Elizabeth Llorente, MSN, Feb 23, 2022
Kim Kenny had all the telltale symptoms.
She battled fatigue, headaches and brain fog for months, a prototypical and debilitating case of long COVID after she contracted the coronavirus in March 2020.
But those symptoms masked something else. Something even more ominous.
"I also had tightness in the chest, but I hadn't noticed that or that my heart rate was out of control because the fatigue, headache and brain fog had overtaken everything," said Kenny, 26, a project manager for a theatrical lighting accessory manufacturer. "I didn't piece it together."
Then she paid a visit to Dr. David Landers, the associate director of the Heart & Vascular Hospital at Hackensack University Medical Center. Kenny, a former Jersey City resident who now lives in New York, was diagnosed with erratic heart rhythms and systemic vascular resistance - when the circulatory system needs to work harder than normal to push blood through the body.
"I was perfectly healthy before COVID," she said. "I was exercising every day. I was eating healthy."
Kenny is just one of the untold number of coronavirus patients who mysteriously developed cardiovascular disease weeks or even months after being diagnosed with COVID-19.
In fact, people who had the coronavirus are at high risk of developing heart and blood vessel issues as long as a year after being diagnosed with the virus, according to a new study.
Examining the medical records of more than 150,000 U.S. veterans who had been infected with COVID-19, researchers found patients who had contracted the virus had a far higher rate of cardiovascular problems within a year of their diagnosis than uninfected veterans.
The study appeared recently in Nature Medicine and is described as one of the first of its kind on the long-term health impact of COVID-19.
It just might suggest a looming cardiac crisis triggered by the coronavirus, according to experts.
While Kenny's case is not symbolic of many of the veterans in the study - who generally had mild COVID-19 cases, then felt fine, only to discover months later that they had heart disease - it does reveal that even young, healthy people face serious cardiovascular issues after a bout with the coronavirus.
"A very common story is that they'd feel fine [for a while] and then they'd come back with blood clots or a stroke or a heart attack, heart failure or inflammation," said Dr. Ziyad Al-Aly, a co-author of the study and chief of research and development for the Veterans Affairs St. Louis Health Care System as well as a clinical epidemiologist at Washington University.
"We found this in even people who had low risk or no risk of heart problems, including young adults, people who never smoked, who didn't have obesity or diabetes. Most of the infected veterans who had a higher risk of heart disease didn't have any problems before they got COVID."
The main takeaway, Al-Aly said, is COVID-19 should be considered a risk factor for heart disease, just like obesity and high blood pressure.
"Having COVID is tantamount to having a really significant risk for cardiovascular disease," Al-Aly said, "and it's important for the health care provider community to be aware of it when treating and evaluating these patients."
The study analyzed the medical records of more than 150,000 veterans who had contracted the coronavirus between the onset of the pandemic in early 2020 through January 2021. Their health was tracked through January of this year.
They were compared with two groups of veterans who had not suffered a known case of COVID-19: a group of 5 million who visited a VA medical facility during the pandemic, and another 5 million who had used the VA medical system in 2017.
Among the findings: The infected group was 52% more likely to have suffered a stroke and 72% more likely to have heart failure.
The risk held steady across gender, age, race and ethnicity - even among those who had only a mild COVID-19 case, Al-Aly noted. Veterans who developed a serious case showed a higher risk of heart disease.
"I went into it thinking that most likely the risk would be happening to people who were older, or who had risk factors like they smoked, had heart problems or diabetes, etc.," he said. "And what we learned is that it really doesn't matter if you're young, old, had diabetes or didn't. The risk was in all of the groups."
And almost as scary? The cardiovascular illness didn't always show up immediately, Al-Aly said.
"Some people had it six months, seven months, eight months, up to a year, after their infection," he added.
As with so much involving COVID, many unanswered questions remain. Why the heart? Why does the virus affect it as it does?
"It's most likely that SARS-CoV-2, the virus that causes COVID, is maybe attacking the heart in ways that produce these long-term manifestations and produce long-term damage," Al-Aly said. "How does it do that? It's still not very clearly understood. But what is 100% clear is that these heart issues are related to COVID."
Using the same groups of veterans, Al-Aly and other researchers are analyzing medical records to see what effect, if any, vaccination has had. COVID vaccines were not a factor in the first study, he said, because the shots became available to the broader public months after its analysis began.
But Kenny is another disturbing example that even the young and healthy are at significant risk. And if someone like her is, potentially thousands of Americans could be as well.
She is taking beta-blockers and an anti-inflammatory medication to ease her erratic heart rate and systemic vascular resistance.
"Systemic vascular resistance is where like your blood vessels got injured, so they work harder to move oxygen through your body," said Kenny, who remains under the care of Landers and Hackensack Meridian Health's COVID-19 Recovery Center.
For the time being, she is under orders not to engage in physical activity.
While Landers said the VA study findings are not surprising, "it's very, very important because it helps us understand the impact of COVID infections."
"We know that there are many patients - somewhere between 10% and 30% - who have had COVID and are still suffering. So the COVID phenomenon can be a durable one and persistent," he said.
"It's not just unique to the heart, but all tissues. There is concern that over time, we'll see diseases of the heart, the brain - dementia, Parkinson's - gastrointestinal disorders, heart failure."
At the same time, Landers added, people who experience such conditions should find solace in the many efforts worldwide to understand and respond to COVID-19 and its impact on health.
"Their suffering is being experienced by many in many nations," he said. "Knowledge is accumulating to identify the causes, which will result in more targeted, directed therapy. These studies are all ongoing, and I think there'll be breakthroughs coming in rather quick succession because of the terrible nature of this disease and the number of people who have it."
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