How Can COVID-19 Affect the Heart?

COVID-19 was originally described as a respiratory illness (one that affects the lungs). Studies now show that COVID-19 can affect several important organs besides the lungs, including the heart and blood vessels. Heart damage caused by COVID-19 is such an important issue that the American Heart Association has pledged $2.5 million for research in this area.

How does COVID-19 affect the heart and blood vessels?

Data is still being collected on this topic, but this is what we know so far: COVID-19 is caused by the SARS-CoV-2 virus. The virus infects the cells of the body by attaching to a specific receptor, called ACE2, which is located on the cells of the heart, blood vessels, and lungs. When SARS-CoV-2 attaches to ACE2 and enters these cells, the virus can cause significant damage, and can even cause cells to die. In addition, the body launches a strong immune response — and in some cases, an autoimmune response — to the virus, which can also lead to organ damage. When blood vessels are damaged, abnormal blood clots can form in the arteries and veins, which can lead to more problems with your organs, including the heart, lungs, and brain. 

What types of heart disease can COVID-19 cause?

COVID-19 affects people very differently. Some people have no symptoms, or very mild symptoms, and have no significant damage to their heart or blood vessels. Others become very ill, require treatment in the hospital, and can have extensive heart and blood-vessel damage. It is still unclear why some people get sicker than others do, but this is a subject of ongoing research.

Can COVID-19 cause a heart attack?

Yes, people who are sick with COVID-19 can have heart attacks. It is not always clear whether heart attacks in these people are caused by the virus, or whether they already had blockages in their heart arteries before they became ill. When a person with problems in their arteries gets an infection, their heart and blood vessels are placed under a lot of stress. The heart needs to work harder than it does in normal circumstances, and this extra demand can trigger a heart attack. To make matters worse, people with COVID-19 can have lower oxygen levels, and are at a higher risk of blood clots — both of which can also contribute to a heart attack. 

What other heart problems can COVID-19 cause?

In addition to increasing the risk of heart attacks, COVID-19 can affect the heart in other ways. The virus can directly infect the heart and blood vessels. It can also cause high levels of inflammation all over the body as the immune system tries to fight off the virus. These factors, in combination with decreased oxygen levels, can create a “perfect storm” for heart problems, including:

• Abnormal heart rhythms, also called arrhythmias: Affect the efficiency of the heart to pump blood to the body

• Heart muscle inflammation, also called myocarditis: Causes chest pain, shortness of breath, and heart muscle weakness in severe cases

• Stress cardiomyopathy: Heart muscle weakness that is usually temporary, caused by extreme stress on the body, such as an infection

• Heart failure: A condition in which the heart has a reduced ability to pump blood to the body and lungs

• Cardiac arrest: When the heart goes into a dangerous heart rhythm, which can cause the heart to stop, leading to death

Can COVID-19 cause blood clots?

Yes. As we’ve mentioned already, COVID-19 can lead to abnormal blood clots in blood vessels. One of the most serious types of blood clot caused by COVID-19 is a pulmonary embolism, or PE. This dangerous blood clot forms in the blood vessels of the lung, preventing oxygen in the lungs from getting into the blood. A PE can also put the right-sided chamber of the heart (the right ventricle) under a lot of stress. Weakness and enlargement of the right ventricle are the most common abnormalities seen on heart scans of people hospitalized with COVID-19.

What if I already have heart issues and get COVID-19?

People who already have certain risk factors and heart conditions have a higher chance of becoming severely ill from COVID-19.

These conditions include:

• Heart failure

• Coronary artery disease

• Arrhythmias

• High blood pressure

If you have heart problems, and are diagnosed with — or suspect you could have — COVID-19, you’ll want to be extra cautious.

If you think you have COVID-19, call your healthcare providers immediately so they can assist you with what to do next. Do not stop or start any medications or supplements until talking to your provider. And you should immediately call 911 or go to the emergency room if you develop any concerning symptoms, including shortness of breath, chest pain, or dizziness.

Do the COVID-19 vaccines cause heart damage?

Recently, there have been some rare reports of young adults and teens getting a heart condition called myocarditis (heart inflammation) after receiving the COVID-19 vaccine. The American Heart Association released a statement confirming that myocarditis is a very unusual complication, that the risks of the vaccine are much less dangerous than the risks of COVID-19 infection, and that the vaccine is still recommended for people older than 12. If you have any additional concerns about this issue, please talk to your, or your child’s, healthcare provider.

Does “long haul” COVID cause heart problems?

At least 10% of people who get COVID can have symptoms for more than 4 weeks. This condition is called long COVID or long-haul COVID. Many people with long COVID report lingering cardiac symptoms, such as: 

• Chest pain

• Shortness of breath

• Palpitations

• Postural orthostatic tachycardia syndrome, or POTS 

POTS is an abnormal increase in heart rate when a person stands up from a lying position, which can lead to: 

• Dizziness

• Weakness

• Exercise intolerance

• Fatigue

Because long COVID is so new, data is still being collected on people dealing with this condition.

What can I do to protect myself from heart complications of COVID-19?

There are many simple steps you can take to reduce your risk of having heart complications after COVID-19:

1. First and foremost, reduce your chances of becoming ill with COVID-19: This can be done by getting vaccinated and practicing social-distancing measures, like wearing a mask, washing your hands, keeping distance between yourself and others (especially indoors), and limiting travel.

2. If you already have heart disease, check in regularly with your healthcare provider: Because of the pandemic, many people with heart disease have missed out on routine health visits. If you are not comfortable going to the office and you are due for a check-up, ask your provider whether they offer telemedicine visits.

3. Work with your physician to check for and treat any heart risk factors, such as diabetes, high cholesterol, and high blood pressure.

4. Start or keep up with healthy lifestyle changes: Several lifestyle changes can help your heart stay healthy. These include eating a balanced diet, making exercise a part of your daily life, losing weight or maintaining a healthy weight, and cutting out smoking.

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Written by:

Alice Perlowski, MD, MA, FACC

Dr. Alice Perlowski is a board-certified cardiologist and fellow of the American College of Cardiology. She has seen patients and supervised trainees in the academic and private sector, with focuses in interventional cardiology, vascular medicine, preventative cardiology, and women’s heart health.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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