For people who have had COVID-19, lingeringCOVID-19 heart problemscan complicate their recovery.
Some of the symptoms common in coronavirus long-haulers, such as palpitations, dizziness, chest pain and shortness of breath, may be due to heart problems or, just from having been ill with COVID-19. How do you tell if your symptoms are heart-related, and what can you expect if they are?
Johns Hopkins cardiologistsWendy Post, M.D., and Nisha Gilotra, M.D., clarify which post-coronavirus symptoms may point to a heart issue, when to call your doctor, and other facts all long-term COVID-19 survivors should know.
Yes: Although COVID-19 is primarily a respiratory or lung disease, the heart can also suffer.
Temporary or lasting damage to heart tissue can be due to several factors:
Lack of oxygen.As the virus causes inflammation and fluid to fill up the air sacs in the lungs, less oxygen can reach the bloodstream. The heart has to work harder to pump blood through the body, which can be dangerous in people with preexisting heart disease. The heart can fail from overwork, or insufficient oxygen can cause cell death and tissue damage in the heart and other organs.
Myocarditis: inflammation of the heart.The coronavirus may infect and damage the hearts muscle tissue directly, as is possible with other viral infections, including some strains of the flu. The heart may also become damaged and inflamed indirectly by the bodys own immune system response.
Coronavirus infection also affects the inner surfaces of veins and arteries, which can cause blood vessel inflammation, damage to very small vessels and blood clots, all of which can compromise blood flow to the heart or other parts of the body. Severe COVID-19 is a disease that affects endothelial cells, which form the lining of the blood vessels, Post says.
Stress cardiomyopathy.Viral infections can causecardiomyopathy, a heart muscle disorder that affects the hearts ability to pump blood effectively. When attacked by a virus, the body undergoes stress and releases a surge of chemicals called catecholamines, which can stun the heart. Once the infection resolves, the stressor has ended and the heart can recover.
Most serious of all, Gilotra says, is the possibility of the immune system launching an attack on the invading virus that is so severe that it destroys healthy tissues.
When responding to infection with the coronavirus, the body releases a flood of proteins called cytokines that help cells communicate with one another and fight the invaders.
In some people, perhaps due to a genetic difference, this normal defensive event is exaggerated, leaving them vulnerable to acytokine storm. In a cytokine storm, the immune system response causes inflammation that can overwhelm the body, destroying healthy tissue and damaging organs such as the kidneys, liver and heart.
A cytokine storm and its resulting heart damage can also affect the hearts rhythm. Serious ventricular arrhythmias due to a cytokine storm can be catastrophic, Gilotra says.
A cytokine storm is difficult to survive. Current research is exploring the possible benefit of using immune-suppressing drugs to treat patients with COVID-19 who experience this serious complication.
After you have had COVID-19, if you are experiencing a rapid heartbeat or palpitations, you should contact your doctor. A temporary increase in heart rate can be caused by a lot of different things, including dehydration. Make sure you are drinking enough fluids, especially if you have a fever. Symptoms of a rapid or irregular heart rhythm may include:
In some people, heart rates can vary from fast to slow, unrelated to exertion, for no apparent reason. But, Post says, shortness of breath, chest pain or palpitations after having COVID-19 is a common complaint. Any of these problems could be related to the heart, but they could also be due to other factors, including the aftermath of being very ill, prolonged inactivity and spending weeks convalescing in bed.
You want to consult a doctor if any of your symptoms are severe, especially shortness of breath, Post says. She recommends using a commercially available O2 (oxygen) saturation monitor.
Shortness of breath by itself is not always a sign of a serious problem, but if you have that symptom along with low O2 (below 92%), that is a reason to be concerned. Sometimes people are short of breath with exertion after COVID-19 because they have been less active for a long time and need to gradually build their fitness level back up.
A diagnosis ofheart failureafter COVID-19 is rare. But if you have shortness of breath or leg swelling after COVID-19, you should contact your doctor, who may recommend evaluation by a cardiologist if tests indicate you are at risk.
What about lingering chest pain, another common post-COVID complaint? Chest pain may be nothing serious, but if you are having severe chest pain, get help, especially if it is persistent or if you are also having nausea, shortness of breath or lightheadedness: These could besymptoms of a heart attack.
If you have chest pain when you inhale, you might have lung inflammation. Sudden, severe chest pain could be ablood clot in the lung (pulmonary embolism), Post says.
People recovering from the coronavirus sometimes show symptoms of a condition known asPOTS (postural orthostatic tachycardia syndrome). Researchers are exploring whether or not there is a link.
POTS isnt directly a cardiac problem, but a neurologic one that affects the part of the nervous system that regulates heart rate and blood flow. The syndrome can cause rapid heartbeats when you stand up, which can lead to brain fog, fatigue, palpitations, lightheadedness and other symptoms.
Yes. People with COVID-19 can have symptoms similar to those of a heart attack, including chest pain, shortness of breath and changes on their echocardiogram (ultrasound of the heart) or EKG. But often when these patients are given an angiogram, there is no evidence of a major blockage in the hearts blood vessels, which would indicate a heart attack in progress.
Symptoms of myocarditis can also mimic those of a heart attack. Also, viral infections such as COVID-19 can cause very small blood clots to form, which can block tiny blood vessels and cause pain.
People with signs and symptoms of a heart attack should seek urgent medical attention and not manage these symptoms at home.
Symptom
When to call 911
When to call your doctor
Shortness of breath
Chest pain
If your symptoms are not severe but you want to be checked out, Post says a cardiologist doesnt need to be your first stop if youve never had heart problems before and are not at risk. For nonemergency post-COVID-19 symptoms, your primary care practitioner can advise you, she says.
That depends: Post says that heart attack has several different forms. A type 1 heart attack, caused by a blood clot blocking one of the hearts arteries, is rare during or after COVID-19 infection.
Type 2 heart attacks are more common with COVID-19, she says. This heart attack can be caused by increased stress on the heart, such as a fast heartbeat, low blood oxygen levels or anemia, because the heart muscle isnt getting enough oxygen delivered in the blood in order do this extra work. We have seen this in people with acute coronavirus disease, but it is less common in those who have survived the illness.
Blood tests have shown that during COVID-19, some people have elevated levels of a substance called troponin in their blood, along with EKG changes and chest pain. Elevated troponin levels are a sign of damaged heart tissue. Sometimes this is from a heart attack. This is less commonly seen after COVID-19.
During acute COVID-19, elevated troponin levels with an abnormal EKG are linked to higher mortality, but not in patients with a normal EKG, Post says.
In general, children who get sick with the coronavirus do not have serious problems as often as adults do. An uncommon but serious complication of COVID-19 calledmultisystem inflammatory syndrome in children, or MIS-C, can cause serious heart damage, cardiogenic shock or death.
Some children who survive MIS-C can be left with abnormal heart rhythms and stiffened heart muscle that prevents the heart from relaxing normally and beating properly. MIS-C has some similar characteristics to Kawasaki disease.
Post says that if symptoms are due to a cardiac cause, recovery depends on the severity of injury. Very few people have a severe heart attack, such as an acutemyocardial infarction, or MI, due to COVID-19, she says.
Still, heart imaging can reveal minor changes in the heart muscle of some COVID-19 survivors. Post notes that some studies on athletes recovering from the coronavirus have shown some scarring, but stresses that some of these studies did not compare these results with those who had not had COVID-19. How long these minor changes persist and how they affect heart health are not yet known. Experts are developing protocols and recommendations for which athletes should get cardiac testing before returning to play.
COVID-19 can also affect the strength of the heart pumping, Post says, but subtle abnormalities in heart pumping are not likely to cause people problems.
A person recovering from COVID-19 may benefit from physical therapy,breathing exercises and, most of all, time. Post advises anyone recovering from COVID-19 should expect a gradual course of recovery, and should not expect a rapid return to their normal activity levels.
A heart condition could be exacerbated by severe COVID, but not likely after mild or asymptomatic cases, Post says. But the effects of the coronavirus on preexisting heart disease are not yet known.
If you have had COVID-19, recovered and feel all right now, should you worry? Are heart problems likely to show up later on?
Post emphasizes that many of these questions do not have clear answers yet. SARS-CoV-2 was isolated in 2019, and a large number of COVID-19 survivors have only been recovering since 2020. It is hard to know exactly how the disease will affect peoples hearts long term, and this is just one area of intense concern among researchers, she says.
Although many people recover quickly from COVID-19, the disease caused by the coronavirus, others who recover may continue to experience symptoms for months. Researchers are still determining the cause of these extended symptoms, but some COVID-19 "long-haulers" may actually be dealing with a known condition, called postural orthostatic tachycardia syndrome. This condition, also called POTS, affects involuntary nervous system functions, such as heart rate and blood pressure, usually upon standing from a reclining position.
Tae Chung, M.D., is a neuromuscular specialist and rehabilitation physician, and director of the Johns Hopkins POTS Program. He explains what we know about post-COVID POTS and how to go about getting a diagnosis.
POTS can be triggered by a variety of conditions, including viral or bacterial infections. Some researchers believe that coronavirus can be a trigger for POTS, as an increased number of people who recovered from COVID-19 are now experiencing POTS-like symptoms, such as brain fog, tachycardia (increased heart rate) and severe chronic fatigue. This similarity in symptoms led doctors to start testing patients for POTS.
The autonomic nervous system regulates functions we dont consciously control, such as heart rate, blood pressure, sweating and body temperature. Malfunction in any of these areas can produce symptoms that can be shared by numerous conditions. Doctors who are not familiar with POTS may dismiss these symptoms as lingering effects of COVID-19 or even psychological symptoms. At the same time, POTS can be very debilitating and requires specific treatment, so an accurate diagnosis is vital.
The research in this area is still ongoing. So far, there have been reports of people with mild COVID-19 symptoms developing POTS as well.
You should talk to your doctor if you have had COVID-19 and are experiencing ongoing symptoms, including:
Your doctor will first try to rule out other complications. We are being very careful with regard to diagnosing our patients with POTS, as we know COVID-19 can cause blood clots or scars in the lungs, which can cause similar symptoms as POTS but would require very different treatment, explains Chung.
At Johns Hopkins, we consult a team of doctors from physical medicine and rehabilitation, pulmonary and critical care medicine, and neurology, who work together to carefully rule out various causes of long-lasting symptoms from a COVID-19 infection says Chung. Once other lingering conditions are ruled out, you may be referred to a specialist to start the process of getting diagnosed with POTS.
At this point, there is no one standard approach to post-COVID patients with POTS-like symptoms, and treatment should be personalized, based on the diagnosis. If POTS is confirmed, we generally start aggressive hydration, dietary modifications and certain medications, says Chung.
Eventually, physical therapy is key, but it often takes months before patients respond to treatment sufficiently to be ready for a physical therapy regimen. I think dont give up is probably one of the most important principles of the treatment, Chung explains.
As with any viral infection, COVID-19 can temporarily worsen POTS symptoms, which could make recovery harder. Because this is a new disease, the long-term effects of COVID-19 in patients with POTS are not well known.
If you have POTS and contract COVID-19, you should work with your doctor to manage your symptoms while you recover, says Chung. This might include a temporary dosage increase for certain medications, as well as dietary adjustments.
The COVID-19 pandemic has created a unique research opportunity for physicians interested in POTS. In many patients with POTS, it can be difficult to pin down the cause of the condition. In patients with POTS after COVID-19, the cause is clear, and researchers will be able to compare these patients with those who recovered fully from the virus. Theres hope that this cohort of patients will help further research into treatment for all people suffering from POTS.
One of the main reasons that I started a clinic to help people with post-COVID POTS is research, says Chung. I am planning to develop many different research projects out of our clinic experience, so we can better understand and treat the long-lasting symptoms after COVID-19 infection.
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OverviewThe flu, common cold and COVID-19 have similar symptoms. The flu and COVID-19 can be severe, but colds rarely are.What is the flu (influenza)?
The flu is an illness you get from the influenza virus. It causes symptoms like head and body aches, sore throat, fever and respiratory symptoms, which can be severe. Flu is most common in winter months, when many people can get sick at once (an epidemic).
Flu season when cases of the flu go up dramatically in the Northern Hemisphere (which includes the U.S.) is October through May. The highest number of cases (peak) usually happen between December and February.
The flu is one of the most common infectious diseases. Every flu season, about 20 to 40 million people in the U.S. catch the flu.
The flu and the common cold can have similar symptoms, like runny nose and cough. But cold symptoms are usually mild and flu symptoms can be severe and lead to serious complications. Different viruses cause colds and the flu.
Since they have similar symptoms, the only way to know for sure if you have the flu or COVID-19 is to get tested. They both have a risk of serious illness. But different viruses cause these infections, and providers treat them with different medications.
Certain health conditions can put you at higher risk for severe illness from the flu. This includes life-threatening complications that require hospitalization. Youre at higher risk for serious illness if you:
Non-Hispanic Black people, non-Hispanic American Indians, Alaska Native people and Hispanic or Latino people have the highest rates of severe illness from the flu compared to non-Hispanic White people and non-Hispanic Asian people.
Symptoms of the flu usually come on quickly, and can include:
You may not have all of these symptoms.
The influenza virus causes flu. Influenza A, B and C are the most common types that infect people. Influenza A and B are seasonal (most people get them in the winter) and have more severe symptoms. Influenza C doesnt cause severe symptoms and its not seasonal the number of cases stays about the same throughout the year.
H1N1 (swine flu) and bird flu are both subtypes of influenza A.
Yes, the flu is contagious (it spreads from person to person). For every person infected, they spread the flu to one to two more people.
The influenza virus spreads from direct or indirect contact with someone else whos infected. Common ways to get the flu include:
If infected, youll usually get symptoms of the flu one to four days after exposure (incubation period).
Your provider diagnoses the flu by listening to your symptoms and testing a sample of mucus from your nose. Theyll put a long stick with a soft tip (swab) in your nose to test for influenza. Results may take a few minutes or your provider may send the sample to a lab, where youll get results in a day or two.
Providers can treat the flu with antiviral medications under certain circumstances. Antivirals can reduce your risk of severe illness and shorten the amount of time youre sick. Many people can treat the flu without prescription medications. Providers prescribe antivirals if you:
Antiviral drugs for influenza include:
Tell your provider about any health conditions you have before starting an antiviral medication.
Each antiviral medication has different side effects, but common ones include nausea and diarrhea. Inhaled medications can cause spasms that tighten and narrow your airways (bronchospasm).
Many people can manage the symptoms of flu at home with over-the-counter (OTC) medications and other therapies, including:
Not everyone should take certain OTCs, so check with your provider before you use them. Its also a good idea to make sure certain medications are okay to use together or with supplements. Dont give aspirin to children under the age of 16 unless their provider says its okay.
The best way to prevent the flu is to get the flu vaccine every year. Vaccines train your immune system to recognize infections and fight them off before you get sick. The influenza virus can change (mutate) a little bit every year, which is why you need to get vaccinated every year.
Even if you get sick with a different version of the flu than the one in the vaccine, vaccination reduces your risk of getting seriously ill. Your provider can give you the flu vaccine as a shot or as a mist they spray into your nose.
Other ways to reduce your risk of getting the flu include:
Most people are able to manage flu symptoms at home and recover within a few days to a week. Because it can cause severe illness, its important to keep an eye on your symptoms and get medical attention if you need it. This is especially important if you have an underlying health condition.
If youre sick with the flu, you should avoid being around others, except to seek medical care.
Flu can last from a few days to two weeks. Symptoms like fever and body aches can come on suddenly but usually go away faster than other symptoms. A cough or runny nose can last longer.
You can be contagious with the flu from a day before your symptoms start to up to a week after. Youre most contagious for three to four days after your symptoms start. People with weakened immune systems and infants may be contagious for longer.
To avoid spreading the flu to others, you shouldnt go back to work or school until its been at least 24 hours since youve had a fever (without taking fever-reducing medications). Your employer or school may have different requirements for returning.
The flu virus itself can cause complications or it can weaken your immune system and allow bacteria to infect different parts of your body (secondary infection). Complications and secondary infections include:
In a typical flu season in the U.S., its estimated that between 20,000 and 50,000 people die from the flu. Another 300,000 to 500,000 require hospitalization for serious illness.
If you think you have the flu, its important to get tested early on so that antiviral medications are most effective if your provider prescribes them. Contact a healthcare provider right away if:
Go to the ER or seek immediate medical attention if you have symptoms of severe illness, including:
No, gastroenteritis, commonly called stomach flu, isnt caused by the influenza virus. Its not related to the seasonal flu.
A note from Cleveland Clinic
While the flu is very common, its also important to remember that it can lead to life-threatening complications. Getting your flu shot is the best way to avoid getting sick and protect your loved ones and neighbors, too. If you have underlying health conditions or are pregnant, talk to your provider about reducing your risk of flu. Having the flu isnt fun for anyone, but most people can get through with some movies and chicken soup at home.
The National Adult and Influenza Immunization Summit created resources to assist in the planning and operation of vaccination clinics, including annual flu clinics, school-based clinics, and vaccination clinics. This document summarizes key points in running a successful clinic, and provides links to many other useful resources. Learn more: Tools to Assist Satellite, Temporary, and Off-Site Vaccination Clinics
CDC also has a clinic resource page entitledGuidance for Planning Vaccination Clinics Held at Satellite, Temporary, or Off-Site Locations, which outlines the logistics and considerations needed to plan a vaccination clinic.
Public providers interested in holding vaccination clinics may benefit from enrolling in theVaccine Reimbursement Program for Public Providers. Commonwealth Medicine, the health care consulting division of UMass Medical School, manages this program that reimburses public providers for vaccines and their administration by billing health plans.
Influenza vaccines may be given at the same time as other vaccines, including COVID-19 vaccines. CDC's clinical guidance for the use of COVID-19 vaccines states that any vaccine may be given on the same day or any day before or after COVID-19 vaccination, at a different anatomic site. If administered at the same time, COVID-19 vaccines and influenza vaccines that might be more likely to cause a local reaction (aIIV4 or HD-IIV4) should be administered in separate limbs, if possible. Learn more: Coadministration of COVID-19 vaccines with other vaccines.
Always screen patients for contraindications and precautions before a vaccine is administered, even if the same vaccine was administered previously. A patients health status or the recommendations for contraindications and precautions may have changed since the last dose was given. Screening helps prevent adverse reactions, such as anaphylaxis. At each visit, use a standardized screening tool to assess patients consistently and correctly. Screening forms can be found at theImmunization Action Coalition website.
Clinic Vaccine Administration Record(DOC) is an important tool for vaccination clinics. It serves as a centralized location to keep track of required documentation for vaccinations, including brand and lot number of vaccine administered, dose, and route of administration.
TheWithdrawal of Permission Sample Form for Schoolscan be modified by districts/schools to fit their needs. It can be used for parents to withdraw previously given permission for a child to receive a vaccination at school.
MDPH has developedModel Standing Ordersfor influenza and other vaccine preventable diseases.
For guidance on how to properly store vaccines, please visit theVaccine Managementpage as well as theCDC Vaccine Storage and Handling Toolkit
A universal flu vaccine: Here's what you need to know World Economic Forum
