Heart Inflammation in the Age of COVID-19
February 22, 2022
COVID-19 is known to cause a variety of cardiovascular problems in some patients. Among them is inflammation of the heart muscle.
Viruses are a common cause of heart inflammation – known as myocarditis – and the coronavirus is no different.
The Centers for Disease Control and Prevention reported in September research showing patients with COVID-19 had nearly 16 times the risk of myocarditis compared with patients without COVID-19.
The condition also is an extremely rare side effect of the COVID-19 vaccine – an incidence of about 2 in 100,000 people, according to an Israeli study published in the New England Journal of Medicine.
UH cardiologist Sadeer Al-Kindi, MD, says the vast majority of myocarditis cases are asymptomatic or mild, and patients recover without treatment.
“We have known that viruses cause myocarditis for a long time. Early in the COVID-19 pandemic, studies suggested that a small proportion of patients with COVID-19 may also have myocarditis,” Dr. Al-Kindi says. “Studies using heart MRI can also detect signs of heart inflammation after recovery from COVID-19, but the clinical significance of these findings remains unknown.”
Myocarditis related to COVID-19 is most common in young men and teenage boys, for reasons not fully understood, Dr. Al-Kindi says.
“There may be some hormonal changes that are implicated,” he says. “But it can happen to anybody. We're learning more and more. COVID-19 offers the opportunity to study the natural history of myocarditis systematically.”
While some people may not know they have myocarditis, others experience symptoms such as chest pain, heart palpitations or irregular heartbeat, or signs of congestive heart failure (shortness of breath or leg swelling). Sometimes the inflammation leads to congestive heart failure.
“Symptoms such as these lead to series of tests that will determine whether a patient has myocarditis,” Dr. Al-Kindi says. “Typically, there would be an EKG and echocardiogram (ultrasound images of the heart). Cardiac MRI is sometimes used for confirmation and to rule out alternative diagnosis.”
Some patients are treated with drugs such as ACE inhibitors and beta blockers. Doctors will also discuss with patients exercise restriction for a time because it may trigger heart rhythm problems, Dr. Al-Kindi says.
The vast majority of patients with myocarditis recover completely. Rarely, in severe cases, the heart's diminished pumping ability requires mechanical pumps or transplantation.
With regard to rare cases of myocarditis linked to COVID-19 vaccination, Dr. Al-Kindi says the risk is extremely small and benefit of vaccination vastly outweighs the risk. Myocarditis should not deter people from getting vaccinated.
Myocarditis after COVID-19 vaccination is extremely rare, and is typically mild and short duration. COVID-19, however, can lead to several heart and lung conditions.