How Covid might affect your heart
John Naish reports on new research suggesting some of those hospitalised with coronavirus may suffer a legacy of cardiac issues
After surviving Covid infection, most people simply recover to get on with their lives. But UK scientists are uncovering a hidden legacy. Stark evidence is emerging that many thousands of Britons who suffered serious illness when infected have been left with debilitating heart damage as a result of the virus attacking their major organs.
Covid-19 has been considered to be primarily a lung infection. However, early results from large-scale national studies now suggest that up to one in eight hospitalised patients subsequently has signs that the virus has injured their hearts.
Colin Berry, professor of cardiology and imaging at the University of Glasgow, is leading one such study. His team has assessed a random sample of 161 recovering Covid patients, 90 per cent of whom had been hospitalised, and one in five of whom had needed high-level or intensive-care treatment. At between one and two months after discharge, their hearts, lungs and kidneys were medically scanned.
The results are yet to be published in a peer-reviewed scientific journal, but Professor Berry told The Daily Telegraph: “About one patient in eight had evidence of heart inflammation. That is a high incidence.”
Research is showing that Covidassociated inflammation of the heart muscle – myocarditis – can reduce the heart’s ability to pump and cause arrhythmias – rapid or irregular heart rhythms – as well as dizziness, chest pain and shortness of breath. It may cause scarring of the heart muscle that can affect its ability to pump properly. Study evidence also suggests that Covid infection can injure heart valves. In Prof Berry’s study the cardiac damage does not end there.
“The heart inflammation fits with a bigger picture of illness,” he explains. “We found that quality of life, in terms of physical and mental health, were lower in patients who had heart inflammation. We also saw damage to kidney function in patients who had inflamed hearts.”
A similar picture is being uncovered by Dr Betty Raman, a British Heart Foundation clinical research fellow at the University of Oxford. She is using magnetic resonance imaging to study the hearts, brains, livers and kidneys of 500 people taking part in the Post-hospitalisation Covid-19 study (Phosp-covid), that covers 10,000 UK patients.
While her full study is still ongoing, Dr Raman told The Telegraph that in a preliminary assessment of 58 patients, “we are seeing inflammation of multiple organs, the heart and vascular system in particular”.
It seems that the worse a person’s initial Covid symptoms, the worse the subsequent damage, she says.
“The severity of infection during the acute stage of illness is a powerful determinant of whether people get heart problems. Mild infection does not seem to leave damage. But some 10 to 15 per cent of people who have severe infections can develop complications.”
Quite how Covid damages the heart is yet to be fully understood, she says. “It seems to stem from chronic inflammation, as well as problems with blood flow.”
One possibility is that virus particles are persisting in patients’ hearts after not being eradicated in the acute phase of the infection.
“This may be because the patient’s immune system was not sufficiently strong to do this. It is now still trying to clear the virus completely, and this is causing inflammation,” says Dr Raman.
Another potential explanation is that patients’ immune defences are mistakenly identifying proteins in their bodies’ own cells as viral cells.
Worryingly, post-covid inflammation can damage hearts and blood-vessel tissues so seriously that they may create clots that can cause strokes and damage other vital organs.
“Some people may have inflammation damage. Other patients have the vascular damage, and some may have both,” Dr Raman says. “This might explain the differences in how the virus affects people in Long Covid. The wide range of differing symptoms suggests that there are multiple mechanisms.”
The figures foreshadow a leap in demand for hard-pressed NHS cardiac services. The Office for National Statistics estimates there are now some 1.2 million people in the UK with long Covid – post-coronavirus symptoms that may frequently include heart disturbances.
Already hospital waiting lists for vital heart care are at record levels, the British Heart Foundation warned last month. More than 275,000 people are waiting for heart tests and treatment in England alone. Dr Sonya Babunarayan, the foundation’s associate medical director, says: “We saw growing waiting lists for heart care even before the pandemic. Now the pressure on the NHS has only grown and the scale of this current cardiovascular crisis is unsustainable.”
Further evidence of a looming cardiac crisis comes from Danish research which shows that other post-covid patients can also suffer physical heart damage to their heart valves – the ventricles – from inflammation during the acute phase of Covid infection.
In September, a study in the European Journal of Heart Failure by cardiologists at the University of Copenhagen reported that while the right ventricle appears to heal once the infection has abated, damage to the left ventricle may be permanent. Heart failure generally begins with left-ventricle problems, as this is the heart’s main pumping chamber.
And in the Journal of the American Medical Association last month, a study of 4,000 patients who suffered heart attacks while hospitalised with Covid warned that their risk of death was 79 per cent, compared with 46 per cent for people who had the same type of heart attack but were not infected with Covid.
Such findings underline the crucial importance of staying fully vaccinated and boosted against Covid-19 and its variants.
Covid’s long-term impact on heart health is only now beginning to be understood
The statistically large peril of heart trouble that Covid can cause is in stark contrast to the very small risk of heart inflammation that might follow Covid-19 vaccination.
Fears about the jabs were stoked last month by Dr Aseem Malhotra, a London-based cardiologist, who claimed that recent research showed that MRNA vaccines can markedly increase the risk of severe myocarditis.
His claims were based on a 319-word research abstract, published in the American Heart Association journal Circulation, which said that MRNA vaccines, such as the Pfizer-biontech jab, can cause heart-cell inflammation. Numerous clinical experts criticised the abstract, which does not detail a full study and has not been peer-reviewed.
The American Heart Association subsequently published an “expression of concern” in Circulation to warn that the passage may not be reliable and that a “suitable correction” was needed.
Meanwhile, two large studies published in the highly regarded New England Journal of Medicine in October have shown that the risk of myocarditis inflammation of the heart muscle after receiving the Pfizer vaccine is very low, even among teenage boys and young men – the groups most at risk of developing the condition.
One of the studies, from Israel, puts the chance of developing the condition at about one in 50,000, adding that the vast majority of cases are mild and people recover quickly.
David Strain, a clinical senior lecturer at Exeter University who is conducting studies of long Covid, told The Telegraph: “Any myocarditis from the vaccine probably involves the same process that occurs when Covid causes heart inflammation. It’s likely the same people are at risk in both cases. The symptoms they get after the vaccine would be minor, but they would be really bad if they are unvaccinated and get Covid.”
Dr Strain says chronic post-covid inflammation may not only be affecting people’s hearts in ways doctors can see now, but in future it may drive a huge rise in other, slower-developing diseases associated with systemic inflammation, such as Type 2 diabetes and Alzheimer’s disease.
“Long Covid caused by systemic inflammation could cause much bigger problems than we imagined, with heart failure and dementia further down the line,” says Dr Strain. “We have to help people to prevent this.”
The best course of action is to avoid getting Covid in the first place, he says.
“But if you do test positive, then relax and take it easy. Don’t put your body under any excess stress, because the virus is damaging the body’s systems for looking after itself, and this can trigger inflammation problems,” says Dr Strain.
“Don’t think, ‘I can keep working while I get through this.’ Go into isolation and use the 10-day period to relax. Being careful now could make a massive difference in the long run.”