Can the Heart be Injured by Covid?

Can the heart be damaged by asymptomatic Covid-19 infection? This article (link below) is reporting actual patient scenarios, which is fair, but it is very alarmist.  As a physician, I do not agree with much of this and would like to clarify a few things.

The big picture:  Many viruses are known to cause infection and inflammation of the heart and its outer membrane (myocarditis and pericarditis).  In fact, viral infection is the number one cause of myocarditis.  Examples of respiratory viruses that can infect the heart tissue: Enteroviruses (Coksackie, Echo, and a slew of others), Influenza and Para-Influenza viruses, Parvoviruses, Adenoviruses, and many others.  Infection of the heart can be mild or severe, depending upon the immune system’s response to the viral infection. This is the same ‘cytokine storm’ in the heart that causes acute respiratory distress syndrome (ARDS) in the lungs.

The journalist who wrote this article is inflating SARS-CoV2 into a more serious pathogen than it is.  Don’t get me wrong, all of these viruses are serious pathogens that can be dangerous for the very few unfortunate individuals among us. But the Coronavirus has not proven to be more of a foe than the others, with regard to the heart.  And for the record, the article primarily emphasized competitive athletes experiencing cardiac complications following Covid-19. Extreme exercise is not generally recommended during or immediately following a significant viral infection (flu-like illness). One example of this is Epstein-Bar Virus (EBV) infection, which can cause the Spleen to rupture (which can be fatal) for as much as 6 weeks after recovery, therefore contact sports are routinely contraindicated for this time period.

Another item of dispute with this article is that supposedly asymptomatic Covid-19 can cause Myocarditis. However, even a mild case of myocarditis would cause symptoms. Myocarditis by definition is a very serious condition that would necessitate a hospital admission to a cardiac telemetry unit to monitor the heart’s rhythm. If a person is “asymptomatic” then they do not have a heart infection. In other words, ‘asymptomatic myocarditis’ is an oxymoronic term. This also begs the question; how would an asymptomatic person get diagnosed with a heart infection? Even if an asymptomatic person were screened for Covid-19 infection and found to be positive, without symptoms there would be no medical reason to perform a diagnostic test of the heart.

The final item of dispute with this article is that cardiomyopathy was claimed to be a possible complication of Covid-19. However, cardiomyopathy is rarely caused by infection, but even when it is the result of a severe myocarditis, it is characterized by a change in the actual structure of the heart, which is a process that typically requires years. Perhaps in a rare case it could take months, though it is likely too soon in the pandemic to make such a claim.

One thing we can all agree on is that the pandemic has unfortunately necessitated scrutiny of everything we read.

Click here to read article in the Scientific American

Justin Groode MD | Patient Advocate Alliance LLC

Please let me know what you agree and disagree with. We are all learning about Covid-19 every day, patients and doctors alike, we are all ill-prepared for this pandemic.

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