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Infection with COVID-19 can endanger the heart

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Doctor's Hand Checking Blood PressureIt was already known that people with pre-existing heart conditions such as hypertension (high blood pressure) were more likely to suffer more severe symptoms if they became infected with the SARS-CoV-2 virus. A recent analysis of electronic medical records for more than 45,000 people found that the converse may also be true. Infection with COVID-19 can subsequently endanger a normal heart, and it was significantly associated with the subsequent development of high blood pressure. 

This is a significant reversal of the understanding of cause and effect in the relationship between COVID-19 and heart disease.

What are the observed symptoms of COVID-19?

COVID-19 can cause increased risks of complications not directly associated with the heart but involving the lungs, kidneys, and other organs.

  • Lung injury that impairs oxygenation and can result in the need for mechanical ventilation is called Acute Respiratory Distress Syndrome (ARDS). Even in non-severe cases, pneumonia-like symptoms are common in people infected with the virus, and individuals may experience long-lasting respiratory issues after recovery.
  • COVID-19 can lead to acute kidney injury  (AKI), particularly in critically ill patients, due to direct viral damage to kidney cells, inflammation, or problems with blood clotting that affect renal blood flow.
  • While COVID-19 primarily affects the respiratory system, it can also cause gastrointestinal symptoms, including nausea, diarrhea, and abdominal pain. Some patients with severe COVID-19 may develop bowel ischemia, where blood flow to the intestines is compromised.
  • COVID-19 can have neurological effects. These range from mild symptoms like loss of taste and smell to more severe complications like strokes, encephalitis, or Guillain-Barré syndrome. The exact mechanisms are still under investigation, but COVID-19 can affect the nervous system.
  • COVID-19 has been associated with an increased risk of blood clots, which can affect various organs. This hypercoagulable state can lead to complications like pulmonary embolism (clots in the lungs) or strokes.
  • While children generally experience milder cases of COVID-19, a rare but serious condition known as MIS-C has been reported. This syndrome involves inflammation of multiple organ systems, including the heart, kidneys, lungs, and gastrointestinal organs.
  • Many individuals who have recovered from COVID-19 continue to experience lingering symptoms, often referred to as “Long COVID.” These symptoms can affect many organs and systems, including the heart, lungs, and brain, and can persist for months.

How does COVID-19 affect people with pre-existing cardiac problems such as hypertension?

Although it is understood that individuals with cardiac conditions are not inherently more susceptible to infection by the SARS-CoV-2 virus, there is risk that COVID-19 can endanger the heart and create more severe symptoms if they do become infected. There is substantial evidence to suggest that hypertension can exacerbate the severity of COVID-19 in those who do become infected.

There may be many reasons for this:

  • Hypertension can lead to structural changes in the heart and blood vessels, making it harder to handle the additional stress of a viral infection like COVID-19 on the cardiovascular system. This can result in a more severe course of the disease.
  • People with hypertension often have coexisting conditions such as diabetes, obesity, or other cardiovascular problems, which further increase the risk of complications from COVID-19. The combination of these existing morbidities can contribute to a higher likelihood of hospitalization, the need for intensive care, and a longer recovery period.
  • Studies have demonstrated a higher risk of death among COVID-19 patients with hypertension compared to those without this pre-existing condition. The exact mechanisms underlying this association are still under investigation but may involve the virus’s effects on the cardiovascular system, inflammation, and clotting abnormalities.

What does new research show about the reversed relationship between hypertension and COVID-19?

Before this study, while doctors were aware that COVID-19 typically causes more severe symptoms in patients with preexisting high blood pressure, including higher rates of hospitalization and mortality compared to people with normal blood pressure, it was unknown whether the virus may be triggering or worsening the development of high blood pressure and that infection with COVID-19 can endanger the heart.

An analysis of electronic medical records of more than 45,000 people treated at Montefiore Health System in New York City and published by the American Heart Association journal Hypertension found that COVID-19 infection was significantly associated with the development of high blood pressure.

The study analyzed the records of patients hospitalized with a COVID-19 diagnosis admitted over roughly 22 months beginning in March 2020. It compared them to those hospitalized with influenza in an overlapping period starting in January 2018. The study found that over 20% of patients who had to be hospitalized for COVID-19 subsequently developed hypertension, compared to only 16% of patients who had to be hospitalized for influenza. 11% who weren’t hospitalized for coronavirus developed the condition, while by comparison, only 4% of those not hospitalized for influenza developed hypertension

What action can be taken to avoid COVID-19 infection and protect the heart?

People with pre-existing cardiac conditions need to take special precautions to avoid infection because of the strong indication that COVID-19 can make their heart condition worse.

The same goes for anyone who has diabetes or any other chronic health problems that affect their lungs, kidneys, or central nervous system because they are more likely than other people to develop severe symptoms from an infection by the virus. Also, anyone who already has low immune functionality, including HIV/AIDS, or who is receiving immunosuppressant medications is more likely to be infected and to go on to develop more severe outcomes. On top of that, the statistics point to an increased risk that they could develop life-threatening heart complications.

What lessons will be learned from findings about post-COVID-19 infection effects on heart health?

What’s to be learned from this new evidence that infection by COVID-19 can endanger the heart? In reality, no major discoveries have improved the treatment of people once they have been infected. The takeaway remains the same: prevention is better than cure. As we shared in Learn what you can do to protect yourself and New strains of COVID-19, the best starting point is to take measures to keep the virus out of your system.

Especially relevant now for anyone who has a degree of risk of developing cardiac problems such as hypertension, as well as people who are already vulnerable because of pre-existing compromised immune systems or everyone over the age of 65, is the knowledge that vaccines work. It’s a matter of deep concern to the authorities that while 95% of people over the age of 64 received the initial vaccine dose for the most recent bivalent booster, only 43% of those aged 65 and older have received the shot of 64.

As well as helping the body to fight off infection via a vaccine, there are ways to minimize the chance of getting infected in the first place. Enovid creates a physical barrier against air-borne viruses by delivering a measured dose of nitric oxide nasal spray (NONS) designed to kill the respiratory viruses that cause COVID-19 in the nasal cavity long before it can begin to infect.

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