Pericarditis and Long COVID Effects on Heart
Medically reviewed by Geetika Gupta, MD
Infection with the virus that causes COVID-19 increases a person's risk for heart-related complications, including pericarditis (inflammation of the heart's outer lining) and myocarditis (inflammation of the heart muscle).
Receiving a COVID-19 vaccine has also been associated, albeit rarely, with potential adverse heart-related effects, namely myocarditis and pericarditis.
Though pericarditis and myocarditis are both inflammatory heart conditions and can coexist (called myopericarditis), this article focuses mainly on the link between pericarditis and the COVID-19 infection and vaccine.
andreswd / Getty Images
Facts About Pericarditis and COVID-19
Pericarditis is inflammation of the pericardium, a thin sac surrounding the heart. The purpose of the pericardium is to stabilize the heart's position in the chest and minimize friction between the heart and nearby organs/structures like the lungs.
Pericarditis causes sharp or stabbing chest pain that worsens with breathing and typically improves when sitting up or leaning forward.
There are multiple potential causes of pericarditis, including viral infections like COVID-19, as well as autoimmune diseases (e.g., lupus), cancer, and kidney failure.
How COVID-19 Causes Pericarditis
COVID-19-induced pericarditis is believed to be caused by three processes:
Direct invasion of the heart muscle by the virus
Reduced blood flow to parts of the heart
Development of a cytokine storm (an exaggerated immune system response)
In addition to COVID-19 infection possibly causing pericarditis, rare cases of pericarditis have been observed after receiving the COVID-19 vaccine. Specifically, research has also found a causal link between pericarditis and the mRNA COVID-19 vaccines, Pfizer-BioNTech and Moderna.
Moreover, findings from clinical studies and vaccine safety monitoring outside of the United States suggest an elevated risk of pericarditis after receiving the Novavax vaccine, a protein-based vaccine.
Learn More: Types of COVID-19 Vaccines
Triggered by COVID Infection
Heart-related conditions, including pericarditis, are a potential consequence of COVID-19 infection.
A study whose statistical findings were reviewed by the Centers for Disease Control and Prevention (CDC) analyzed over 800,000 people infected with COVID-19 from 40 healthcare systems in the United States.
In males, results revealed the incidence of myocarditis or pericarditis seven to 21 days after infection to be:
12.6 to 17.6 cases per 100,000 among males ages 5–11 years
56.0 to 64.9 cases per 100,000 among males ages 12–17 years
85.5 to 100.6 cases per 100,000 among males ages 18–29 years
100.2 to 114.0 cases per 100,000 among males ages 30 years or older
In females, the results included:
8.1 to 10.8 cases per 100,000 among females ages 5–11 years
24.7 to 35.7 cases per 100,000 among females ages 12–17 years
23.8 to 33.6 cases per 100,000 among females ages 18–29 years
53.8 to 61.7 cases per 100,000 among females ages 30 years or older
This article uses the terms for sex or gender from the cited studies and sources. In those sources, they generally pertain to sex assigned at birth.
Related: What Exactly Do Incidence and Prevalence Mean?
Triggered by COVID Vaccination
The development of pericarditis (and myocarditis) after receiving the COVID-19 vaccine is very rare but has still been reported more often than expected.
A study that analyzed data from 40 healthcare systems in the United States (same as above) found the incidence of pericarditis or myocarditis after the mRNA COVID-19 vaccine to be the following across all age groups and after any vaccine dose:
For males:
6.5 cases per 100,000 among males ages 5–11 years
37.1 cases per 100,000 among males ages 12–17 years
22.0 cases per 100,000 among males ages 18–29 years
15.8 cases per 100,000 among males ages 30 years or older
For females:
0 cases per 100,000 among females ages 5–11 years
7.5 cases per 100,000 among females ages 12–17 years
8.7 cases per 100,000 among females ages 18–29 years
10.1 cases per 100,000 among males ages 30 years or older
Summary
Current research has found that the risk of pericarditis is significantly higher after a COVID-19 infection than after an mRNA COVID-19 vaccination for males and females in all age groups.
Regarding pericarditis from the Novavax COVID-19 vaccine, data is scant, and more investigation is required, although cases have been reported in the United States and worldwide.
Highest-Risk Groups
In a review article collecting data from 33 studies, COVID-19-related pericarditis was found to affect individuals at any age and be twice as common in males compared to females.
Also, nearly 50% of people with COVID-19-related pericarditis had reported a history of high blood pressure, followed by diabetes and high cholesterol, suggesting that certain underlying health conditions could increase a person's risk for this heart complication.
Regarding the COVID-19 vaccines, an increased risk for pericarditis was observed among individuals—particularly adolescent and young adult males—within seven days after receiving the second dose of an mRNA COVID-19 vaccine.
Data is still limited regarding links between pericarditis and the Novavax vaccine. However, one study analyzing reports to the World Health Organization (WHO) found that most cases of myopericarditis after the Novavax vaccine involved males with a median age of 35.5 years.
Similar to the mRNA vaccines, most cases of pericarditis also occurred after the second Novavax vaccine dose.
Long COVID Effects on Heart and Body
COVID-19 infection can present itself in many different ways, ranging from no symptoms to a mild cold to severe illness, including respiratory failure (the inability to breathe on your own) and multiple organ failure.
Though most people with COVID-19 fully recover, a significant number of affected individuals experience long-term health complications—what's known as long COVID or post-COVID-19 syndrome.
Symptoms of long COVID-19 may start during or after the acute illness and can last for weeks, months, or even years.
Possible heart-related manifestations of long COVID-19 include:
Myocarditis and/or pericarditis
Heart failure (the heart can't pump enough blood for the body's needs)
Arrhythmia (abnormal heart rhythm)
Related: Mild COVID Can Trigger Heart Disease One Year After Infection
Other examples of potential long COVID-19 health manifestations include:
Long-term anxiety and depression
Breathlessness and limited exercise tolerance
Decline in kidney function
Muscle and joint stiffness
Digestive problems causing diarrhea or stomach pain
Emergency Pericarditis and Myocarditis Symptoms
The most commonly reported symptoms of pericarditis associated with COVID-19 infection are:
Chest pain
Fever
Other reported symptoms include cough, fatigue, muscle aches, and diarrhea.
Symptoms in Young Children
According to the CDC, young children with pericarditis (or myocarditis) may have irritability, vomiting, poor feeding, rapid breathing, or lethargy.
According to the American Heart Association, individuals should seek immediate medical attention for the following symptoms:
Chest pain, including student, sharp, or stabbing sensations
Difficulty breathing or shortness of breath
Abnormal heartbeat (e.g., fast, fluttering, or pounding)
Fainting or loss of consciousness
How Soon After COVID Does Pericarditis Occur?
Pericarditis may develop when a person is acutely ill with COVID-19 or after they have recovered from the infection.
Specifically, one study reported that in people with COVID-19-related pericarditis, the condition was diagnosed between five and 56 days after infection.
Another study of people who had received the COVID-19 vaccination found an increased risk of pericarditis in the one to 28 days following a positive COVID-19 test.
Cases of pericarditis after receiving the Moderna or Pfizer-BioNTech COVID-19 vaccine most commonly developed within seven days after receiving the second dose.
Minimal data regarding pericarditis after the Novavax vaccine suggest a timeline similar to that of the mRNA vaccines, with symptom onset beginning eight to 10 days after the second dose.
Pericarditis and COVID Hospitalization
Scientific data has found that the incidence of pericarditis developing in people with COVID-19 who are hospitalized is less than 0.5%.
That said, people hospitalized with COVID-19-induced pericarditis have higher mortality (death) rates than those hospitalized with COVID-19 without pericarditis.
Moreover, hospitalized people infected with COVID-19 with pericarditis were more likely to stay in the hospital longer. They also had a higher chance of developing complications, namely cardiac arrest and acute kidney injury.
Treatment for COVID-Induced Pericarditis
There is no defined or predominant strategy for treating COVID-19-induced pericarditis, although any treatment aims to ease the inflammation of the pericardium and alleviate symptoms, namely chest pain.
Studies of COVID-19-induced pericarditis found that most affected individuals were safely and effectively treated to reduce inflammation with colchicine, a nonsteroidal anti-inflammatory drug (NSAID), or a combination of these drugs.
The NSAIDs typically used were:
Aspirin (the most common brand of which is Bayer)
Advil or Motrin (ibuprofen)
Less commonly, corticosteroids ("steroids"), which also work to reduce inflammation, were used.
Interventional therapies were only implemented when people developed cardiac tamponade, a complication of pericarditis wherein extra fluid collects around the heart, impairing the heart's function.
The treatment of cardiac tamponade involves urgent draining of the excess fluid surrounding the heart, which is usually performed using a needle or, less commonly, surgery.
Living With Long COVID Complications
The complications of long COVID are diverse and sometimes debilitating. To best cope, experts recommend devising a personalized care plan under the guidance of one or more healthcare providers.
Try to make the most of your appointments by preparing beforehand with a list of your symptoms, medications, and past medical conditions. Also, consider bringing a loved one to your appointments for support and perhaps help detailing what you are going through.
In addition to managing physical symptoms (e.g., intense fatigue, breathlessness, and muscle pain, among many possible others), it's also important to acknowledge the various emotional challenges of living with long COVID. You might feel anger, frustration, or anxiety over the impact this illness has had on your daily functioning and quality of life.
To combat negative feelings and thoughts, reach out to trusted friends, family members, or colleagues for comfort. Also, talk with a healthcare provider because you may benefit from medication or a referral to a therapist.
Related: Have Long COVID and Can't Work? Here's What to Do
Summary
Pericarditis—the inflammation of the tissue surrounding the heart—can develop during an acute COVID-19 infection or after recovery. Other heart-related consequences of COVID-19 include myocarditis, heart failure, heart attack, and arrhythmia.
Pericarditis may also rarely occur following receipt of an mRNA COVID-19 vaccine (Moderna or Pfizer-BioNTech), with the risk being highest in adolescent and young adult males after receiving the second dose. Data regarding the risk of pericarditis from the Novavax protein-based vaccine is still emerging.
Overall, experts have found that the risk of pericarditis is higher from getting infected with COVID-19 than receiving the COVID-19 vaccine for people of any sex across all age groups. As such, the CDC recommends staying up to date on COVID-19 vaccination for all eligible individuals.
Read the original article on Verywell Health.
