The effects of long COVID on the heart

COVID symptoms can be varied, ranging from cough, runny nose, sore throat and fever to diarrhoea and vomiting. These symptoms have appeared in both vaccinated and unvaccinated, young and old. The virus does not seem to discriminate.

For some, the symptoms are quite mild, and they recover fairly quickly with no visible after-effects. For others, however, effects are still felt long after recovery from initial COVID-19 infection – some complain of bone-deep exhaustion that just comes out of nowhere.

Long COVID is the term used to describe the chronic fatigue that persists after confirmed or suspected COVID-19 infection and which was not present prior. Sometimes it can last weeks, but often it can last months. Some have touted long COVID as another form of chronic fatigue. Those who have existing medical conditions and then contract COVID-19 tend to have a much harder road to recovery, or COVID could make their condition worse, depending on the condition.¹

According to the World Health Organization, a post-COVID condition is “a history of probable or confirmed SARS CoV-2 infection, usually three months from the onset of COVID-19” with symptoms that last for at least two months and cannot be explained by anything else. For all, it appears to be after the initial symptoms of COVID have dissipated and they no longer test positive.

Long COVID can also include a multitude of ailments afflicting people for a period time after having contracted COVID, such as breathing difficulties or cognitive dysfunction like confusion, forgetfulness or lack of clarity. A persistent loss of the sense of taste and smell has also been commonly reported.

Long COVID symptoms of fatigue and breathlessness can become so great that they severely impact a person’s daily life. Sufferers do not seem to have the same amounts of energy and strength that they used to have to go about their everyday activities, from doing their jobs to household tasks like carrying shopping bags and cleaning the house.

The immediate effects of COVID on the heart are relatively well known – inflammation caused by the virus can impact the heart, causing myocarditis and pericarditis (inflammation of the heart muscle or outer lining of the heart). COVID can also cause blood clotting, which can block a heart or brain artery causing a heart attack or stroke, as well as abnormal heart rhythms, blood clots in the legs and lungs, and heart failure.

Investigations into the long-term cardiovascular outcomes of COVID-19 are still underway.

One study² analysed 11 million US veterans’ health records, finding that the risk of heart and blood vessel issues was significantly increased in those who had contracted COVID a year prior, compared with those who had not. These cardiovascular issues included heart attack, stroke, cardiac arrest and arrhythmias like atrial fibrillation. This was evident even in those who did not require hospitalisation during the initial infection. However, it is unknown if these veterans had other existing ailments or if they were vaccinated.

Another study³ found that in patients who presented for cardiac bypass surgery, those who tested positive for COVID experienced more complications with coagulation and oxygen exchange than those who did not. The study also notes that those who were positive had less blood-thinning medication than those who were negative. It is not clear why this was the case.

There is no set treatment for long COVID per se. As each individual symptom or condition arises, different treatment protocols would be utilised. Just as someone might have different medical conditions and their doctor prescribes different medicines or requests different tests, long COVID can only be managed as it emerges. Note that COVID hasn’t been around long enough for the full long-term impact to be investigated, and more data about long COVID needs to be gathered to help determine treatment protocols.³

• Symptoms of breathlessness or fatigue: The best course of action is to pace yourself and take as much time as you need to complete a task. Choose the best time of day to complete tasks based on your energy levels and take more frequent, shorter breaks.
• Feeling faint or dizzy, experiencing nausea, vomiting or headaches: Treat these as you would if you had them normally. This could include resting, taking over-the-counter pain relief medications and keeping up your fluids.
• Mood and mental health: If long COVID is affecting your mental health, setting up a daily routine will help with your mood and sense of stability. Connect with friends and family, or perhaps seek the support of others also experiencing long COVID. Exercise or do things you find enjoyable to help release the endorphins that help you feel good.
• Memory issues: If you find yourself having issues with your memory, take notes to help you remember things or set out a plan before tackling a new problem or situation. Try to get a good night’s sleep, and limit your alcohol intake.

Call 000 if you feel chest pain or have symptoms of a stroke, such as weakness or paralysis of the face, arm or leg, or difficulty speaking or understanding.

Seek medical advice if symptoms persist. Experts recommend that if symptoms persist for four weeks or more after the initial infection then further investigation should be done to rule out any acute, life-threatening conditions or identify any unrelated diagnoses.

A clear change with the onset of the pandemic is a greater vigilance over preventing infectious spread. Face masks, hand sanitising and social distancing have become the norm. This, together with taking care of yourself so that you stay as healthy as possible, can offer protection from COVID as well as any other illnesses that may be making the rounds.

• Take care of yourself: Being rundown could make you more susceptible to getting sick. Make a point to rest when you need it, and listen to your body – if it’s too much, it’s too much.
• Eat nutritious foods: Try to fill your meals with nutrient-rich vegetables and healthy sources of protein. Avoid too much alcohol and junk or fatty foods. Try to limit caffeine intake and energy drinks.
• Get moving and exercise regularly: Being physically active can improve overall energy levels, strength and endurance. If you’re just getting started, try light and gentle activities, such as walking or yoga, to build up your stamina and strength.
• Keep stress to a minimum: Chronic stress is associated with cardiovascular disease. Practise mindfulness and meditation, and use techniques to minimise your stress like to-do lists or building a support network. Know that you’re not alone.

Speak to your doctor for recommendations specific to your circumstances of if you experience symptoms that persist.