Common Heart Tests and Screenings for COVID-19 Long Haulers
We are nearly two years into the COVID-19 pandemic, and more information surrounding the long-term effects of the disease is brought to light each day. Even though little was known in the early days of the pandemic, a top concern was and remains to be its impact on the heart.
Although most people who have had COVID-19 get better within a couple of weeks, some deal with the lingering effects for weeks and even months later. These conditions are commonly referred to as “long COVID” and can present themselves in different ways. Given the fickle nature of COVID, those infected may or may not display symptoms. However, long COVID conditions can occur in people that were asymptomatic in the days or weeks after they were infected.
Some of the symptoms common in COVID “long haulers” may be heart-related, causing damage to the heart and affecting its function. Examples include palpitations, dizziness, shortness of breath, and chest pains. While COVID-19 was originally known as a respiratory infection, cardiologists have seen patients with signs of inflammation and scarring in their hearts even after recovery.
According to UC Davis Health Cardiologist Nayereh Pezeshkian, about 20-30 percent of patients hospitalized with COVID-19 show heart problems. These patients also tend to have more severe symptoms and worse health outcomes.
It is known that COVID-19 causes inflammation, which is a normal bodily response to infection. Those predisposed to inflammatory risks, such as those with pre-existing health conditions like obesity and diabetes, may be adversely affected by COVID compared to those without. When the body’s immune system fights off the virus, its inflammatory response can cause damage to healthy tissues, including the heart and lungs.
Per Johns Hopkins Cardiologist Wendy Post, M.D., “Severe COVID-19 is a disease that affects endothelial cells, which form the lining of the blood vessels.” The virus affects the inner surfaces of a patient’s veins and arteries and can cause blood vessel inflammation leading to damage and potential blood clots. Blood vessel inflammation and blood clots compromise blood flow to the heart and other vital organs which can lead to damage. As a result of inflammation and blood clots, the risk of heart attack and stroke is higher among COVID-19 patients.
Heart issues as a result of COVID can be due to direct damage from the virus, resulting in heart inflammation, or indirectly from cytokines released in the bloodstream. From the beginning days of the virus, many were concerned with developing myocarditis once infected. This disease often has no symptoms and many who get it are otherwise healthy.
Pezeshkian notes that most cases of myocarditis heal if the patient survives the acute illness. However, some cases may have cell death, scar formation, heart attacks, or damage to the vascular lining resulting in long-term problems (heart failure, rhythm abnormalities, etc.).
For those who have had COVID-19, a return to “normal” life is desirable but often difficult. Given the virus’ effect on both the pulmonary and cardiovascular systems, a proper screening can ease the process.
“We know that patients that had COVID-19, depending on medication treatments and severity of disease, have experienced a lot of inflammatory and clotting phenomenon in hearts and lungs that could impair blood flow to those organs. If you were to start becoming active again, and the heart and lungs start demanding more output, you can run into issues because of it,” said Associate Chair of Medicine at Staten Island University Hospital, Dr. Thomas Gut.
Types of Tests and Screenings
Depending on one’s fitness level and goals, who has to be tested and what type of test may vary. Common tests for those who had moderate to severe COVID-19 are:
- Electrocardiograms (EKG or ECG): Records the electrical signals in the heart and tests for arrhythmias.
- MRI: Creates detailed images of the organs, testing for size and function, damage, inflammation, etc.
- Echocardiograms: Produces images of the heart using sound waves and used to detect problems with valves or chambers.
- Troponin Blood Tests: Measures levels of troponin T or troponin I proteins in the blood, which are released when the heart muscle has been damaged.
The University of Alberta Faculty of Medicine and Dentistry also found a potential use case for a blood test that “reliably predicts outcomes for heart failure patients” which could lead to new diagnostics and treatments for COVID-19 patients. These researchers examined angiotensin peptide (short proteins that regulate the cardiovascular system) levels in the blood of 110 people who were experiencing heart failure due to heart attack or stroke. These levels are altered in patients with heart failure and those with COVID-19. According to the study, new coronavirus and cardiovascular disease are linked thanks to ACE2 enzyme and may respond to similar treatments.
As we approach the two-year mark since the first case of COVID-19 in the United States, there is still a lot to learn about the long-lasting effects of COVID on the heart. As research continues, so too does the development of potential diagnostic tests that will paint a better picture of one’s health post-COVID.
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