Even after the virus is gone, COVID-19 can change the heart?

While the effects of COVID-19 on the lungs and respiratory system are well recognised, there is mounting evidence that the virus is also damaging the heart, with possibly long-term consequences.

Dr. Andrew Marks, chair of the department of physiology at Columbia University, and his colleagues reported on changes in the heart tissue of COVID-19 patients who died from the disease, some of whom also had a history of heart conditions, in a presentation at the annual meeting of the Biophysical Society, an international biophysics scientific group. The scientists performed autopsies and discovered a number of anomalies, particularly in the way heart cells regulate calcium.

Calcium is required for all muscles to contract, including those in the heart. Muscle cells store calcium and open specific channels within their cells to release it as necessary. The channel remains open in some cases, such as heart failure, in a desperate attempt to assist the heart muscle contract more aggressively. Calcium leakage eventually depletes calcium reserves, weakening the muscle in the end.

“We discovered signs of anomalies in the way calcium is managed in the hearts of COVID-19 patients,” adds Marks. In fact, when it came to their calcium systems, the cardiac tissue of these ten COVID-19 victims resembled that of persons with heart failure.

Marks intends to investigate the heart alterations caused by SARS-CoV-2 further by researching how the virus affects the hearts of mice and hamsters. In order to document any residual effects, he plans to evaluate changes in immune cells as well as any changes in heart function in the animals both while they are sick and after they have recovered.

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“The facts we give suggest that the heart is changing dramatically,” Marks says. “The specific cause and long-term repercussions of them should be investigated further.”

Prior research has found a relationship between COVID-19 infections and heart issues. A comprehensive 2022 review of VA patients—some of whom had recovered from COVID-19 and others who had never been diagnosed—found that individuals who had COVID-19 had increased rates of a variety of heart-related hazards, including irregular heartbeats, heart attack, and stroke. Dr. Susan Cheng, chair of women’s cardiovascular health and population science at Cedars-Sinai, is researching whether there are any links between heart attack rates and surges in COVID-19 infections in order to better understand how the virus affects the heart.

There is also preliminary evidence that persons with hypertension may be at greater risk of heart events if they get COVID-19.

The cause of the viral infection is unknown, although the body’s immune system is likely to play a role. “With SARS-CoV-2, the body responds with an inflammatory response that entails engaging the immune system in a very dramatic way,” Marks explains. “It appears that the same inflammatory process is activating pathways in the heart that may be deleterious to heart function.” Further research, however, is required to elucidate that process, according to Dr. Mariell Jessup, chief scientific and medical officer of the American Heart Association. “If the idea is that the virus produces inflammation, and that the inflammation causes more cardiovascular events, how does it achieve that?”

It is also plausible that viruses can infect and harm cardiac cells. “We’re only scratching the surface in terms of understanding how COVID-19 influences health,” explains Cheng.

Marks hopes that the animal tests he expects to do may provide some of the answers. “We intend to refine the animal model so that it best reflects what we think is happening in patients,” he explains. “We want to study what occurs in the heart when the virus infects an animal in great detail.”

Ultimately, this knowledge will assist to better treat patients who may be at increased risk of COVID-19-related heart problems, perhaps reducing hospitalisations and deaths from the condition. If leaking calcium is found to be a problem with COVID-19, Marks has already devised a potential medication to treat it; he is ready and eager to test it if his animal tests justify the experiments.

Until more definite research reveal how the COVID-19 virus affects the heart, Jessup advises her patients to “manage the things we know how to control,” such as risk factors that may predispose them to heart disease in the first place, such as obesity, high blood pressure, and high cholesterol. With more data coming in, if patients are getting repeat COVID-19 infections, they should see their doctor to have their heart disease risk factors examined as well.

“We spend a lot of time telling people they should get vaccinated,” she says. “For people who have had COVID-19, we should also be making sure they know their heart numbers and make sure they know blood pressure. “We know how to prevent heart disease, so let’s do the things we know how to do.”