Long COVID patients have reported more than 200 symptoms across 10 organ systems. While all symptoms can be serious and are important to investigate, the impact on vital organs, like the heart, are of most concern. The heart doesn’t easily mend after damage, and the long-term implications can be dire.
The micromorts you discussed in your "Understanding Risk" post really helped me get perspective on the risks of getting COVID, to the point where I was considering giving up my "extreme social distancing," but I wanted to hear what you had to say about long COVID first. Now, I'm worried that we're in it for the long haul... but if micromorts for these long COVID heart and brain risks were available (knowing that they would only be based on the minimal info we have so far, which is better than nothing), perhaps it would help put my fears in check, even if only ever so slightly. Last but definitely not least, THANK YOU SO MUCH from the bottom of my heart for helping us all make truly informed decisions, not decisions based on sound bites in the news, which often seems only marginally better than the info on social media.
A comment not about this article: I would appreciate hearing your take on the latest variant BA.2. Seeing contradictory things on Twitter from the virologists, etc.
I started viewing COVID-19 as a primary vascular process perhaps 6 or 8 months ago (I'd have to go to my notes). Yes, the heart does have ACE2 receptors, but the vessels do, as well, and angiotensin II has a pronounced effect on alpha adrenergic effect overall, hence the use of ARBs and ACE inhibitors for hypertension.
Of some interest, vascular changes in the lungs are believed responsible for the changes we saw in the COVID pneumonias. With "traditional" ARDS, and mechanical ventilation, we used higher pressure to "recruit" damaged or fluid-filled alveoli, but found this didn't work (we saw barotrauma in undamaged alveoli but no real evidence of recruitment of the diseased portions of the lung). Autopsy results also showed the affected alveoli were filled with a near-gel consistency fluid rather than a more liquid serous fluid, and the alveolar capillaries showed evidence of increased viral infiltration.
And, recall that angiotensin is also secreted in the kidney as an active element of the renin-angiotensin-aldosterone system. Autopsy results have shown increased viral load in kidney and liver tissue as well as gut vasculature.
None of this directly explains the spectrum of symptoms of COVID, especially in its long-term manifestation but it does help paint a picture of a much more complicated disease than a "simple" respiratory virus.
I'm an OB and wish to convey my thanks at these posts and comments. When faced with patients who will not protect themselves, even when faced with overwhelming evidence that they are risking themselves and their unborn child, it is refreshing to just read the data. Exhaustion with our vaccine belligerent patient population is real.
Having a 19 y/o college swimmer granddaughter with heart inflammation after getting Covid (pre vaccination), this has been very helpful, as are all your articles.
Would like you to comment after this series on the China surge presently going on. Is this a new variant that we can look forward to?
This is timely. A relative was recently treated for dysrhythmia. He had a moderate case of COVID prior to the vaccine (no medical treatment needed). But he also had other health problems prior to the pandemic - which is why we were so relieved that his case was moderate - and has close relatives who had dysrhythmia issues before the pandemic. So who knows what is behind his symptoms? We likely will never know, but your post helps explain the larger picture in a very clear way.
Thank you so much for all of these newsletters. I am new to the subscription so I am trying to catch up, but I am so grateful for your work. I have a 3 year old that I am having a hard time assessing risk for. His father has an undiagnosed (he has had genetic testing) blood-clotting disorder (he has had 3 separate clots) for which he now takes blood thinners daily. His family has a history of vein-heath problems--is sister had surgery for very large varicose veins, and his father, deep vein thrombosis. I am worried that if my 3 year old has inherited any blot/vein disorder he may be at higher risk if he gets Covid. Also, his pediatrician recently, at his 3-year well-check, discovered he has a heart murmur. She was not concerned but recommended he see a specialist. He will be seeing a pediatric cardiologist at the end of the month. We homeschool and work from home so we are able to control our risk. My sister and her husband and 3 kids are coming from Montana to visit my parents in Wisconsin next week (both areas are yellow on the CDC's new map). We would like to see them too, as we live close to my parents. None of my extended family are masking anywhere anymore except the hospital and they will mask on the plane. I don't know if we should see them indoors without masks/eat meals with them. It feels like testing is less accurate with Omicron too. Everyone in my extended family seems to have moved on from the pandemic and I still feel scared and uncertain for my little unvaccinated guy who may (or may not) be at higher risk. They think I am over-reacting, they don't want to be the only ones wearing masks in social situations prior to our visiting. I know we are all so tired of figuring out what feels like the right thing to do. Any guidance or reassurance from anyone to make me feel less crazy? Thank you so SO much for all you do. I am so grateful.
Is there anything in the study regarding vaccine status and long-term cardiac implications? (I'm not a medical person, though I see a lot of you are who comment. Reading the study is just not within my skill set, so if anyone sees it addressed in it, I would appreciate it. I know some people who got covid after being vaccinated and are wondering.)
I also read this study tonight of 10 patients reporting exercise intolerance (shortness of breath, muscle weakness) 1 year after Covid to be troubling as well.
Cardiac and pulmonary function in these patients was normal, unlike the many you've cited here with cardiac pathology.
Instead, they found a marked decrease in oxygen extraction and aerobic capacity (VO2) at the level of the muscle tissue. Direct muscle damage, perhaps endothelial damage, I didn't read the whole Chest study - but the gist is, once again, long Covid is a multifaceted beast.
Great explanation. But today, I am So concerned about the Fl DOH coming out yesterday advising parents not to get their child vaccinated. I understand a small number of kids (usually males) getting myocarditis with the vaccine, but there are also kids having long COVID and heart issues from COVID. Please comment on this. Thank you for all you do to help us understand.
First, recall that Dr. Lapado has been a vocal critic of almost every bit of science-based guidance developed regarding COVID. That he's directed the Dept of Health to renounce pediatric vaccinations is rather sad, but not unexpected. The absolute number of pediatric myocarditis cases is likely alarming to the public, and has been used to provide a foil against vaccination for awhile, but despite rising numbers, we know that, statistically, the number is exceedingly small, and that the vast majority recover in a matter of days to a normal state. At this point, we do need more research on vaccination for younger children, and the potential exists that Pfizer's dose selection was not sufficient to initiate a solid immune response... or there are other issues at play. In fact, as Katelyn points out the incidence of myocarditis is much higher in kids who had COVID than in the vaccinated population, and those who suffered from COVID and subsequent myocarditis were less likely to have an uncomplicated course.
I still think universal vaccination will be our best bet to overcome SARS-CoV-2 in the long run. That means vaccines for all age groups, mandating COVID vaccination as part of the standard immunizations including for school. I was warned today that such opinions in public health are now seen as condescending and paternalistic, but I see it as a critically determined, evidence-based result.
Thank you for your thoughts. It really is a BIG FAT mess. For pediatricians - advising parents is getting so complicated! With Dr. Google and so much mis-information - it is really tough. The news media blows everything up making it sound like the majority of kids getting the vaccine will get very sick and have permanent heart damage. The facts are different - you are absolutely correct. A number of my friends are now saying "I told you so! I knew this vaccine was poison for myself and my kids!". UGGHHHHH. I really feel terrible for all docs trying to explain this to their patients.
My patients all warn me about the medical care they receive in Florida. A great place to go for humid weather, Mickey Mouse, and fantasy worlds in general. But the relative risk of harm from vaccination in kids versus benefit, even if diluted and less than we had hoped for, still tilts strongly towards vaccination. I'm ashamed of this Dr.'s political advice. Hoping to get my kid a booster, not questioning the value of the 2 shots she's received.
wondering the health of the "Had an infection" vs the "didn't have an infection" were the same. If those getting an infection had comorbidity's it would skew the results.
I wondered that myself, but the question seemed to be addressed. From Dr. Jetelina's post: "Heart outcomes were elevated among the infected regardless of age, race, sex, obesity, smoking, high blood pressure, diabetes, high cholesterol, or having a pre-existing heart problem."
It is saying that those who were infected with Covid and did NOT have the pre-existing conditions were just as likely to have a negative heart outcome. That is the remarkable aspect. For example (I don't know the actual numbers, so this is just an illustration) if 7/10 patients with a comorbidity ended up with a negative heart outcome several weeks/months after infection, and 7/10 patients with no comorbidity also ended up with a negative heart outcome several weeks/months after infection, the main causative factor would be assumed to be the infection.
The micromorts you discussed in your "Understanding Risk" post really helped me get perspective on the risks of getting COVID, to the point where I was considering giving up my "extreme social distancing," but I wanted to hear what you had to say about long COVID first. Now, I'm worried that we're in it for the long haul... but if micromorts for these long COVID heart and brain risks were available (knowing that they would only be based on the minimal info we have so far, which is better than nothing), perhaps it would help put my fears in check, even if only ever so slightly. Last but definitely not least, THANK YOU SO MUCH from the bottom of my heart for helping us all make truly informed decisions, not decisions based on sound bites in the news, which often seems only marginally better than the info on social media.
A comment not about this article: I would appreciate hearing your take on the latest variant BA.2. Seeing contradictory things on Twitter from the virologists, etc.
I started viewing COVID-19 as a primary vascular process perhaps 6 or 8 months ago (I'd have to go to my notes). Yes, the heart does have ACE2 receptors, but the vessels do, as well, and angiotensin II has a pronounced effect on alpha adrenergic effect overall, hence the use of ARBs and ACE inhibitors for hypertension.
Of some interest, vascular changes in the lungs are believed responsible for the changes we saw in the COVID pneumonias. With "traditional" ARDS, and mechanical ventilation, we used higher pressure to "recruit" damaged or fluid-filled alveoli, but found this didn't work (we saw barotrauma in undamaged alveoli but no real evidence of recruitment of the diseased portions of the lung). Autopsy results also showed the affected alveoli were filled with a near-gel consistency fluid rather than a more liquid serous fluid, and the alveolar capillaries showed evidence of increased viral infiltration.
And, recall that angiotensin is also secreted in the kidney as an active element of the renin-angiotensin-aldosterone system. Autopsy results have shown increased viral load in kidney and liver tissue as well as gut vasculature.
None of this directly explains the spectrum of symptoms of COVID, especially in its long-term manifestation but it does help paint a picture of a much more complicated disease than a "simple" respiratory virus.
I'm an OB and wish to convey my thanks at these posts and comments. When faced with patients who will not protect themselves, even when faced with overwhelming evidence that they are risking themselves and their unborn child, it is refreshing to just read the data. Exhaustion with our vaccine belligerent patient population is real.
Having a 19 y/o college swimmer granddaughter with heart inflammation after getting Covid (pre vaccination), this has been very helpful, as are all your articles.
Would like you to comment after this series on the China surge presently going on. Is this a new variant that we can look forward to?
This is timely. A relative was recently treated for dysrhythmia. He had a moderate case of COVID prior to the vaccine (no medical treatment needed). But he also had other health problems prior to the pandemic - which is why we were so relieved that his case was moderate - and has close relatives who had dysrhythmia issues before the pandemic. So who knows what is behind his symptoms? We likely will never know, but your post helps explain the larger picture in a very clear way.
Thank you so much for all of these newsletters. I am new to the subscription so I am trying to catch up, but I am so grateful for your work. I have a 3 year old that I am having a hard time assessing risk for. His father has an undiagnosed (he has had genetic testing) blood-clotting disorder (he has had 3 separate clots) for which he now takes blood thinners daily. His family has a history of vein-heath problems--is sister had surgery for very large varicose veins, and his father, deep vein thrombosis. I am worried that if my 3 year old has inherited any blot/vein disorder he may be at higher risk if he gets Covid. Also, his pediatrician recently, at his 3-year well-check, discovered he has a heart murmur. She was not concerned but recommended he see a specialist. He will be seeing a pediatric cardiologist at the end of the month. We homeschool and work from home so we are able to control our risk. My sister and her husband and 3 kids are coming from Montana to visit my parents in Wisconsin next week (both areas are yellow on the CDC's new map). We would like to see them too, as we live close to my parents. None of my extended family are masking anywhere anymore except the hospital and they will mask on the plane. I don't know if we should see them indoors without masks/eat meals with them. It feels like testing is less accurate with Omicron too. Everyone in my extended family seems to have moved on from the pandemic and I still feel scared and uncertain for my little unvaccinated guy who may (or may not) be at higher risk. They think I am over-reacting, they don't want to be the only ones wearing masks in social situations prior to our visiting. I know we are all so tired of figuring out what feels like the right thing to do. Any guidance or reassurance from anyone to make me feel less crazy? Thank you so SO much for all you do. I am so grateful.
Is there anything in the study regarding vaccine status and long-term cardiac implications? (I'm not a medical person, though I see a lot of you are who comment. Reading the study is just not within my skill set, so if anyone sees it addressed in it, I would appreciate it. I know some people who got covid after being vaccinated and are wondering.)
Nope, this study was conducted almost entirely before vaccination was available
Good summary!
I also read this study tonight of 10 patients reporting exercise intolerance (shortness of breath, muscle weakness) 1 year after Covid to be troubling as well.
Cardiac and pulmonary function in these patients was normal, unlike the many you've cited here with cardiac pathology.
Instead, they found a marked decrease in oxygen extraction and aerobic capacity (VO2) at the level of the muscle tissue. Direct muscle damage, perhaps endothelial damage, I didn't read the whole Chest study - but the gist is, once again, long Covid is a multifaceted beast.
https://journal.chestnet.org/article/S0012-3692(21)03635-7/fulltext
If it is causing issues with vascular elasticity, is there any increase in high blood pressure?
Great explanation. But today, I am So concerned about the Fl DOH coming out yesterday advising parents not to get their child vaccinated. I understand a small number of kids (usually males) getting myocarditis with the vaccine, but there are also kids having long COVID and heart issues from COVID. Please comment on this. Thank you for all you do to help us understand.
First, recall that Dr. Lapado has been a vocal critic of almost every bit of science-based guidance developed regarding COVID. That he's directed the Dept of Health to renounce pediatric vaccinations is rather sad, but not unexpected. The absolute number of pediatric myocarditis cases is likely alarming to the public, and has been used to provide a foil against vaccination for awhile, but despite rising numbers, we know that, statistically, the number is exceedingly small, and that the vast majority recover in a matter of days to a normal state. At this point, we do need more research on vaccination for younger children, and the potential exists that Pfizer's dose selection was not sufficient to initiate a solid immune response... or there are other issues at play. In fact, as Katelyn points out the incidence of myocarditis is much higher in kids who had COVID than in the vaccinated population, and those who suffered from COVID and subsequent myocarditis were less likely to have an uncomplicated course.
I still think universal vaccination will be our best bet to overcome SARS-CoV-2 in the long run. That means vaccines for all age groups, mandating COVID vaccination as part of the standard immunizations including for school. I was warned today that such opinions in public health are now seen as condescending and paternalistic, but I see it as a critically determined, evidence-based result.
Thank you for your thoughts. It really is a BIG FAT mess. For pediatricians - advising parents is getting so complicated! With Dr. Google and so much mis-information - it is really tough. The news media blows everything up making it sound like the majority of kids getting the vaccine will get very sick and have permanent heart damage. The facts are different - you are absolutely correct. A number of my friends are now saying "I told you so! I knew this vaccine was poison for myself and my kids!". UGGHHHHH. I really feel terrible for all docs trying to explain this to their patients.
My patients all warn me about the medical care they receive in Florida. A great place to go for humid weather, Mickey Mouse, and fantasy worlds in general. But the relative risk of harm from vaccination in kids versus benefit, even if diluted and less than we had hoped for, still tilts strongly towards vaccination. I'm ashamed of this Dr.'s political advice. Hoping to get my kid a booster, not questioning the value of the 2 shots she's received.
Oh - GREAT IN YET AGAIN
Yep, that's how I felt when I first started reading it.
wondering the health of the "Had an infection" vs the "didn't have an infection" were the same. If those getting an infection had comorbidity's it would skew the results.
I wondered that myself, but the question seemed to be addressed. From Dr. Jetelina's post: "Heart outcomes were elevated among the infected regardless of age, race, sex, obesity, smoking, high blood pressure, diabetes, high cholesterol, or having a pre-existing heart problem."
So how does that effect the results - wouldn't it be unremarkable for the preexisting cardiac patients to have a cardiac issue after COVID?
It is saying that those who were infected with Covid and did NOT have the pre-existing conditions were just as likely to have a negative heart outcome. That is the remarkable aspect. For example (I don't know the actual numbers, so this is just an illustration) if 7/10 patients with a comorbidity ended up with a negative heart outcome several weeks/months after infection, and 7/10 patients with no comorbidity also ended up with a negative heart outcome several weeks/months after infection, the main causative factor would be assumed to be the infection.
Thank you for the clarification. I did not get that. Have a wonderful day and sheeeshhh... Stay safe.