A racing heart, chest pain, or dizziness when standing up? These are all symptoms that can also occur with Long & Post Covid. This can be quite frightening, but in most cases it is only temporary.

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Cardiological symptoms of Long & Post Covid

Although Covid-19 is still stored as a lung disease in many people, it can also affect some 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 immediate period of infection. Typical persistent heart problems include:

• shortness of breath
• Quick exhaustion
• palpitations
• heart stumbling
• chest pain

According to studies, 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): The symptoms indicate a clear cardiovascular disease (e.g. heart muscle inflammation).
• PASC-cardiovascular syndrome (PASC-CVS): In this case, the symptoms cannot or cannot be completely combined into a diagnosis.

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Cardiovascular consequences after Covid-19: risks and course of symptoms

Cardiological symptoms often only occur a few days or weeks after the actual acute phase of the infection. On average, they peak around seven weeks after the start of infection. After that, in most cases, they subside slowly.

While these symptoms are usually harmless, serious heart problems can occur in rare cases that persist for several months. For example, if cardiovascular diseases are already present during the acute phase of a Covid-19 infection, the risk of an acute course of symptoma is increased. At the same time, studies have observed that new cardiovascular symptoms occur more frequently in the first six months after the Covid-19 disease, when the course of the disease was more severe. The incidence of new heart problems was therefore directly associated with the severity of the acute illness. Patients who have had to be treated in hospital or even have to be artificially ventilated are at increased risk that the disease will also affect the heart.

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Causes of heart symptoms in long Covid: lack of exercise vs. heart tissue involvement

The causes of rapid heartbeat, reduced performance, or increased resting heart rate in long Covid patients are being discussed scientifically. There are various approaches 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 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.

Nevertheless, a whole series of studies have now shown that heart tissue itself can also be affected. These can include a chronic inflammatory response due to the persistence of the virus in the heart, as well as diffuse autoimmune reactions or the stiffening of the vascular walls due to permanently high oxidative stress. However, it is important to stress that in most cases there is no extensive damage to the heart muscle and the associated impairment of heart function.

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Treating cardiovascular symptoms of long Covid

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

Diagnostic procedures then usually include examining cardiac symptoms (chest pain, pulse, heart rhythm disorders,...) and recording the troponin level, which can be used to identify circulatory disorders in the heart. If necessary, an ECG, MRI, or further imaging tests may be added.

Further treatment steps will 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 some non-drug therapies to deal with the symptoms:

• Adequate hydration
• Sufficient salt intake as long as there is no high blood pressure. 8-10 g of salt per day are recommended as part of the daily diet
• Compression stockings/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 people had returned to normal after just three to six weeks on average, while it remained elevated for an average of eleven weeks for unvaccinated people. However, no causality was investigated, and the extent to which this was related to other heart problems is still unclear.

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synopsis

Cardiovascular complaints are a frequent companion after a Covid-19 infection and occur increasingly only after the actual acute phase in Long Covid patients. It has not yet been finally clarified what causes the symptoms and what long-term consequences arise from them. In most cases, however, the symptoms are mild and subside after just a few weeks. However, in case of severe, sudden or long-lasting symptoms, pre-existing conditions, or any other development of concern, a doctor should be consulted directly.