New Guidelines Explain How to Manage Post-COVID Heart Problems - Verywell Health

Key Takeaways

• Although COVID-19 is a respiratory infection, it can cause serious heart problems, too.
• The American College of Cardiology (ACC) recently released a report about the evaluation and management of COVID-19-related heart issues.
• Those who experience cardiac symptoms after recovering from COVID-19 are recommended to consult their healthcare provider and/or get a cardiac evaluation before doing physical activity.

While it's clear that COVID-19 is a respiratory infection, the virus can also affect the cardiovascular system and cause serious heart problems.

"COVID-19 is a respiratory virus and causes a predominantly respiratory disease, namely pneumonia," Saurabh Rajpal, MBBS, cardiologist and assistant professor in the Division of Cardiovascular Medicine at The Ohio State University Wexner Medical Center, told Verywell. "However, the cardiac and vascular effects of COVID-19 are also recognized."

To provide actionable knowledge regarding the cardiovascular consequences of COVID-19, the American College of Cardiology (ACC) recently released clinical guidance for the evaluation and management of adults with myocarditis and long COVID. They also provided recommendations for athletes looking to return to exercise training after recovering from the infection.

How Does COVID-19 Affect the Heart?

COVID-19 mainly affects the heart through myocarditis—the inflammation of the heart muscle—or pericarditis, the inflammation of the lining of the heart, Jason Womack, MD, division chief of sports medicine and associate professor of family medicine at the Rutgers Robert Wood Johnson Medical School, told Verywell.

"There are also manifestations of people having an increased risk of blood clots during and after COVID-19 infection," he adds. "This doesn't change how we treat COVID during an acute infection, but providers should be aware that these are potential consequences of infection that may need further evaluation and treatment."

A recent study published in Nature Medicine found that patients who survive the acute phase of COVID-19 exhibited increased risks of various cardiovascular issues about one to 12 months after the infection compared to those who did not get COVID-19. These issues included heart disease, stroke, and arrhythmia, among others.

"Some patients also continue to have fast heart rates and postural dizziness after recovery from COVID-19, which could be a sign of vascular inflammation," Rajpal said. "However, the vast majority of people who get COVID-19 recover without cardiovascular [conditions]."

What This Means For You

If you are experiencing symptoms like chest pain, palpitations, or shortness of breath after recovering from COVID-19, consult a healthcare provider to know more about managing your condition.

What Are the ACC's Recommendations?

The ACC's goal was to bring forward established literature on COVID-19-associated heart and vascular disease and develop recommendations after discussing among experts in the field, said Rajpal, who was part of the committee that formed the ACC clinical recommendations.

"This document attempts to answer commonly asked questions regarding [the] care of adults with COVID-19 and cardiac symptoms such as chest pain, shortness of breath, palpitations, etc. after COVID-19 infection," he adds. "It is intended to give practical guidelines related to evaluation and management. This practical advice will be very useful to both patients and doctors."

Myocarditis

Viral infection is the most common cause of myocarditis. Research shows that it is a rare but serious COVID-19 complication.

The ACC guidance issued the following recommendations regarding the treatment and management of myocarditis and other forms of cardiac involvement:

• Patients with definite myocarditis are recommended to be hospitalized, ideally at an advanced heart failure center
• Patients with severe myocarditis should be treated at centers that have mechanical circulatory support and other advanced therapies
• Patients with myocarditis and COVID-19 pneumonia can be treated with corticosteroids
• Patients with suspected pericardial involvement may be treated with medications like non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, and/or prednisone
• Patients with suspected or confirmed COVID-19 myocarditis whose blood pressure is abnormal or unstable may be treated with intravenous corticosteroids

According to the report, myocarditis after a COVID-19 vaccination is rare, and it should be diagnosed and treated similar to myocarditis that occurs after a COVID-19 infection.

Resuming Exercise

When returning to exercise after having COVID-19, it's important to take things slow.

"People that have no symptoms after their COVID infection can return to activity gradually, but anyone that has symptoms suggestive of cardiac involvement—i.e. chest pain, shortness of breath, exercise intolerance, heart palpitation, etc.—should have a cardiac evaluation prior to a full return to activity," Womack said.

Based on the report, athletes who are asymptomatic after recovering from COVID-19 may resume exercise training after going three days without it during self-isolation. Those with mild or moderate non-cardiopulmonary symptoms after COVID-19 may also resume exercise training when the symptoms go away completely.

Athletes may only resume exercise training without additional testing if it has been three or more months since the infection and there are no ongoing cardiopulmonary symptoms.

Moreover, those who have myocarditis must not exercise for three to six months.

Long COVID

Long COVID is generally defined as the variety of new, returning, or ongoing health problems patients experience four or more weeks after the initial COVID-19 infection.

The ACC recommends that individuals with long COVID who have the following are recommended to undergo cardiology consultation:

• Cardiovascular disease with new or worsening symptoms 
• Documented cardiac complications during COVID-19 infection
• Unexplained, persistent cardiopulmonary symptoms
• Abnormal cardiac test results

Some people with long COVID may develop tachycardia, deconditioning, or orthostatic intolerance—the development of certain symptoms when upright or standing, which is relieved by going into a lying down position.

These individuals are recommended to do exercises lying down or semi-lying down like cycling, swimming, or rowing for about five to 10 minutes a day. They can increase exercise duration when their capacity gets better, or transition to upright exercise when their symptoms no longer worsen when standing or sitting up.

"The best way to avoid the cardiovascular consequences of COVID-19 is to get vaccinated," Womack said. "It appears that vaccinated individuals are less likely to develop severe sequelae or issues with long COVID after an acute COVID-19 infection."

In general, you should keep track of any ongoing or new symptoms after recovering from COVID-19. Get in touch with a healthcare provider if you have any questions or concerns regarding your condition.

"It is also important to get your cardiovascular screening up-to-date by discussing with your primary care doctor," Rajpal said. "If someone has cardiac symptoms after COVID-19, such as chest pain, palpitations, shortness of breath, or exertional intolerance, they should consult with their primary care doctor to check if any more workup is needed."

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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