Myocarditis is one of the most serious complications after COVID-19 (and the passage of any other viral infection). It develops in young people who have not had heart problems before and are generally quite healthy. “The consequences can be very serious, it can even lead to death” – warns cardiologist Michał Chudzik, MD, PhD. What happens to the heart when there is an inflammatory reaction and what signals should light a red light in our head.
- An important factor that increases the risk of myocarditis is having the flu and immediately afterwards (i.e. while the body is still weakened) increased physical activity
- If someone, six months or a year after suffering COVID-19, experiences heart rhythm disturbances, unusual chest pain, or gets tired more often, it should be examined. Such signals are disturbing – warns the cardiologist
- Dr. Michał Chudzik: the risk of myocardial damage after vaccination exists, but does not exceed the general risk, the risk of inflammation after COVID-19 is incomparably higher
- The doctor emphasizes that each drug that we take and each vaccine will always generate a risk of side effects. “Things that don’t have side effects just don’t work”
- For most people, having myocarditis will have no lasting consequences. In 10 percent however, the heart is damaged. “It does not seem like much, but looking at the number of people who may be ill, it is quite a lot” – says Dr. Chudzik
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Adrian Dąbek, Medonet: What is myocarditis?
Michał Chudzik, MD, PhD: It is a disease that results directly from the penetration of microorganisms, most often viruses, into the heart cells, but also from the inflammatory reaction of the body. The body defends itself and these defensive reactions damage it. Myocarditis is not common, but unfortunately it affects young people who have not had heart problems before, are generally quite healthy, but due to lack of luck they can get sick. The consequences can be very serious, it can even lead to death.
Why does it affect young people?
Myocarditis affects one to 10 people in 100. In general, it is not very common in the population, but since the starting point is most often viral infections, such as influenza, and in the period of increased flu cases, up to millions may suffer, often myocarditis passes asymptomatically. These few percent of the millions make the disease noticeable.
For comparison, I can say that with COVID-19, the risk of developing the disease is already 150 per 100. people. Which is 15 times greater after the coronavirus than after the flu. It is dangerous that myocarditis can affect completely healthy people, so we doctors recommend that even with banal flu, stay at home for a few days, lie in bed with the disease.
A very important factor that increases the risk of myocarditis is the flu that you pass and then increased physical activity. Playing sports, working excessively while the body is still weak. This weakness increases the risk that this virus can enter and damage the cells of the heart muscle.
This condition causes two problems. The first: the body defends itself by seeing viruses in the heart, but at the same time wants to separate the affected cells of the heart muscle with such fibrosis, scarring. This fibrosis protects the heart from the spread of the virus, but unfortunately it can be disadvantageous as it increases the risk of abnormal heart rhythms. These disorders appear as a faster, uneven heart beat, “palpitations”. Such arrhythmias can be life threatening.
The second problem arises when the fibrotic pattern is excessive. The body begins to defend itself, but it cannot stop this defense, turn off these mechanisms. When fibrosis covers too much of the heart muscle, it breaks down because we have scar tissue instead of the cells that should be working. As a result, the heart becomes inefficient. Then we often have to tell the young person that their heart is in a very bad condition and is suitable for transplantation.
Is the formation of these scars an irreversible process?
Yes, it is irreversible. If this is the initial stage of the disease, i.e. the period of acute myocarditis, we have drugs that can inhibit the inflammatory process. Then we treat the sick in the hospital. When a patient comes in a few weeks after infection, when the heart begins to fail, we have cardiovascular drugs that can inhibit the process of heart failure.
When a few months or several years pass, unfortunately only symptomatic treatment remains. We’re reducing the symptoms, but we’re not changing the damage. The time of arrival to the doctor and starting treatment is always decisive.
Myocarditis now seems to be talked about much more often than in previous years. This is perhaps one of the most serious complications after COVID-19.
Indeed, during this most severe hospital period of the pandemic, the percentage of people who had a broken heart was high. At the moment, according to estimates based on a very large group of people who were ill only at home, we see post-inflammatory changes without damage in 15-20 percent. It’s a lot. And we see damage to the heart at the level of 1 percent. It can be said that 1 percent. it’s not a lot, but when we multiply it by the millions of people who have passed COVID-19 at home, it already gives a very large group. Usually, the disease in Poland affects about 20 people a year.
Myocarditis is one of the immediate complications after COVID-19. Or is it part of this broad spectrum of long COVID symptoms?
Our observations show that in half of people these changes are withdrawing. This is good news. But on the other hand, in half of the people in the control tests carried out one year after Covid, these ailments still persist. We also see a disturbing trend that in people who have had post-inflammatory changes in the heart, arrhythmias are getting worse. Worldwide data on previous viral infections show that if someone has had a trace of fibrosis in the heart, within 5-10 years he or she is at increased risk of serious arrhythmias or even death. COVID-19 is a new disease, so we carefully examine our patients and monitor them every six months using the Holter method, because we cannot allow the heart to be damaged and become life-threatening.
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The problem is still difficult to estimate and to say what it will look like in the long run, but looking at the results so far, one must be very careful. If someone, six months, one year after COVID-19, experiences arrhythmias, unusual chest pain, and gets tired more often, it is necessary to check whether it is not due to inflammatory changes in the heart. Such signals are disturbing.
These symptoms can be very non-specific. What should you first pay attention to?
There is no typical symptom, actually. Patients most often report a greater feeling of fatigue, but this is a symptom that occurs practically with every disease. They also talk about chest pains. They tend to be uncharacteristic, they resemble neuralgia. There are also feelings of uneven heartbeat and heart arrhythmias in people who have not had heart disease before. Patients also report the impression that their physical performance has decreased. We used to go to the third floor without any problems, now we have to rest on the second floor. These signals should prompt you to check your heart rate.
Recently, it has also been said that myocarditis may be a side effect of COVID-19 vaccination. What was the actual frequency of such events?
It is estimated that it was at the level of two people per 100. Let me remind you that the risk of myocardial damage after each viral infection is at the level of one to 10 people per 100. Thus, the risk of postinflammatory complications after vaccination exists, but does not exceed the overall risk. And for COVID-19, this risk is 150 per 100. residents. So the risk of inflammation after covid is incomparably greater.
Our observations show that out of 3,3 thousand of patients who came to our clinic with complaints after COVID-19, only three to four reported complaints after vaccination, but the tests did not confirm myocarditis. In my observations I do not have such patients, and I have almost 800 people who have post-inflammatory changes in the heart. This scale is disproportionate.
However, any reported post-vaccination changes are always more media-driven. You have to be aware that every drug you take and every vaccine will always generate a risk of side effects. Things that don’t have side effects just don’t work. You can drink herbs, it has always been believed that they help, but have no side effects. But they are good for healthy people.
Can myocarditis, as a heart disease, be ranked in terms of risk to human health? For example, compared to a heart attack?
I think it is a more dangerous disease. Modern cardiology has good treatment methods. Nowadays, with a heart attack, if we see a doctor in the first or second hour from the beginning of the infarction and use invasive treatment, we practically leave with an undamaged heart. There has been tremendous progress in cardiology. When I started working 20 years ago, the patient who had a heart attack died in 80%. cases. Today, this mortality rate does not exceed two or three percent.
Unfortunately, in the case of myocarditis, we do not have antiviral drugs that could stop, slow down or reverse this process. With drugs, we support the heart more (so that it does not cause more damage) than we can actively work to destroy this virus. As a result, this type of disease is more worrying, because we have no influence on effective treatment.
Is the asymptomatic transition of myocarditis always associated with consequences or can they be avoided?
For most people, having myocarditis will have no lasting consequences. 5 to 10 percent the inflammations we know from previous viral infections ended up with moderate or severe damage to the heart. 90 percent people who have been in the hospital can be cured or the body can cure it well, inhibiting this process with the help of drugs.
However, in 10 percent. the heart is damaged. Again, it doesn’t seem like much, but looking at the number of people who can get sick, it’s quite a lot. The severity of the infection did not correlate with the risk of myocarditis. You can get COVID-19 or any other infection lightly and have a complication in the form of myositis, on the other hand – you can get infected hard and have no complications.
Are there any risk factors?
We have no clear predictors. We are preparing material for publication, it is in the process of statistical calculations. Initially, I can say that in the risk group there were people who had a course of severe muscle pain, for example in the back. People with elevated temperature were also much more likely to develop a post-inflammatory complication in the heart. These two ailments that persist after covid should not be taken lightly. And there is one more feature related to ECG results, but this is more information for family doctors. Such a patient needs to be referred for MRI to confirm or rule out these changes.
And since it is difficult to talk about risk factors, it is probably also difficult to talk about specific prevention.
The only specific factor in prevention is the development of any viral infection in the bed regime. Plus, you have to remember about inflammatory changes in athletes, not only professional but also amateur. Today a lot of people run, ride a bike, and these are big efforts. And if an athlete has had myocarditis, from a medical point of view, they should be excluded from training for six to nine months to avoid permanent damage to the heart. And for many professional athletes, being off for so many months can mean a significant career halt. Many athletes do not report such ailments at all. And then we have these dramas that we see on the TV. Like the Danish footballer Christian Eriksen. Because inflammatory changes in the heart in athletes are the most common cause of cardiac death.
If someone practices a sport more intense than Nordic walking or Saturday cycling and has had COVID-19, before resuming his activity, he should be examined by a cardiologist. A simple ECG seen by a cardiologist who has experience with inflammation can tell you whether you can return to sport, or whether there are indications for a cardiac echo or magnetic resonance imaging. Only then can we make a decision. This should be the course of action.
Eriksen even recently returned to professional football. Examples like his are quite loud and have a didactic dimension as well. Because a young, sports-active man, who is frequently tested, who nourishes himself well and leads, suddenly collapses on the pitch.
While researching covid patients, I sent test invitations to several teams, not only football, for players who had experienced COVID-19. Nobody came forward. These people risk their health or life without revealing many things, because for them sport is often the only way of life. Even a history of flu, which may result in inflammation of the heart muscle. Nobody wants to reveal it. Because such facts immediately make the player’s value fall. Athletes undergo routine examinations, but one that is unlikely to find anything. UEFA and FIFA keep an eye on this, indicating what tests should be done.
Professional sport is not healthy. This is not a path that an ordinary person should choose. These are people with incredible burdens. Please indicate former athletes who are 80 or 90 years old. How many of these do we have? Athletes live in serious rigor, then after retirement, they quickly gain weight and the body cannot cope with it. The abandonment of these habits generates many problems, especially since few people are interested in these people after the end of their career.
And when it comes to amateur sport, there are also monstrous efforts, such as in the case of marathons. This is already a pathological phenomenon. Honestly, I don’t know why the marathon is an Olympic sport. After all, the first marathon runner died after running. I don’t know why we do the same. Cardiologists recommend a maximum of one hour a day or 10 exercise. steps. This is physiologically acceptable. We didn’t come down from the tree to run marathons.
You said there was no response from the athletes. And what is the awareness of heart disease in general among Poles?
It is better. Also thanks to covid. The pandemic has caused many patients to come for tests that they would not normally have come to. We discover not only myocarditis. We also see that healthy people who are not sick have hypertension at an early age. This applies to 50 percent. population. 30 percent on the other hand, it has elevated blood sugar levels. 50 percent has elevated cholesterol levels. Were it not for COVID-19, most of these people would find out about their ailments in five to 10 years after their first heart attack or stroke.
This positive scare is needed because the consequences can be serious. And the earlier we report, the better the chances of a cure are. However, many people are still unaware of myocarditis as a complication of viral infections. But it is being talked about more and more often.
Another thing is that we once lay the flu in bed, now we don’t want to give up our job or contract and go on sick leave. Then we pay for this overwork and exhaustion with our health. An exhausted body does not have the strength to regenerate.
We encourage you to listen to the latest episode of the RESET podcast. This time Kamila Wykrota, the resilience trainer, will tell us about what resilience is. How does the ability to adapt to changing circumstances and react to adversities affect our quality of life? You will find out by listening to the latest episode of our podcast.