Post COVID heart: Cardiological clarification after a corona infection

Post COVID Herz-Beschwerden sind ein zunehmend anerkanntes Phänomen, bei dem Symptome wie Herzrasen, Brustschmerz oder Leistungsminderung auch Wochen und Monate nach einer überstandenen SARS-CoV-2-Infektion fortbestehen oder neu auftreten können. Viele Betroffene fühlen sich verunsichert, da ihr Körper nicht mehr so funktioniert wie vor der Erkrankung. In unserer kardiologischen Praxis nehmen wir diese Beschwerden sehr ernst und bieten Ihnen eine strukturierte Abklärung, um mögliche Ursachen zu finden, ernsthafte Komplikationen wie eine Herzmuskelentzündung zu beurteilen und mit Ihnen das weitere Vorgehen zur schrittweisen Rückkehr zu Ihrer Belastbarkeit zu besprechen.

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).

Je nach Befund können weiterführende Untersuchungen wie ein Langzeit-EKG, ein Belastungs-EKG oder eine Lungenfunktionsprüfung sinnvoll sein.

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

Eine der häufigsten Fragen nach einer Corona-Infektion betrifft die sichere Rückkehr zum Sport. Eine zu frühe und zu intensive Belastung ist ein erhebliches Risiko. Bei sportkardiologischen Fragen berät Sie Dr. Raphael Bruno fundiert, wann und wie Sie Ihr Training sicher wieder aufnehmen können. Die Empfehlungen richten sich nach der Schwere des ursprünglichen Verlaufs.

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 den allermeisten Fällen ist die Prognose gut. Viele funktionelle Störungen wie POTS oder die allgemeine Leistungsschwäche bilden sich bei den meisten Patienten über einen Zeitraum von 6-12 Monaten langsam zurück. Eine vollständig ausgeheilte Myokarditis hinterlässt oft keine bleibenden Schäden. Wichtig ist jedoch, die akute Phase ernst zu nehmen und dem Körper die nötige Zeit zur Erholung zu geben.

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

EKG und Herzultraschall sind die Basis der Diagnostik, erfassen aber eine milde oder fleckförmige Myokarditis nicht immer. Wenn der klinische Verdacht bei typischen Symptomen und z.B. erhöhten Troponin-Werten hoch bleibt, ist das Herz-MRT die sensitivste nicht-invasive Methode, um eine Entzündung nachzuweisen. Ein unauffälliger Basis-Post COVID heart-check is already very reassuring.

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

Ein anhaltend erhöhter Ruhepuls (Ruhetachykardie) ist ein sehr häufiges Symptom nach COVID-19. Er ist meist Ausdruck einer Überaktivierung des vegetativen Nervensystems und nicht primär gefährlich, aber oft sehr belastend. Eine kardiologische Abklärung ist wichtig, um andere Ursachen zu beurteilen und eine symptomatische Therapie (z.B. mit Betablockern in niedriger Dosis) zu besprechen.

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.

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