Cardiological symptoms of Long & Post Covid

Although many people still think of Covid-19 as a lung disease, it can also affect other areas of the body such as the heart and vascular system (cardiovascular system). Since the start of the pandemic, numerous studies have shown that cardiological complications can also occur beyond the direct infection period. Typical persistent heart problems include

• Shortness of breath
• Rapid exhaustion
• palpitations
• Heart palpitations
• Chest pain

According to research, between 10% and 30% of all Long Covid patients are affected. Depending on the symptoms that occur, a cardiovascular distinction is made between two forms of post-acute consequences of SARS-CoV2 infection (PASC):

• PASC-cardiovascular disease (PASC-CVD):Here, the symptoms are indicative of a clear cardiovascular disease (e.g. myocarditis).
• PASC-cardiovascular syndrome (PASC-CVS):In this case, the symptoms cannot be combined into one diagnosis, or not completely.

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Cardiovascular consequences after Covid-19: risks and symptom progression

Cardiovascular symptoms often only appear a few days or weeks after the actual acute phase of the infection. They peak on average around seven weeks after the start of the infection. After that, they usually subside slowly.

While these symptoms are usually harmless, serious heart problems can occur in rare cases and persist for several months. For example, if cardiovascular disease is already present during the acute phase of a Covid-19 infection, the risk of an acute symotome progression is increased. At the same time, studies have observed that new cardiovascular symptoms occur more frequently in the first six months after Covid-19 disease if the course of the disease was more severe.

The incidence of new cardiac symptoms was therefore directly associated with the severity of the acute illness. Patients who had to be treated in hospital or even artificially ventilated are at an increased risk of the disease also affecting the heart.

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Causes of cardiac symptoms in Long Covid: lack of exercise vs. cardiac tissue involvement

The causes of palpitations, reduced exercise capacity or an increased resting heart rate in Long Covid patients continue to be the subject of scientific debate. Various approaches are under discussion, two of which are presented below:

One possibility is that the symptoms are not caused by problems in the heart itself, but are a reaction to the reduced movement during the illness. For example, prolonged lying down and inactivity can lead to reduced performance. Dehydration can also trigger an increased heart rate.

However, a number of studies have now shown that the heart tissue itself can also be affected. This can include a chronic inflammatory reaction due to the persistence of the virus in the heart, as well as diffuse autoimmune reactions or the stiffening of the vessel walls due to permanently high oxidative stress. However, it is important to emphasize that in most cases there is no far-reaching damage to the heart muscle and the associated restriction of heart function.

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Treatment of cardiovascular symptoms with Long Covid

The treatment guidelines are primarily based on the respective symptoms. If cardiac symptoms occur during or after a Covid-19 infection, a doctor should be consulted first and foremost. Especially if symptoms occur suddenly, severely or over a longer period of time. A doctor should also be consulted as soon as possible if there are already pre-existing cardiovascular conditions.

Diagnostic procedures usually include an examination of cardiac symptoms (chest pain, pulse, cardiac arrhythmia, ...) and a troponin level, which can be used to detect circulatory disorders in the heart. If necessary, an ECG, MRI or further imaging tests can be added.

Further treatment steps then follow the current guidelines for cardiovascular diseases. Depending on the severity, this can range from rest and slowly increasing activity to pharmacological or even inpatient interventions.If there is no damage to the heart muscle or other organ systems, the S1 guidelines recommend a number of non-drug therapies to deal with the symptoms:

• Adequate fluid intake
• Adequate salt intake, unless you have high blood pressure. We recommend 8-10 g of salt per day as part of the daily diet
• Compression stockings/leading bandages if necessary
• Slowly increasing cardiac endurance training, as long as there is no worsening of symptoms

In addition, a correlative study found that the resting heart rate of vaccinated patients returned to normal on average after three to six weeks, while it remained elevated for an average of eleven weeks in unvaccinated patients. However, no causality was investigated here, and the extent to which this was related to other heart complaints is still unclear.

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