Long COVID and heart issues: What do we know about lingering symptoms — and treatment?

A college volleyball player with a racing heart came to see cardiologist Dr. Tamanna Singh in August 2020.

The athlete had an unusually high heart rate and would get palpitations just by walking from one room to the next, Singh, the co-director of the Cleveland Clinic’s Sports Cardiology Center, told McClatchy News in an interview.

She was the first long COVID patient Singh saw. She says she’s seen hundreds since.

Singh found the athlete’s heart rate could jump from 60 to 70 beats per minute to 140 to 150 beats per minute, Singh said. A resting heart rate for most healthy adults is 60 to 100 beats per minute.

This was a “quite robust response, something that we really should not see with that minimal level of exertion,” Singh said of her patient.

The athlete was also extremely tired, could no longer work out and compete in sports.

Singh put her through rigorous cardiac testing — primarily to ensure she wasn’t at an increased risk of sudden cardiac death while playing sports or after — and nothing out of the ordinary was noticed, according to Singh.

Singh says there could be more than 200 post-COVID symptoms. The most common ones Singh sees include heart palpitations or racing sensations, chest pains, difficulty exercising, shortness of breath, dizziness and lightheadedness.

Long COVID is a “multisystemic illness” affecting millions of people after their COVID-19 infection, research published Jan. 13, 2023 in Nature Reviews Microbiology notes. Symptoms can potentially last years.

When Singh sees her long COVID patients, she has heard about other symptoms such as brain fog, intense migraines, gastrointestinal issues, altered menstrual cycles and mental health issues. Some of these are potential long COVID symptoms, according to the Centers for Disease Control and Prevention.

About 1 in 5 adults may develop at least one long COVID-19 symptom after COVID-19 infection, according to CDC research published in May 2022.

Cardiac tests come back as normal for some long COVID patients experiencing heart issues

After Singh saw the college volleyball player in 2020, she started seeing a “smattering” of post-COVID patients with similar symptoms. For some, their cardiac tests also came back as normal, she said.

In mid-2020, patients experiencing lingering symptoms after their COVID-19 infection began to pop up, according to a review published Feb. 2, 2023 in Nature Reviews Cardiology. Similar to some of Singh’s patients, they had a range of symptoms — including heart palpitations, a racing heart rate, chest pains and an intolerance to exercise.

Dr. Harlan Krumholz, a cardiologist and scientist at Yale University and Yale New Haven Hospital, has spoken to several people with heart problems related to their COVID-19 infection, he told McClatchy News via email.

“They continue to have (heart) symptoms even though their test come(s) back without an indication of the underlying cause,” Krumholz said.

The patients’ heart symptoms began soon after getting COVID-19, and have persisted over time, Krumholz said.

”Most people who have a COVID-19 infection do not end up having any sort of long-term cardiovascular issues,” Krumholz said. “This is not something that should worry them. For (a) minority, however, there can be persistent, cardiovascular symptoms.”

What a few studies suggest about long COVID heart issues

A study published in the journal Nature Medicine in December 2022 identified four “major patterns” or clusters of long COVID conditions. The work involved Weill Cornell Medicine researchers.

The four major long COVID subtypes were:

• Heart, kidney and circulatory problems

• Respiratory issues, anxiety, sleep disorders and chest pains

• Musculoskeletal and nervous system issues, including arthritis

• Digestive and respiratory issues

The most prevalent long COVID symptom cluster, affecting roughly 34% of patients out of thousands studied, involved heart, kidney and circulatory systems, according to the research.

A meta-analysis of 11 studies involving 5.8 million people suggests people experiencing long COVID are more than twice as likely to develop cardiovascular problems, according to a Feb. 23, 2023 American College of Cardiology news release on the work published in March 2023/ in the journal of the American College of Cardiology.

”There is some evidence that long-term cardiovascular risk may be increased after COVID-19 infection, but these studies are not definitive and there’s still a fair amount of uncertainty,” Krumholz said.

Another study published in the journal Nature Cardiovascular Research in December 2022 focused on a specific heart condition that may occur after a COVID-19 infection — POTS or postural orthostatic tachycardia syndrome.

The condition is a nervous system disorder that causes a person’s heart to rapidly race in the 10 minutes after standing up, according to Johns Hopkins Medicine. It is accompanied by symptoms that are known to get worse, including lightheadedness and fainting.

People may have a higher chance of developing this debilitating heart condition after getting infected with COVID-19, the work involving researchers at Cedars-Sinai Medical Center in Los Angeles found.

The review published Feb. 2, 2023 in Nature Reviews Cardiology theorizes that either COVID-19 infection or vaccination can “trigger” POTS and other cardiovascular-related symptoms.

Krumholz told McClatchy News that there may be immunologic factors related to POTS after a COVID-19 infection. He acknowledged that some people have reported similar conditions after vaccination and that potential adverse effects from the vaccine are being studied in detail.

Why can a COVID-19 infection potentially harm the heart?

“A COVID-19 infection can directly damage the heart,” Krumholz said. “The virus itself can cause damage or the body’s response to the virus can cause damage. It seems the inflammation in other parts of the body can also affect the blood vessels and inside the body.”

When COVID-19 causes inflammation and fluid filling the lungs, this may impact the amount of oxygen hitting one’s bloodstream, according to Johns Hopkins Medicine. When there’s less oxygen entering the bloodstream, it may cause the heart to pump harder.

“The heart can fail from overwork, or insufficient oxygen can cause cell death and tissue damage in the heart and other organs,” Johns Hopkins Medicine says.

The virus could also directly infect and damage the tissue of the heart, causing it to become inflamed, according to Johns Hopkins Medicine. This is known as myocarditis.

Woman experiencing long COVID symptoms, including heart issues

A 47-year-old woman, of Mission Viejo, California, was diagnosed with COVID-19 pneumonia on Dec. 22, 2020.

By Dec. 26, she was suffocating as fluid filled her lungs, her lips turned blue and she went into a coma that would last longer than a month, she told McClatchy News in emailed statements.

While on a ventilator, she experienced respiratory failure for eight days and had repeated cardiac episodes — specifically a heart rate over 100 beats a minute.

Before she awoke on Feb. 1, 2021, doctors tried taking her off her ventilator but were unable to because of her racing heart.

“My heart was beating so fast they were worried I’d have a heart attack,” she said.

When asked if she had any heart issues prior to her COVID-19 infection, she told McClatchy News that she had high blood pressure in middle school when her kidney disease was detected. Since then, she’s taken Losartan every day to manage it.

High blood pressure increases the risk for heart disease, heart attack and stroke, according to the CDC.

However, following her COVID-19 infection and after her discharge from the hospital in late February of 2021, she would receive a new diagnosis related to her heart.

Beginning in April of 2021, a cardiologist ordered her to undergo cardiac testing until the end of the year and most of these tests were normal.

However, when she was ordered to wear a waterproof, adhesive Zio patch over her heart — a device offering “near real time cardiac event monitoring” — in August 2021 for three weeks, these test results were “not normal,” she said.

Over these weeks, the Zio patch showed 43 cardiac episodes in which her heart rate was faster than 200 beats per minute.

Because of this, she was officially diagnosed with supraventricular tachycardia when the heart beats suddenly and rapidly. It occurs “when the electrical system that controls your heart rhythm is not working properly,” according to the National Health Service in the UK.

She said her heart rate jumped randomly and wasn’t related to physical activity. She still experiences cardiac episodes a couple times a day and feels chest pains.

“It is really scary and makes it hard to breathe,” she said.

Now she takes medication, in addition to Losartan, to help manage her heart issues.

She added that it’s frustrating there’s no definitive answers when it comes to heart problems after COVID-19.

She received her first COVID vaccine six months after leaving the hospital.

‘We have yet to really isolate the underlying cause or to determine best treatments’

Singh told McClatchy News that it’s important to not negate the physical symptoms people feel from long COVID.

For post-COVID symptoms that appear to be related to cardiovascular system dysfunction, Krumholz said that “we have yet to really isolate the underlying cause or to determine best treatments.”

“It’s a very frustrating situation of the patients and even for the doctors.”

If you are experiencing heart issues in general, it’s good to see a healthcare provider, Krumholz advises.

While there’s there are no “definitive” steps to reduce the risk of heart conditions after COVID-19, according to Krumholz, “some people have suggested the vaccination can reduce this risk, and that may be true,” he said.

“Of course, the best possible strategy is to avoid getting COVID-19 in the first place.”

He said that over time, that is becoming an almost impossible task.

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