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Cardiologist Sam Mohiddin is trying to answer the question of whether people who have had a mild COVID-19 (like himself) a few months earlier have to worry about their heart? Concerns that COVID-19 may cause myocarditis are becoming more and more valid.
- More and more studies are emerging that suggest that even a mild disease of COVID-19 can have complications, including myocarditis
- Scientists do not know exactly whether the heart damage is caused by the virus itself or caused by the body’s immune response to infection.
- Even though COVID-19 rarely causes severe heart inflammation, one hypothesis suggests that mild cases may increase the risk of heart disease over the years. In a few years, you may find that doctors routinely ask when they diagnose heart problems, “Have you had COVID-19?”
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Doctors are increasingly suggesting that the mild course of COVID-19 in young and healthy patients may be responsible for later complications in the form of myocarditis. Cardiologist Sam Mohiddin wants to investigate this relationship. He recently treated a 42-year-old man who had the typical symptoms of COVID-19 in April, including loss of smell and mild breathlessness, and developed severe myocarditis a month later. The man spent over two weeks in the intensive care unit.
Scientists need to answer several questions related to cardiac complications after undergoing COVID-19. First, how can the virus damage the heart muscle? It’s also important to find out how common myocarditis is post-COVID-19, how long it lasts, and whether it responds to certain treatments.
Scientists also want to know if this complication from COVID-19 is similar to what happens with complications from other viruses. In more than half of the cases caused by viruses, heart inflammation resolves without further complications. Sometimes, however, arrhythmia and impaired heart function appear, and in rare cases, a heart transplant is required.
Given that the SARS-CoV-2 coronavirus has already been infected by many millions of people worldwide, even a small percentage of people who develop this complication may significantly increase the number of patients with secondary heart failure.
Scientists do not yet know the exact answer to this question, but they have several theories. Because SARS-CoV-2 triggers an intense immune response throughout the body, people who have passed the infection may be at an increased risk of developing heart inflammation. Another theory is that COVID-19 patients may be more prone to this complication because the coronavirus enters cells thanks to ACE2 receptors, which are also found on the surface of heart muscle cells. “That’s a good hypothesis, but it’s not yet tested,” said Leslie Cooper, a cardiologist at the Mayo Clinic in Jacksonville, Florida, of ACE2.
It is worth noting, however, that it is still unclear whether SARS-CoV-2 causes heart muscle damage to a similar or greater or lesser degree than other viruses, such as the influenza virus. Valentina Püntmann, a cardiologist at the University Hospital in Frankfurt, wanted to find out how often patients with COVID-19 develop heart inflammation.
Her team used MRI to scan the hearts of 100 COVID-19 patients. The study was conducted an average of 71 days after participants were tested positive for COVID-19. It found that the scans showed heart defects in 78 people, and 60 of them had active inflammation. Most of the subjects also complained of long-term symptoms: fatigue and mild breathlessness. The work of the team of prof. Püntmann appeared in July in the journal Jama Cardiology.
Another study, which appeared in the same journal, looked at 26 athletes at Ohio State University who also tested positive for COVID-19. Four subjects developed myocarditis. One of the authors of the study was Matthew Martinez, director of sports cardiology at Morristown Medical Center, who notes that even if scientists can explain the mean duration of myocarditis and the associated risks for a young athlete, these findings may not translate into case 50 -year-old with obesity or high blood pressure. That’s why cardiologists are encouraging people after COVID-19 who have symptoms such as shortness of breath or chest discomfort to get heart tests.
The Sam Mohiddin research we mentioned at the beginning is still in preparation. Their goal is to recruit 140 people who are hospitalized for COVID-19 or have just been cured and who have developed myocarditis, and those without this complication. Mohiddin and his colleagues will look for abnormal levels of T cells in the blood of people with myocarditis, which will help to see if an immune system response during COVID-19 infection could be causing heart damage.
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Even though COVID-19 rarely causes severe heart inflammation, one hypothesis suggests that mild cases may increase the risk of heart disease over the years. Inflammation of the heart muscle can build up scar tissue, which can then make your heart health worse. In a few years, you may find that doctors routinely ask, “Have you had COVID-19?” When they diagnose a heart problem.
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