This week’s article will discuss the cardiovascular complications of COVID-19. We are still learning about how the virus affects the heart and circulatory system. For those interested in more information about the studies mentioned in this article or other current information as it becomes available, I suggest going to idsociety.org. This is the website for the Infectious Diseases Society of America. There is a wealth of information compiled on this website.
COVID-19 Cardiovascular Consequences
Most people with COVID-19 will not experience any clear cardiovascular symptoms. However there is a significant number of people who have suffered from cardiovascular consequences of being infected with SARS-CoV-2. Studies have also revealed that many who have been infected will have evidence of cardiovascular involvement during or after their illness as demonstrated on electrocardiograms, laboratory studies, or imaging of the cardiovascular system.
There is a wide spectrum of effects that SARS-CoV-2 has on the cardiovascular system. Many aspects of the cardiovascular system can be affected with different levels of severity. Signs and symptoms range from fatal irregular heart rhythms to people who have had minimal COVID-19 symptoms but have evidence of cardiovascular damage.
Studies have shown that even young healthy individuals can have cardiovascular effects from their COVID-19 illness. One large study of college athletes showed that 2.3% had evidence of myocarditis. The Big Ten COVID-19 Cardiac Registry investigators collected data prior to vaccinations being available from March 1, 2020, through December 15, 2020 on 1597 athletes with COVID-19.
Athletes who had COVID-19 in the BIG10 had an MRI of their heart and information on their symptoms were collected. Based on the cardiac magnetic resonance imaging studies 2.3% of the athletes had evidence of myocarditis. Of note most did not have severe COVID-19 symptoms and many did not ever have clear symptoms of myocarditis.
This study raised concerns that young athletes could suffer cardiac damage from COVID-19 and that checking symptoms alone would not be an adequate way of determining who and when athletes could return to competition. A limitation of this study was that most of these athletes did not have an MRI done prior to having COVID-19 and they could have had preexisting cardiac damage. It is however reasonable to think that most division I college athletes would have very healthy hearts .
Another study of athletes was conducted through October of 2020 who had tested positive for COVID-19. These athletes were in professional sports leagues that required cardiac testing prior to allowing individuals who had tested positive to return to play (Major League Soccer, Major League Baseball, National Hockey League, National Football League, and the men’s and women’s National Basketball Association). To make sure these athletes were healthy enough to return to play a basic set of screening tests were conducted with follow up testing for those who had abnormal screening tests. Data collected from these screening programs showed that 3.8% of the professional athletes had evidence of potential cardiac complications.
Kids who have COVID-19 are at risk for cardiovascular complications including myocarditis. An analysis published in the MMWR looked at data from 900 hospitals through January of 2021. They concluded that for kids under the age of 16, those who had COVID-19 were 37 times more likely to have myocarditis than the kids who did not have COVID-19.
Many of the more severe consequences of COVID-19 may be related to the direct and/or indirect effects that the virus has on blood and blood vessels. We are still learning the how’s, the why’s and the how much about the involvement that blood and blood vessels play in COVID-19. Some scientists point to research that focuses on the lining of our blood vessels.
Our blood vessels are lined with a thin layer of cells. This lining is called the vascular endothelium. The role of the endothelium is huge. It is in direct contact with everything in our blood and plays an active role in regulating blood vessel and blood cell function.
The vascular endothelium that lines our blood and lymphatic vessels is thought by some of us to be the “largest” organ in the body. It has been said that if you stripped away all of the vascular endothelium in your body and rolled it up into a ball in your hands it would be about the size of a tennis ball and weigh about half as much as a tennis ball. However, if you laid out the vascular endothelium in a flat sheet it would cover about 10 tennis courts.
Mess with the vascular endothelium and you are going to have problems.
Information presented is intended to provide a medical perspective - the articles are not intended as a political statement for or against any public policy. Statements in these articles should be considered coming from myself, not from any organization I represent or my employer. Russ Coash, PA-C
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