Post COVID heart: Cardiological clarification after a corona infection

Post COVID heart complaints are an increasingly recognized phenomenon in which symptoms such as palpitations, chest pain or reduced performance can persist or reappear weeks and months after surviving a SARS-CoV-2 infection. Many sufferers feel insecure because their body no longer functions as it did before the illness. In our cardiology practice, we take these symptoms very seriously and offer you a structured assessment to find the causes, rule out serious complications such as myocarditis and show you a safe way back to your full capacity.

Typical symptoms of post-COVID heart

The cardiac symptoms associated with post-COVID or long-COVID syndrome can be varied and often diffuse. They occur after both severe and very mild courses. If you notice one or more of the following symptoms after a coronavirus infection, it is advisable to seek cardiological clarification.

Frequent complaints in the „post-COVID heart“ area:

• Persistent reduction in performance: You still feel unusually weak weeks after the infection and are nowhere near your previous fitness level.
• Palpitations (tachycardia): An inappropriately fast pulse at rest or during minimal exertion (e.g. when standing up).
• Heart stumbling (palpitations): The conscious awareness of your own heartbeat, which is often perceived as unpleasant.
• Chest pain: A feeling of pressure, tightness or stinging in the chest, which can occur at rest or during exertion.
• Shortness of breath (dyspnea): The feeling of not being able to breathe properly, often even during light everyday activities.
• Dizziness and circulatory problems: Especially when quickly rising from a lying or sitting position.

Possible causes: What is behind post-COVID heart symptoms?

Research into the long-term effects of COVID-19 on the heart is still ongoing, but several possible causes for the symptoms in the area of the heart have emerged. Post COVID heart has crystallized.

• Inflammation of the heart muscle (myocarditis) / inflammation of the pericardium (pericarditis): The virus or the body's own immune response can trigger an inflammation of the heart.
• Autonomic dysfunction (e.g. POTS): A dysregulation of the autonomic nervous system that leads to an excessive increase in heart rate when standing (postural tachycardia syndrome).
• Endothelial dysfunction: Damage to the inner layer of the blood vessels that impairs their function.
• Microthromboses: The smallest blood clots in the tiny vessels can disrupt organ function.
• Deconditioning: A significant loss of general fitness due to the illness-related rest phase.

The exact cause can only be narrowed down by careful cardiologic diagnostics.

Post COVID heart: Diagnostic clarification by a cardiologist

If you suspect Post COVID heartWhen patients come to our practice with complaints, we follow a systematic and step-by-step diagnostic approach. Our aim is to find objectifiable causes for your subjective complaints.

The basic cardiological assessment includes

1. Detailed anamnesis: We ask you about the exact course of your COVID-19 disease, the timing and nature of your symptoms.
2. Physical examination: Including blood pressure and pulse measurement while lying and standing (Schellong test).
3. Resting ECG: To assess the heart rhythm and look for signs of inflammation or other damage.
4. Cardiac ultrasound (echocardiography): The central examination to assess the pumping function, the heart valves and to search for signs of inflammation.
5. Laboratory examination: Determination of specific cardiac (troponin) and inflammation values as well as coagulation parameters (D-dimers).

Depending on the findings, further examinations such as a long-term ECG, an exercise ECG or a pulmonary function test may be necessary.

The special case of myocarditis: heart muscle inflammation after COVID-19

Special attention should be paid to the clarification of Post COVID heart-The first step in the diagnosis of heart muscle problems is to rule out myocarditis. This can also occur after a mild course and is particularly dangerous for athletes, as premature exercise can lead to serious and permanent heart damage or dangerous arrhythmias. Signs in the ECG or ultrasound and elevated troponin values can confirm the suspicion. If the findings are justified but not conclusive, a cardiac MRI is often the next diagnostic step in order to visualize the inflammation directly. If myocarditis is confirmed, consistent physical rest or a break from sport for at least 3-6 months is absolutely essential.

Return to Sport: Train safely with a post-COVID heart

One of the most frequent questions after a corona infection concerns the safe return to sport. Exercising too early and too intensively is a considerable risk. As a sports cardiologist, Dr. Raphael Bruno will give you sound advice on when and how you can safely resume your training. The recommendations are based on the severity of the original condition.

Guide to the resumption of sport

This table is for guidance only. Final clearance for sport should always be given individually after a medical examination, especially if Post COVID heart-symptoms are present.

Frequently asked questions about post-COVID and heart

Here you will find answers to frequently asked questions from patients after a corona infection.

I only had a very mild course. Can my heart still be affected?

Yes, studies have shown that cardiac symptoms and myocarditis can unfortunately also occur after very mild or even asymptomatic courses. Although the risk is lower than after severe courses, it is not zero. Therefore, new heart symptoms should be taken seriously even after a mild infection.

What is POTS and does it have anything to do with post-COVID?

POTS stands for postural tachycardia syndrome. It is a form of autonomic dysfunction in which the heart rate increases excessively (by >30 beats/minute) when standing up from a lying or sitting position without the blood pressure dropping. This leads to palpitations, dizziness and light-headedness when standing up. POTS is one of the most common syndromes associated with Post COVID heart-complaints can be diagnosed.

Are the heart problems after corona permanent?

In the vast majority of cases, the prognosis is good. Many functional disorders such as POTS or general poor performance slowly disappear in most patients over a period of 6-12 months. Completely healed myocarditis often leaves no permanent damage. However, it is important to take the acute phase seriously and give the body the time it needs to heal.

My ECG and ultrasound were unremarkable, could I still have myocarditis?

ECG and cardiac ultrasound are the basis of diagnosis, but cannot always reliably rule out mild or patchy myocarditis. If the clinical suspicion remains high with typical symptoms and e.g. elevated troponin values, cardiac MRI is the most sensitive non-invasive method for detecting inflammation. An unremarkable baselinePost COVID heart-check is already very reassuring.

My pulse has been constantly over 90 since the coronavirus - is that dangerous?

A persistently elevated resting heart rate (resting tachycardia) is a very common symptom after COVID-19. It is usually an expression of overactivation of the autonomic nervous system and is not primarily dangerous, but often very distressing. A cardiological assessment is important to rule out other causes and to discuss symptomatic treatment (e.g. with low-dose beta blockers).

I'm tired all the time. Does that come from the heart?

Persistent, severe exhaustion (fatigue) is a core symptom of post-COVID syndrome and can have many causes. A cardiac cause must be ruled out, especially if the fatigue is accompanied by shortness of breath on exertion. However, it is often a neuro-immunological symptom in its own right.

I'm short of breath after corona. Is it the lungs or the heart?

This is one of the central questions of the Post COVID heart-clarification. Both the lungs (e.g. due to scarring) and the heart (e.g. due to a weak pump or inflammation) can be the cause. Our diagnostic work-up therefore often includes a lung function test in order to make a clear diagnosis.

Should everyone see a cardiologist after a coronavirus infection?

No, a blanket examination for everyone is not necessary. A cardiological examination is advisable if you notice new or persistent cardiovascular symptoms after the acute phase of your illness or if you are an ambitious athlete and want to return to training safely.

Do vitamins or dietary supplements help with post-COVID heart?

To date, there is no scientific evidence that certain vitamins or dietary supplements Post COVID heart-symptoms can be specifically cured. However, a balanced, healthy diet to support the immune system and general regeneration is always advisable. High-dose preparations should only be taken after consulting a doctor and in the case of proven deficiencies.

What is the best therapy for post-COVID heart?

The therapy depends on the underlying cause. In the case of myocarditis, it is physical rest. In the case of POTS, it is circulatory training, increased salt and fluid intake and, if necessary, medication. However, the most important „therapy“ is often patience and a gradual restoration of exercise capacity („pacing“) adapted to the symptoms.

Clarity for your heart after Corona

Complaints following a COVID-19 infection can be unsettling and stressful. You are not alone with your worries. A specialized cardiological examination can identify organic causes for your Post COVID heart-We can detect or rule out symptoms and give you a safe roadmap for your recovery. Take your symptoms seriously and make an appointment for clarification.