalities that COVID-19 might have left, whether it’s in the lungs or somewhere else in the cardiopulmonary system,” Dr. Hindoyan says. “Once that’s ruled out, we can start an exercise program to build your stamina back up to where you were pre-COVID.”
It’s important for someone who was active before COVID-19 to ease back into their routine, Dr. Hindoyan says, especially with victims of fatigue that lasts for several months after the acute, initial infection phase.
“It is important to get back into an exercise routine but to do it in a very conservative fashion,” he says.
That means gradually increasing your exercise until you get back to your pre-COVID level, which follows the American College of Cardiology recommendations.
Cardiac disease related to COVID-19 is an important diagnosis, and it takes a lot of work and persistence to figure out the diagnoses and find the clear cause.Antreas Hindoyan, MD, a cardiologist at Keck Medicine of USC
Unique challenges for cardiology
“COVID-19 presented unique challenges across the health care community and, specifically, for cardiology,” Dr. Hindoyan says. “We are still discovering and understanding how COVID-19 affects the cardiovascular system.
“Cardiac disease related to COVID-19 is an important diagnosis, and it takes a lot of work and persistence to figure out the diagnoses and find the clear cause.”
But once found, it can really change a patient’s life and get them back on track to living a heart-healthy life.