November 10, 2020 — The Smidt Heart Institute at Cedars-Sinai Hospital in Los Angeles has established a specialized cardiac clinic to care for COVID-19 (SARS-CoV-2) survivors who may be subject to long-term heart damage.
"This first-of-its-kind program created uniquely for COVID-19 survivors will benefit patients and aid ongoing research," said Eduardo Marbán, M.D., Ph.D., executive director of the Smidt Heart Institute and the Mark S. Siegel Family Foundation Distinguished Professor. "As an institute, we are committed to understanding how COVID-19 is impacting all survivors."
In addition to the post-COVID-19 heart program, Cedars-Sinai is soon launching other specialized clinics to treat and study the long-term health problems experienced by survivors of COVID-19, including lung damage and cognitive issues. Cedars-Sinai investigators also have initiated more than 80 studies and clinical trials to better understand the impacts and risks of the disease.
Although not all COVID-19 survivors will experience heart complications or damage, Marbán said there are high-risk groups, as well as telltale symptoms warranting a clinic visit or communication with your medical team.
High-risk populations include those with pre-existing conditions, such as patients who had heart failure or were diagnosed with hypertension before coming down with the virus, and survivors who plan to resume vigorous athletics. Symptoms indicating a potential problem include persistent shortness of breath, chest pain, palpitations and an inability to move as easily or as much as before.
"But, if you are otherwise healthy after your coronavirus diagnosis and recovery, the best thing to do is pay careful attention to your body and monitor for new symptoms or ailments," said Marbán. "If any of these symptoms appear, then it is wise to schedule time with a care provider."
Long-term Symptoms of Post-COVID Damage
Former COVID patients are reporting the following types of symptoms long after they recover from the virus, Singh explained:
• Short of breath, especially on extertion.
• Heart palpitations
• Chest pain
How Does COVID-19 Affect the Heart?
When it comes to the "why" of COVID-19 affecting the heart, Siddharth Singh, M.D., director of the specialized clinic, says there is still a lot to learn about the virus.
"Some patients can develop inflammation of the heart muscle, which is called myocarditis. In some patients, inflammation can develop in the lining of the blood vessels and this can effect the heart, and it can lead to developing blood clots in the smaller and larger blood vessels."
Until physicians know more about what makes the virus so debilitating for some patients while others do not experience any symptoms, Singh said the most effective weapon against the virus is prevention.
"I urge everyone to take all necessary precautions," said Singh. "Wear masks, maintain social distancing and use proper hand hygiene."
Marbán adds that what medical science now knows about the effects of COVID-19 on the heart "gives reason for concern." That is because research from three recent scientific studies conducted outside of Cedars-Sinai point to patients, including athletes and others who didn't experience symptoms, having detectable issues with their hearts after surviving the virus.
While it is unclear if these issues were new, because the patients were not studied before they got COVID-19, the frequency of abnormal findings seems much greater than it is in the general population.
These studies, published in the journal JAMA Cardiology,[1,2,3] suggest COVID-19, even in young asymptomatic cases, can cause inflammation and increased fibrosis in the heart. Both of these issues are associated with heart failure and sudden cardiac death.
"These studies give us reason to believe the number of COVID-19 survivors who end up with long-lasting heart issues is greater than we ever imagined," said Marbán.
Marbán also said when discussing the long-term effects of COVID-19 on the heart, it is key to remember the first human experience with the disease was less than a year ago.
"As of today, we are only seeing the tip of the iceberg," said Marbán. "The more we can study the disease and its lingering effects, the better we will understand its lasting impact on our health."
1. Carlos del Rio, Lauren F. Collins, Preeti Malani. Long-term Health Consequences of COVID-19. JAMA. 2020;324(17):1723-1724. doi:10.1001/jama.2020.19719
2. Valentina O. Puntmann, M. Ludovica Carerj, Imke Wieters, et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. Published online July 27, 2020. doi:10.1001/jamacardio.2020.3557.
3. Robert O. Bonow, Patrick T. O’Gara, Clyde W. Yancy. Cardiology and COVID-19. JAMA. 2020;324(12):1131-1132. doi:10.1001/jama.2020.15088.
4. Richard C. Becker. Anticipating the long-term cardiovascular effects of COVID-19. J Thromb Thrombolysis. 2020 Sep 3 : 1–13.