Today, we will be looking at studies on how the heart has been affected by COVID-19 in people with continued shortness of breath and fatigue even 2 months after the initial infection. Last week, we discussed the lung and you can find that blog article here.
The other major organ that can account for the shortness of breath, fatigue, and weakness in post viral syndrome is the heart. The suspicion in the early part of the pandemic that COVID 19 patients complaining of having chronic fatigue with shortness of breath may be from heart disease; some of the symptoms of heart failure overlap. Echocardiograms, however, were not done initially for hospitalized COVID patients unless a major change in management was anticipated. Also other factors were in consideration including the fact that it’s difficult to sterilize the echocardiography machine and hospitals didn't want to expose echo technicians to covid-19 unnecessarily.
Recently a new paper in the European Society of Cardiology paper now makes the case for doing echocardiography for symptoms of fatigue, especially with lower extremity swelling, or shortness of breath when lying flat. These are all symptoms of impairment of their heart or heart failure. The findings in the paper were completely unexpected. They included patients in over 69 countries across 6 continents and looked at over 1200 patients in a number of age groups. 70% were male, 55% of the patients that were admitted with COVID-19 had an abnormal echocardiogram during hospitalization. Patients being admitted to the hospital with covid-19 got an echocardiogram. 55% of those patients had an abnormal echocardiogram that was not just the left or the right sides of the heart but involved both sides with 39% involving the left and 33% right. The conventional thinking was that one would see the majority of the pathology be on the left side of the heart and the minority would be on the right but in fact they were close to being about the same which could be consistent with pathologies including pulmonary thromboembolism or a clot in the lung blood vessles. Other heart pathologies were not seen to any great degree. The actual myocardial infarction or heart attack that was new was only seen in about 3%, myocarditis or inflammation of the heart in only about 3% and takotsubo cardiomyopathy which is heart failure from a very stressed heart that can usually recover was seen in about 2%. One of the key findings that these authors found was that doing the echocardiography changed management in one third of the patients so these authors are advocating that we shouldn't be holding back on getting echocardiography with any COVID 19 patients with possible heart failure symptoms.
So if COVID 19 survivors that had been hospitalized , discharged and then present in the office with any sort of symptoms of shortness of breath especially while lying flat or having increased swelling in their legs should be scheduled for an echocardiogram. Some of these people may have viral myocarditis with reduced ejection fractions or reduced heart function. There are other papers suggesting that over 55% of COVID -19 infections have abnormal echocardiograms perhaps even without symptoms. Those with symptoms may need to be treated and supported for heart failure.
In general, people with post viral symptoms should have further evaluations like pulmonary function tests and echocardiograms. In addition to the usual medical treatments and support, starting N-acetyl cysteine or glutathione may also be considered. More studies need to be done to have a better understanding of whether these symptoms will improve over time or if other nutritional and lifestyle changes can help.
In a 1997 there was a study that looked at influenza and post viral syndromes with similar symptoms of chest tightness , fatigue , shortness of breath that continued after they “recovered from the regular flu. The study looked at those patients who were taking N- acetyl l-cysteine at 600 mg twice a day for 6 months. Even though they had the same number of influenza infections as the placebo group or the group that didn’t take N-acytl L-cysteine , their symptoms were much less. There was a reduction in post viral symptoms from 75% down to 25%. We may not know if this would work for the current post viral syndromes from COVID and more studies may need to be done, but certainly taking N-Actyl Cysteine, along with Quercetin or Zinc as a preventative measure before or during COVID infection would be reasonable without any significant downside risk.
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Take Care and Stay Healthy.
Jeffrey Mark, M.D.