How The Coronavirus Attacks The Heart
International Journal of Cardiology
The coronavirus SARS-Cov-2 can cause severe organ damage in humans. Heart complications are one of the possible consequences of an infection. In addition, the virus also attacks the heart directly, can cause myocarditis and lead to heart failure. Dr. Nazha Hamdani, head of the research department for molecular and experimental cardiology at the Bochum university hospital, has tracked the journey of the virus in detail.
She and her group have found that SARS-Cov-2 infects human cardiac muscle cells, and that this infection is primarily fueled by inflammation and oxidative stress. This occurs mainly in patients with comorbidities such as obesity, diabetes and hypertension. The International Journal of Cardiology has published an article on these findings.
Virus detected in heart cells
In order to track down the new entry mechanism, the research team at the university hospital used histochemical methods and microscopy to analyze heart tissue structures from patients suffering from COVID-19 and those who died from or with the disease. In a first step, they provided evidence that the virus can indeed be detected directly in the cells of the heart muscle. “Our observations show that the virus exerts pressure on the heart muscle, attacks and weakens the contractile force, i.e., the pumping function of the heart,” says Hamdani.
The key role of inflammation and oxidative stress
The Resulting Inflammation Can Cause Debilitating Pain And May Damage Different Parts Of The Heart
People with certain heart valve problems should take antibiotics before dental procedures to lower their risk of endocarditis.Image: Monkey Business Images/Thinkstock
Nestled deep in the chest and covered in a protective layer of tissue, your heart usually fends off infections. But bacteria and viruses in the blood occasionally invade the heart, creating inflammation and other problems. Often, these problems are short-lived and relatively benign. But sometimes, the infection and resulting inflammation are more worrisome.
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Signs And Symptoms Of Myocarditis
Because viruses and bacteria are often passed from mother to baby during birth, newborns are at a higher risk for myocarditis than other age groups. Symptoms tend to be more severe in infants, and can include:
- Pale, cool hands and feet
Some children have a recognizable sickness, such as the flu or chickenpox, before symptoms of myocarditis appear. In other cases children are not noticeably sick before symptoms appear.
Older children may also experience chest pain or heart palpitations and feel unusually tired. Sometimes there are no symptoms or they are very mild.
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How Can I Reduce My Risk Of A Heart Infection
You may not be able to prevent a heart infection, but you can lower your risk by staying healthy. Steps you can take include:
- Avoid contact with people with viral infections.
- Get recommended vaccines, including for COVID-19 and the flu vaccines.
- Not using recreational drugs.
- Shortness of breath or difficulty breathing.
How Do Viruses Trigger Heart Damage
Dr. Slava Epelman is deciphering immune reactions that can lead to heart failure
When you catch a virus like a cold or stomach bug, you usually recover quickly. But sometimes viral infections can have devastating consequences.
Ashley and Frank Greco of London, Ont., were shattered when their newborn son, Emmett, died suddenly from myocarditis, an inflammation of the heart muscle. He was only eight days old. While its not clear how Emmett developed myocarditis, it is often triggered by a viral infection.
Since that tragedy, the couple have organized a walk to raise awareness of myocarditis and to raise funds for research towards a cure.
Dr. Slava Epelman is a Heart & Stroke researcher working to understand how and why some viral infections lead to heart damage, so stories like Emmetts could be prevented.
Immune cells have different jobs
Dr. Epelmans team discovered that immune cells have different roles when the heart is attacked by a virus. Some cells work to repair tissue damaged by the infection, while others fight off infection.
But these fighting cells may actually contribute to further damage by causing inflammation in surrounding tissue, even after a virus has been cleared. This results in myocarditis symptoms such as shortness of breath, exhaustion and feeling weak, which can linger for weeks, or even months.
Its a fine balance and were trying to understand it.
Dr. Slava Epelman Heart & Stroke researcher
Babies at highest risk
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Heart Problems After Covid
For people who have had COVID-19, lingering COVID-19 heart problems can complicate their recovery.
Some of the symptoms common in coronavirus long-haulers, such as palpitations, dizziness, chest pain and shortness of breath, may be due to heart problems or, just from having been ill with COVID-19. How do you tell if your symptoms are heart-related, and what can you expect if they are?
Johns Hopkins cardiologists Wendy Post, M.D., and Nisha Gilotra, M.D., clarify which post-coronavirus symptoms may point to a heart issue, when to call your doctor, and other facts all long-term COVID-19 survivors should know.
How Is Myocarditis Diagnosed
Sometimes symptoms may go away on their own, so a diagnosis wont be needed.However, if symptoms dont go away you may need tests such as:
- an electrocardiogram to check for an abnormal heart rhythm, if you have experienced palpitations
- a chest X-ray, to check for fluid in or around the heart
- an echocardiogram , if your doctor is concerned there may be heart muscle damage
- blood tests to check for infection.
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What Should One Keep In Mind Regarding Heart Muscle Inflammation
With heart muscle inflammation it is particularly important to rest. This pertains not only to sport/exercise, but also to daily household activities. Without sufficient rest, long-term consequences for the heart valves and muscle may arise. A physician should decide when it is permissible for a patient to return to full activity, which can be sometimes take weeks.
When heart muscle inflammation is due to bacteria, medications can help in the treatment. On the contrary, inflammation due to viruses can most often not be treated with medications.
Approximately half of those affected fully recover. The other half remains with long-term side effects, such as a considerable decrease in ones overall state of health.
Cytokine Storm: A Serious Coronavirus Complication
Most serious of all, Gilotra says, is the possibility of the immune system launching an attack on the invading virus that is so severe that it destroys healthy tissues.
When responding to infection with the coronavirus, the body releases a flood of proteins called cytokines that help cells communicate with one another and fight the invaders.
In some people, perhaps due to a genetic difference, this normal defensive event is exaggerated, leaving them vulnerable to a cytokine storm. In a cytokine storm, the immune system response causes inflammation that can overwhelm the body, destroying healthy tissue and damaging organs such as the kidneys, liver and heart.
A cytokine storm and its resulting heart damage can also affect the hearts rhythm. Serious ventricular arrhythmias due to a cytokine storm can be catastrophic, Gilotra says.
A cytokine storm is difficult to survive. Current research is exploring the possible benefit of using immune-suppressing drugs to treat patients with COVID-19 who experience this serious complication.
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What Are The Types Of Heart Infections
There are three primary types of heart infections, all of which can cause various symptoms. There are three primary types of heart infections, also known as cardiac infections, all of which can cause various symptoms.
Diagnosing heart infections or any heart issue may include:
- echocardiogram, which is an ultrasound scan of the heart
- electrocardiogram, which tests the electrical activity of the heart
How Is Myocarditis Treated
Treatment for myocarditis usually depends on the cause. It can involve close monitoring and medication, including anti-inflammatory medicines and antibiotics.
In long term cases myocarditis can affect your heart muscle and tissue, meaning you could develop heart failure. If the damage is severe you may need a heart transplant.
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How Is A Heart Infection Diagnosed
To help diagnose your condition, your healthcare provider will ask about your symptoms and family history. Your provider will listen to your heart with a stethoscope to check for a heart murmur. You may have:
- Blood tests: Blood samples show the levels of inflammatory proteins in your blood. Higher-than-usual levels of inflammatory proteins can indicate active inflammation in your heart muscle. For certain infections, they can also show whether youve developed antibodies against viruses that may cause an infection. Blood tests may also show elevated white blood cell counts to identify signs of infection.
- Chest X-ray: Your healthcare provider can see changes to the shape and size of your heart. They can also look for swelling or excess fluid.
- CT scan or magnetic resonance imaging : Your provider can view images of your heart to look for inflammation, thickening or other changes.
- Cardiac catheterization/heart biopsy: In some instances, your provider inserts a small tube into your vein to reach your heart. They may take a sample of heart muscle tissue to look for a heart infection or inflammation.
The Rise Of A Rare Heart Condition
What is myocarditis? How is it linked to COVID-19? And why is it a concern for athletes? A Carolina researcher explains.
One of the more concerning side effects of COVID-19 infection is myocarditis a once rare condition of inflammation of the heart, leading to scar tissue build-up and a weakening of the heart. A study published last month in The Journal of the American Medical Association found that 60% of participants who had recovered from mild or moderate COVID-19 infections had evidence of myocarditis.
While most cardiovascular conditions are associated with older populations, myocarditis most often affects otherwise healthy, young, athletic types.
What is myocarditis and how is it linked to COVID-19? Why should athletic individuals be concerned? The Well spoke with myocarditis researcher Silvio Antoniak, assistant professor of pathology in the School of Medicines Blood Research Center, to learn more.
What is myocarditis and how is it linked to viral infection?
Why is viral myocarditis a concern for athletes?
At least for pre-COVID-19 myocarditis research, the incidence of viral myocarditis was shown to be higher in younger people, from puberty to 30 years of age. The incidence in males was higher than females. One thing we can say is the female sex hormones protect against myocarditis or reduce the risk.
That is correct.
Before COVID-19, how much of a concern was viral myocarditis for athletes?
Is there a link between COVID-19 and myocarditis?
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Viral Mechanisms Of Myocardial Damage
The direct effects of virus mediated toxicity include focal necrosis of myocytes in the absence of an inflammatory cell infiltrate within three days of infection. At the same time as NK cells, protective antiviral antibodies and infiltrating macrophages begin to clear the virus from the myocardium, with or without the aid of cytokines. Despite these defence mechanisms, acute viral replication maydepending on the circumstances of the patientcause rapid and severe cardiac decompensation. In experimental models of myocarditis the virulence of cardiotropic viruses is increased by malnutrition, age, and exercise. A study of animals forced to perform regular physical exercise following infection with a cardiotropic virus showed an increase in cardiac necrosis and mortality. Sex hormone status also contributes to the outcome of viral infection of the heart, pregnancy being a particularly potent predisposing factor. The most important factor, though, is immune status. If the initial immune response is ineffective and the virus is not eliminated, chronic myocarditis can evolve, with the potential development of dilated cardiomyopathy.
How Can I Tell If I Have Developed A Heart Problem After Covid
In some people, heart rates can vary from fast to slow, unrelated to exertion, for no apparent reason. But, Post says, shortness of breath, chest pain or palpitations after having COVID-19 is a common complaint. Any of these problems could be related to the heart, but they could also be due to other factors, including the aftermath of being very ill, prolonged inactivity and spending weeks convalescing in bed.
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Treatment Of Viral Heart Disease
As soon there is a diagnosis of any kind of symptoms related to viral heart infection, the treatment for the same should be started. The medications mainly include the following:
- Antiviral drugs and agents to treat the overall body infection
- Anti-inflammatory drugs to reduce the inflammation of the heart muscles &
- Diuretics to remove surplus water from body cells and reduce edema
Whenever there is any problem in the heart the most important things recommended by doctors are changes in the lifestyle. Reducing strenuous activities and reducing salt intake is highly recommended. The doctor will prescribe drugs and agents which will heal up the weak heart muscles and arrhythmias of the heart. The overall treatment depends on how severe is the case and how severe are the symptoms.
What Are The Symptoms Of A Heart Infection
Heart infection symptoms vary from person to person, depending upon the disease. Many heart infections include these common symptoms:
Endocarditis is the only type of heart infection that has a heart murmur as a symptom. Your provider can hear a specific sound when blood flows through your heart. Less common symptoms of endocarditis include:
- Blood in your urine .
- Red or purple spots on your skin, inside your mouth or on the whites of your eyes .
- Red spots on the bottoms of your feet and palms of your hands .
- Red spots under the skin on your toes or fingers .
- Spleen tenderness.
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Viruses Are The Most Common Cause Of Myocarditis In Children Experts Offer Guidance
- Viral infection is the most common cause of inflammation in the heart muscle, called myocarditis, in children however, there remains a diverse array of infectious and non-infectious causes of myocarditis that should be considered in diagnosis.
- Myocarditis caused by a virus is more often seen in children than in adults, and children are more likely to have acute myocarditis rather than chronic myocarditis, which is more typically seen in adults.
- The emergence of COVID-19 has led to the description of a new multisystem inflammatory syndrome in children that can involve the heart muscle and heart arteries in some infected patients.
- The new scientific statement from the American Heart Association is helpful in guiding the diagnosis and treatment of myocarditis in children. And while not explicitly addressed, since this statement was in development prior to the COVID-19 pandemic, the statement is also useful in informing the clinical care of suspected cases of myocarditis after COVID-19 vaccination and myocarditis after COVID-19 infection, which have been reported primarily in teens and young adults.
Embargoed until 4 a.m. CT/5 a.m. ET Wednesday, July 7, 2021
Key guidance in the statement includes:
- After July 7, 2021, view the manuscript online.
- Follow AHA/ASA news on Twitter @HeartNews
- Follow news from the AHAs flagship journal Circulation@CircAHA
About the American Heart Association
Immune Mechanisms Of Myocardial Damage
In the immunocompetent patient, the immune response stimulated by viral proteins limits viral replication, and in the majority of patients clears the virus from the host. However, the immune response itself can cause damage to the myocardium, and the balance between beneficial and detrimental effects of the response significantly influences the extent of cardiac cell loss.
After viral invasion of the myocardium, the first wave of infiltrating immune cells consists of natural killer cells. NK cells are thought to have a cardioprotective effect by limiting virus replication. There is evidence in murine models of myocarditis that mice deficient in NK cell responses have a more severe myocarditis. NK cell infiltration is accompanied by the production of various cytokines including interleukin -1, tumour necrosis factor , interferon, and IL-2. These cytokines may have both beneficial and deleterious effects on myocardial function . Experimental studies have reported beneficial effects of IL-10 on survival and subsequent myocardial function in a murine model of myocarditis, and there are convincing data showing a detrimental effect of TNF in myocarditis. There are also recent data showing that the vasoconstrictor substance endothelin plays a role in the pathogenesis of myocarditis.
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Surgeries And Other Procedures
If pericarditis causes fluid build-up around the heart, a surgery or other procedure may be needed to drain the fluid.
Surgeries or other procedures to treat pericarditis include:
- Pericardiocentesis. In this procedure, a sterile needle or a small tube is used to remove and drain the excess fluid from around the heart.
- Removal of the pericardium . The entire pericardium may need to be removed if the sac surrounding the heart is permanently stiff due to constrictive pericarditis. This surgery is only rarely required.
Covid And The Heart: It Spares No One
Research now tells us that COVID doesnt discriminate when it comes to heart problems.
Interview by Stephanie Desmon
Until now, people who suffered mild or asymptomatic COVID-19 were thought to have dodged the brunt of the viruss brutal side effects. But new evidence has revealed that anyone infected with COVID is at higher risk for heart issuesincluding clots, inflammation, and arrhythmiasa risk that persists even in relatively healthy people long after the illness has passed.
In this Q& A, adapted from the of Public Health On Call, Ziyad Al-Aly, director of the Clinical Epidemiology Center and chief of Research and Education Service at Veterans Affairs St. Louis Health Care System, talks with Stephanie Desmon about COVID-19 and the heart, including his recent study, which found a significant risk of heart problems in people a year after being diagnosed with COVID.
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You just published a study that says that in some people whove had COVID, heart issues can persist for a year or more. What does this mean and what did you study?
We did this study to evaluate the one-year risk of heart problems in people who got COVID-19, compared to nearly 11 million controls of people who did not.
What did you find?
What’s going on in the body?
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