How COVID-19 may infect the heart directly

Research on the way the coronavirus attacks the human body is ongoing. It’s kind of like going down a rabbit hole… just when you think you’ve reached the bottom, the tunnel turns, and there’s even more information to digest.

Hopefully, we will come up for air soon, and this nightmare will be long behind us. But until it is, the more we know, the better.

One thing puzzled scientists can’t figure out is why so many people with COVID-19 are dying of heart complications when it’s a respiratory illness that attacks through the lungs.

Recent research suggests it boils down to a few factors…

One is the widespread inflammation the infection causes.

Another is the possibility that the virus directly infects the heart itself.

And a lot of deaths could be accounted for by the overall stress the infection puts on the cardiovascular system for people with preexisting heart conditions.

Out-of-control inflammation

We know that the coronavirus itself is often not the cause of death. Instead, a cytokine storm overwhelms the body.

When this happens, the immune system’s response to the virus — its production of inflammatory cytokines — is way too big for the infection.

An overblown inflammatory response can put a lot of stress on the heart. It makes it work harder to pump blood throughout the body, and healthy cells end up getting attacked along with infected ones.

“In terms of the heart, when there is a cytokine storm, the excess of cytokines can lead to fulminant myocarditis (inflammation of the heart), with heart muscle cell necrosis or death,” said Dr.Joyce M. Oen-Hsiao, director of clinical cardiology at Yale Medicine. This can lead to problems with heart function and heart failure.

ACE2 makes it easy to infect the lungs — and the heart

The COVID-19 virus attaches to angiotensin-converting enzyme 2 (ACE2), which is found in the cells of the lungs. This allows the virus to invade and cause respiratory illness.

But ACE2 is also found in the heart and the cells that line blood vessels. ACE2 is also part of the renin-angiotensin-aldosterone system, which regulates cardiovascular function, kidney function and blood pressure.

According to Dr. Jack Wolfson, a board-certified cardiologist and a fellow of the American College of Cardiology, the coronavirus appears to enter and infect the heart cells though these ACE2 receptors.

“Once inside the heart cell, damage to the cellular machinery directly from the virus and the human immune cell response leads to cell dysfunction and cellular death,” Dr. Wolfson says.

People with pre-existing heart conditions are at highest risk

If you already have heart disease, contracting a COVID-19 infection heightens your risk of a heart attack.

“A person with pre-existing coronary artery disease is more likely to experience cardiac complications since they already have compromised blood flow to their heart and diminished blood vessel function,” says Dr. Wolfson.

It makes sense. The stress of a cytokine storm, or of a COVID-19 attack on the heart muscle, puts a greater strain on the heart as it works to pump the blood your body needs. Heart cells may sustain even further damage, and a heart attack could be the end result.

When COVID-19 mimics a heart attack

Before the coronavirus came along, if you arrived at the emergency room with chest pains and shortness of breath, you’d be treated for a heart attack. Immediately.

Now, the inflammation of the heart muscle (myocarditis) brought on by a cytokine storm can feel exactly like a heart attack, and doctors are faced with the tasks of telling the difference.

Still, if you are experiencing any of the warning signs of a heart attack (and don’t forget, these are different for women than they are for men), don’t stop and think about it: call 911 and get to the emergency room.

 Sources:

1. Heart attacks, heart failure, stroke: COVID-19’s dangerous cardiovascular complications — EurekaAlrt
2. COVID-19 Can Attack the Heart in Addition to the Lungs — Healthline
3. COVID-19 Illness and Heart Failure: A Missing Link? — JACC
4. Can Coronavirus Cause Heart Damage? —Johns Hopkins Medicine