LOUIS, Mo. (AP) — Firefighter and paramedic Mike Camilleri used to have no problem carrying the equipment’s heavy ladders. He now has long covid, and cautiously gets on a treadmill to see how his heart performs on a simple walk.
“This is not some kind of test for super strong guys, so don’t pretend,” warned Beth Hughes, a physical therapist at Washington University in St. Louis.
Somehow, a moderate case of covid-19 set off a chain reaction that ultimately left Camilleri with dangerous spikes in his blood pressure, a heart rate that sped up on exertion, and bouts of intense chest pain.
He is far from the only one. The magnitude of the havoc that Covid-19 has wreaked on Americans’ heart health is only beginning to emerge, years after the pandemic began.
“We’re seeing effects on the heart and the vascular system that unfortunately really outnumber the effects on other organ systems,” said Dr. Susan Cheng, a cardiologist at Cedars-Sinai Medical Center in Los Angeles.
It is not only a problem for patients with long covid like Camilleri. For up to a year after being infected with Covid-19, people may be at increased risk of developing a new heart-related problem, which can range from blood clots and arrhythmias to a heart attack, even if they initially appear to have recovered well. .
Among the points that are unknown are: who is most likely to suffer from these sequelae? Are they reversible, or a warning sign of bigger heart problems later in life?
“We are about to emerge from this pandemic as an even sicker nation” from virus-related heart problems, said Dr. Ziyad Al Aly of Washington University, who helped sound the alarm about persistent health problems related to the covid-19. The consequences, he added, “will likely reverberate for generations.”
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Heart disease has long been the leading cause of death in the nation and the world. But in the United States, heart-related deaths had fallen to record levels in 2019, just before the pandemic struck.
Covid-19 wiped out a decade of those gains, Cheng noted.
Deaths from heart attacks increased during each of the coronavirus upsurges. Worse, young people aren’t supposed to have heart attacks, but Cheng’s research documented a nearly 30% increase in heart attack deaths in people ages 25 to 44 in the first two years of the pandemic.
Here’s a troubling hint that the problems could continue: High blood pressure is one of the biggest risks for heart disease, and “in fact, people’s blood pressure has gone up considerably over the course of the pandemic,” he added. .
Cardiovascular symptoms are part of what is known as long covid, a general term that encompasses dozens of health problems, including fatigue and mental confusion. The National Institutes of Health is starting small studies of some possible treatments for certain symptoms of long covid, including a heart rhythm problem.
But Cheng said both patients and doctors need to know that cardiovascular problems are sometimes the first or main symptom of damage from the coronavirus.
“These are individuals who wouldn’t necessarily go to their doctor and say, ‘I have long covid,'” he said.
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In San Luis, Camilleri first developed shortness of breath and then a series of heart-related and other symptoms after contracting Covid-19 in late 2020. He tried different treatments with various doctors without improvement, until it was to give to the long covid clinic at Washington University.
“Finally, a turn in the right direction,” said Camilleri, 43.
There she consulted Dr. Amanda Verma because of worsening problems with her blood pressure and heart rate. Verma is part of a cardiology team that studied a small group of patients with puzzling heart symptoms like Camilleri’s, and found that blood flow abnormalities could be part of the problem.
How does that happen? Blood flow increases when people move and decreases during rest. But some long-Covid patients don’t slow down enough during rest because the “fight-or-flight” response system, which controls stress reactions, remains activated, Verma said.
Some also have problems with the lining of their small blood vessels, which don’t dilate and constrict properly to move blood, he added.
Hoping that would help explain some of Camilleri’s symptoms, Verma prescribed some heart medications that dilate blood vessels and others to pacify that “fight-or-flight” response.
Back at the gym, Hughes, a physical therapist who works with long-Covid patients, laid out a careful rehabilitation plan after a treadmill test revealed erratic spikes in Camilleri’s heart rate.
“They would be worse if you weren’t taking Dr. Verma’s meds,” Hughes said, showing Camilleri exercises to perform while he lay on the floor and his pulse was monitored. “We need to reconfigure your system” to normalize that “fight or flight” response, he added.
Camilleri said he noticed some improvement after Verma made some modifications to the recipes based on test results. But then a second Covid-19 infection in the spring led to even more health problems, a disability that forced him into retirement.
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How big is the risk of heart problems after getting covid? To find out, Al Aly pored over medical records from a huge Veterans Health Administration database. People who had survived Covid-19 in the early stages of the pandemic were more likely to experience arrhythmias, blood clots, chest pain and palpitations, and even heart attacks and strokes, up to a year later than those who had survived. they had not been infected. That includes even middle-aged people who had no previous signs of heart disease.
Based on those findings, Al Aly estimated that 4 out of 100 people require care for some type of heart-related symptom in the year after they recover from Covid-19.
Per person, that’s a minor risk. But he said the sheer enormity of the pandemic means millions of people were left with at least some cardiovascular symptoms. Although reinfection could still cause problems, Al Aly is now studying whether the overall risk has been lowered by vaccinations and milder strains of the coronavirus.
More recent research confirms the need to better understand and care for these cardiac sequelae. An analysis this spring of a large database of US insurers found that long-Covid patients were twice as likely to seek medical care for cardiovascular problems, including blood clots, arrhythmias or strokes in the year after infection, compared to similar patients who did not get covid-19.
That there’s a link to post-contagion heart damage isn’t all that surprising, Verma noted. She mentioned rheumatic fever, an inflammatory reaction to untreated strep throat—especially before antibiotic use was common—that scars heart valves.
“Is this going to become the next rheumatic heart disease? We don’t know,” he said.
But Al Aly says there’s a simple message to take home: You can’t change your history of Covid-19 infections, but if you’ve ignored other heart risks — like high cholesterol or blood pressure, poorly managed diabetes or smoking—now is the time to change that.
“These are the things we can do something about. And I think they’re more important now than they were in 2019,” he said.
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