COVID-19 and the Heart: Understanding Risks, Effects, and Prevention
Explore how COVID-19 impacts heart health, from immediate cardiovascular effects to long-term risks, and discover strategies to protect your heart.
COVID-19 and the Heart: What’s the Connection?
The ongoing COVID-19 pandemic has brought to light its significant effects beyond the lungs, particularly its complex relationship with cardiovascular health. Evidence increasingly shows that people infected with COVID-19 are at a higher risk for both acute and long-term heart problems, including heart attacks, strokes, arrhythmias, myocarditis, and more. Understanding the mechanisms, risk factors, and prevention strategies is crucial for anyone concerned with heart health during the pandemic and beyond.
How Does COVID-19 Affect the Heart?
Researchers have identified multiple mechanisms by which COVID-19 can impact the heart and blood vessels. These mechanisms can cause a wide range of acute and chronic cardiovascular complications.
1. Direct Infection of Heart Cells
The virus responsible for COVID-19, SARS-CoV-2, uses the ACE2 protein to enter cells. Since ACE2 is present in many organs, including the heart and blood vessels, the virus can directly infect and damage heart cells and vascular tissues.
- Direct infection can lead to inflammation of the heart muscle (myocarditis) and blood vessels (vasculitis).
- This cellular damage can set off a chain of cardiac complications, including impaired heart function.
2. Heightened Immune Response and Inflammation
COVID-19 triggers an intense immune response, resulting in increased systemic inflammation. This ‘cytokine storm’ is the body’s way of fighting the virus but can sometimes become uncontrolled, damaging healthy tissues such as the heart and blood vessels.
- Excessive inflammation is linked to plaque instability in coronary arteries, increasing the risk of a heart attack.
- The immune response may also contribute to arrhythmias and blood clot formation.
3. Oxygen Deprivation
COVID-19 can severely affect the lungs, reducing their ability to supply oxygen to the blood. When the body—and particularly the heart—receives insufficient oxygen, tissues can suffer damage, and the heart must work harder to pump oxygen-rich blood.
- This increased strain can trigger heart failure, especially in individuals with underlying heart disease.
- Low oxygen levels contribute to the risk of cardiac arrest and organ failure.
4. Blood Clotting Abnormalities
COVID-19 patients often experience increased clotting (hypercoagulability), leading to blood clots that can travel to the lungs (pulmonary embolism), brain (stroke), or heart (heart attack).
- Blood clots can obstruct the flow of oxygen-rich blood to vital organs.
- Inflammatory processes and damaged blood vessels aggravate this risk.
5. Stress Cardiomyopathy (Takotsubo Cardiomyopathy)
The intense physical and psychological stress of severe illness—such as a COVID-19 infection—can trigger a temporary weakening of the heart muscle called stress cardiomyopathy.
- The condition resembles a heart attack, with similar symptoms and ECG changes, but usually resolves with supportive care.
- Both physical stress (from the illness) and emotional stress (fear, isolation) are contributing factors.
What Heart Conditions Can COVID-19 Cause or Worsen?
COVID-19’s effects on the cardiovascular system are wide-ranging, affecting both people with existing heart disease and those with previously healthy hearts.
What others are reading
- Myocarditis: Inflammation of the heart muscle, which can reduce the heart’s pumping ability and lead to heart failure or arrhythmias.
- Arrhythmias: Irregular heartbeats (fast, slow, or erratic rhythms) can develop during or after COVID-19 infection.
- Heart Failure: The heart’s inability to pump sufficient blood, which may be triggered by direct viral effects, increased metabolic demand, or preexisting conditions.
- Acute Coronary Syndrome: Heart attacks and unstable angina, often related to plaque rupture or increased clotting.
- Blood Clots: Increased risk of stroke, deep vein thrombosis (DVT), and pulmonary embolism.
- Pericarditis: Inflammation of the sac around the heart, causing chest pain and other symptoms.
Who Is Most at Risk for Heart Issues From COVID-19?
Certain individuals are more susceptible to cardiovascular complications from COVID-19. Key risk groups include:
- Older adults, especially those over 65
- People with preexisting cardiovascular disease: Such as coronary artery disease, heart failure, high blood pressure, or arrhythmias
- Individuals with diabetes, obesity, or chronic kidney disease
- Patients with non-O blood types: Recent studies indicate higher long-term cardiovascular risk among people with A, B, or AB blood types versus type O
- Immunocompromised individuals
However, even those without prior heart conditions can develop heart complications after COVID-19, sometimes weeks or months after recovery. COVID-19 hospitalization further multiplies this risk, with some studies showing nearly fourfold increases for those hospitalized for COVID-19 compared to non-hospitalized peers.
How Long Do Cardiovascular Risks Last After COVID-19?
Emerging research suggests that the cardiovascular risks associated with COVID-19 can persist well beyond the acute phase of infection. Some key findings include:
- Increased risk may last for at least 12–36 months after infection, especially for those who were hospitalized.
- People with no previous heart disease can face double the risk of stroke or heart attack up to three years later.
- Hospitalized COVID-19 patients with no cardiovascular history are up to seven times more likely to experience a major heart event within three years.
- For people with existing cardiac conditions and a history of COVID-19 hospitalization, the risk can be 12 times higher.
- The risk increase is seen even among those with mild cases, but is highest in people who required hospitalization.
Long COVID and the Heart: What We Know
Some individuals experience persistent symptoms months after recovering from initial COVID-19 infection, a condition termed long COVID or post-acute sequelae of SARS-CoV-2 infection (PASC). Cardiovascular complaints are common features of long COVID. Common symptoms include:
- Palpitations (a racing or irregular heartbeat)
- Shortness of breath (dyspnea)
- Chest pain or discomfort
- Exercise intolerance
- Dizziness or fainting (often related to postural orthostatic tachycardia syndrome, or POTS)
These symptoms may be due to subtle heart dysfunction, persistent inflammation, damage to the autonomic nervous system, or ongoing blood vessel abnormalities.
COVID-19, Blood Type, and Cardiovascular Risk
One notable discovery links a person’s blood type to both the likelihood of getting COVID-19 and their subsequent risk of cardiovascular complications. Here’s what research indicates:
- Type O blood: Lower risk of both initial infection and long-term cardiovascular events after COVID-19.
- Type A, B, or AB: Higher risk for developing cardiovascular issues such as heart attacks, strokes, and blood clots post-infection.
Globally, almost 60% of people have a non-O blood type, highlighting the large number of individuals who may be at increased risk following COVID-19 infection.
| Blood Type | Relative Risk of Infection | Risk of Heart Issues After COVID-19 |
|---|---|---|
| O | Lower | No significant increase observed |
| A | Higher | Increased risk |
| B | Higher | Increased risk |
| AB | Higher | Increased risk |
How to Protect Your Heart During and After COVID-19
While some risks are unavoidable, several strategies can help reduce your risk of developing heart problems during or after COVID-19.
- Get vaccinated: COVID-19 vaccination lowers the risk of severe infection, hospitalization, and related cardiovascular complications.
- Manage chronic conditions: Keep high blood pressure, diabetes, and high cholesterol under good control.
- Maintain a heart-healthy lifestyle:
- Eat a balanced diet rich in fruits, vegetables, and whole grains
- Exercise regularly as tolerated
- Avoid tobacco use and limit alcohol
- Monitor for symptoms: If you develop chest pain, shortness of breath, dizziness, or palpitations during or after COVID-19, seek prompt medical evaluation.
- Follow up with your healthcare provider: Especially if you have underlying cardiovascular risk factors or lingering symptoms post-COVID-19.
- Manage stress: Engage in practices such as mindfulness, meditation, or counseling to address psychological stress, which can affect heart health.
When Should You Seek Medical Care?
Contact your healthcare provider right away or seek emergency care if you experience any of the following, during or after a COVID-19 infection:
- Chest pain or pressure
- Sudden shortness of breath or trouble breathing
- New or worsening palpitations
- Fainting or severe dizziness
- New leg swelling or pain
- Sudden weakness, numbness, trouble speaking, or loss of coordination (possible signs of stroke)
Early recognition and intervention can be life-saving for cardiac complications.
FAQs: COVID-19 and Heart Disease
Can COVID-19 cause heart problems even in healthy people?
Yes. Even people with no previous heart conditions can develop myocarditis, arrhythmias, blood clots, or other heart complications during or after COVID-19. The risk increases with severe illness and hospitalization but can also occur after milder infections.
How long does the increased risk for a heart attack or stroke last after COVID-19?
Studies indicate that the risk is elevated for at least 1–3 years after infection, particularly for people who were hospitalized, had non-O blood types, or have other cardiovascular risk factors.
Does vaccination against COVID-19 reduce cardiovascular risks?
Yes. Vaccination lowers the chances of severe COVID-19, thereby reducing the risk of cardiac complications associated with a severe immune response and hospitalization.
Are people with heart disease more vulnerable to severe COVID-19?
Yes. Preexisting heart disease increases the risk of complications, hospitalization, and death from COVID-19. These individuals should be extra vigilant about prevention and seek care early if they develop symptoms.
What should I do if I develop heart symptoms after recovering from COVID-19?
Contact your healthcare provider for evaluation, especially if you have chest pain, trouble breathing, palpitations, or severe fatigue. Cardiac tests such as EKGs, echocardiograms, or blood tests may be necessary to assess heart health.
Takeaway
COVID-19 can significantly increase the risk of heart problems, sometimes for years after infection. Understanding these risks—and acting on prevention, monitoring, and healthy lifestyle choices—can help protect your cardiovascular health in the era of COVID-19. If you have concerns about your heart or experience new or persistent symptoms, do not hesitate to reach out to a healthcare professional.
References
- https://www.healthline.com/health/heart-disease/covid-heart-disease
- https://www.healthline.com/health-news/covid-19-heart-attack-stroke-cardiac-risk
- https://www.heart.org/en/news/2024/10/09/covid-19-may-increase-heart-attack-and-stroke-risk-for-years
- https://pmc.ncbi.nlm.nih.gov/articles/PMC11345335/
- https://www.nature.com/articles/s41591-022-01689-3
- https://keck.usc.edu/news/severe-covid-19-infection-increases-heart-attack-and-stroke-risk-as-much-as-having-a-history-of-heart-disease-study-finds/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7274628/
- https://www.cdc.gov/mmwr/volumes/71/wr/mm7114e1.htm
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