Transcription:
What You Need to Know About Your Heart Health After COVID

Melanie Cole (Host): Welcome to Bryan Health podcast. I'm Melanie Cole. Joining me today is Dr. Mathue Baker. He's a Cardiologist with Bryan Heart and he's here to highlight post COVID heart health. Dr. Baker, it's a pleasure to have you join us again today. It's been a little while, but this is such an important topic. Can you tell us, is Bryan Heart seeing recovered COVID patients coming in with cardiac issues these days?

Mathue Baker, MD (Guest): Yeah, we've been seeing a lot of patients coming in, spanning the spectrum, really, of patients who are just freshly out of the hospital with recent COVID infection, all the way to patients who've been struggling with the long COVID type syndromes over months and months.

Host: That's such a bummer. So what sort of issues and symptoms are we talking about here? How severe have they been and does it differ Dr. Baker between those ones that you say that are just fresh from the hospital and what we're hearing about these long COVID symptoms and long haul COVID from maybe a year ago?

Dr. Baker: Yeah. So there is a pretty large spectrum of the types of patients that we've been seeing a post COVID. A lot of the degree of heart issues correlates with how sick they were in the hospital with their COVID infections. Sometimes what we're seeing is just the underlying heart disease that they had heading into their COVID diagnosis and the sickness that that's created and the heart problems that's created. Some of what we're seeing is fresh heart problems that were brought on by COVID itself. Some of the things we're seeing are problems that have popped up after COVID was diagnosed when they were in the hospital or not even hospitalized and didn't realize they had any heart issues going on at all.

Host: Wow. This has really been such a mystery, hasn't it? We're just more and more things seem to be cropping up. Is there any demographic that you've been seeing? More in another, I mean, are you seeing mostly the older? We expected our older individuals to maybe have some long haul symptoms or some, you know, kind of hangers on there things because COVID was pretty serious, but are you also seeing this in a younger person?

Dr. Baker: Well, my practice specifically, I've seen a little bit of a unique population, that being the younger athletes. I also participate in the Big-10 Subcommittee for Cardiology and take care of all of the athletes here at the University of Nebraska, as well as a lot of other small colleges in the area. So I've seen hundreds of hundreds of athletes over the last couple of years. And some of the information that we've gotten about COVID and heart disease has actually come from that group. There's been some very directed studies done within that population, mostly to make sure that it was safe for them to return to play, but as we all organized, that information came together. And so we do have a lot of information particularly about that group of people. And that's been a major focus of cardiologists around the country is not just in athletes, but in general public making sure that people are safe to return to exercise.

One of the issues that we see frequently after viral infection is something called myocarditis. That's gotten a lot of attention from the mainstream media as well as from the medical literature. So that information is coming together nicely. There was just a new article released in the month of May for providers that kind of outlined all of COVID-19 and all of the complications that we've been seeing, both acutely and subacutely ongoing, and kind of how to address those in a stepwise fashion. But as far as that group, the younger group, what we've seen mostly, following COVID, has been some very rare instances of myocarditis.

That's been a little bit of a tough thing to put an exact number on based mainly on how you define myocarditis. And most people put that number somewhere between 1% and 3%. The incidence of any of that low number being of any sort of a severe category or doing any permanent damage has been exquisitely rare in my practice. In those hundreds and hundreds of patients, I've had one patient in that age range and demographic that ended up hospitalized and she completely recovered and is back to competing. The vast majority, it's been very mild symptoms and something that we saw just because we were screening, basically all athletes that were diagnosed with COVID before they returned to play.

In terms of the older generation, more of what we've seen with them has been what we see with other viral infections that are of the severe nature and a lot of the sequelae of that we've seen oh more of an exacerbation of underlying heart problems that maybe they did or did not know that they had. We've seen for some of those patients, they've developed heart failure if while they were in the hospital, they had significant heart function damage, or heart muscle damage, and then just dealing with those things afterwards.

The one thing that I would say that's been more unique with COVID than a lot of other viral infections, is this issue with heart rate variability that develops weeks to months after COVID infection. And that can be really in any age or demographic. We see it a lot in the younger population because they tend to be more active and tend to notice it when their heartrate doesn't respond appropriately with activity. But essentially what we're seeing is people's heart rates running faster than they should be. So when you think about your cardiovascular system, you have a gas pedal, which is your fight or flight system, your adrenaline type system. And then you have a brake pedal, which is your vagal nerve. And it seems to be more of a problem with the brake pedal and normally your body is riding the brake throughout the day.

And then when it's time to do something active or something you need more output for your body, less off of the brake and hits the gas pedal. And something about COVID is causing us to not really have much brake pedal function at all, and so people notice their heart's racing all the time and very little activity and their heartrate shoots up to a number higher than they would normally expect and makes you feel short of breath and sometimes uncomfortable. And we've seen a lot of evidence with that, just with monitoring people's heart rates. And these days people have a lot of wearable devices that tell them that kind of simple information like watches and things like that.

That's probably been the most unique and common thing we've seen post COVID. That is something that's typically pretty treatable with medical therapy. Most of the time we can get people back down to a comfortable level. You treat it for a couple of months and it seems like things tend to get back to normal after that.

Host: How are you narrowing it down? How are you putting that link there, that it might not be caused by other symptoms, that they might not have had existing heart disease? Does this involve a battery of tests or is it just medical history that we're taking? How are you narrowing it down? That this could be linked to a prior COVID infection?

Dr. Baker: That's a good question. Definitely something that seems to be a little harder to define and within cardiology, we're just now starting to really kind of organize those thoughts and trends and patterns. And how do you define a causal link between one thing and the next. That's always a difficult thing until you start seeing large groups of patients with similar timing, for instance, from when they get COVID and when they start getting symptoms. We've actually just even started to begin organizing our taxonomy with this and just what we call things. And so now, instead of calling things the sort of long hual or long COVID, we have all these kind of general terms for it. So it's PASC. So post acute sequella of COVID-19 and then they break that down further into simply just symptoms or whether or not there is any objective evidence of heart damage.

So there's CVS with symptoms or CVD with cardiovascular disease. So kind of two offshoots of that term. And the first three tests that you do when somebody comes in after a COVID infection with symptoms that you think might be related to their heart; number one, a simple EKG which can be done in the office.

Number two, a blood test called troponin, where we check for any markers of damage. As the heart muscle tissue dies, it releases this protein into your bloodstream, which only comes from heart muscle tissue, and it can be detected and very low levels. So we have a good way to measure for that. And then lastly, we do something called an echocardiogram or an ultrasound of the heart to see if there's been any structural or functional damage to the heart.

Those are generally the first three tests that you. Do if all of those tests turn out okay, that generally rules out most of the dangerous things. And then it just becomes more of a symptom management strategy. If any of those come back abnormal, then the next step we often do is a cardiac MRI, which is an even more sensitive way to look for any evidence of viral damage to heart muscle tissue.

Host: So tell us a little bit about things that can exacerbate this. Are we looking, I mean you deal with athletes, but the older folks that have been more prevalent in COVID, I mean, a lot of them are very active. Is exercise, can that exacerbate some of these heart issues post COVID and really what do we know about any long-term impact about how COVID impacts the heart? You can speak about any research that you're doing there at Bryan or anywhere else.

Dr. Baker: Oh, that's a great question. I think a lot of COVID we've had to learn on the fly. And so we're finally getting to the point where we're over a year out from a lot of the waves that have came through and sort of trying to organize our thoughts on how this affects the heart. Systemically, COVID can affect you in so many different ways.

And a lot of times when people come in to see us after a battle with COVID, multiple organ systems have been affected. Not uncommon to see somebody who had, let's say a pulmonary embolus or a blood clot to their lungs to go along with maybe some myocardial dysfunction or, an elevated troponin while they were in the hospital, which can be related to many, many numbers of things when you're that sick.

And most of those people have also had lung damage. And so they have some residual shortness of breath, some are even requiring oxygen. So trying to sort through all that and get to what's cardiac versus what's pulmonary versus what's maybe from a blood clot. Sometimes there is a little bit of guesswork in trying to get to the exact answer for what's causing issues.

It depends very specifically on exactly what things are pathologic, what things are going on at the moment in getting people back on their feet. And it's kind of a long-term game for some of those patients who got sicker. But I think as time goes on, we've been able to sort of pick out different things like this autonomic dysfunction, where you see a lot of heart racing.

Well, that's something, we can treat and help out with. Some things, are a little bit more difficult. For instance, scarring to the lungs. Sometimes you can have permanent damage to heart muscle, for instance, if you had a heart attack while you were in sick with COVID. Some of that's permanent damage and some of that is stuff that we can help with medication. So it does become pretty individualized when you're talking about a systemic illness that can cause problems with so many different organ systems.

Host: Well, I certainly think so. And we're learning more all the time and I certainly hope you'll come back and update us as we learn more. But as we wrap up, do you have any advice for people who have recovered from COVID and may be dealing with some of these issues as they recover?

Dr. Baker: I think the key as you're recovering from an illness like that is just to have good communication with your healthcare team and if there is something that just isn't getting better. You know, there are things we're learning every day and ways, I think we're helping people trying to recover from COVID.

So just having that good conversation with your healthcare team and continuing to be an advocate for yourself, and progressing down the line to getting the testing you need, I think is probably the best thing people can do for themselves.

Host: I agree, and good communication, just as you say, an advocating for ourselves is so important. So thank you so much Dr. Baker for joining us today and thank you to our Bryan Foundation Partner Davis Design. You can always go over to our website at bryanheart.org for more information, and to get connected with one of our providers.

That concludes this episode of Bryan Health podcast. Please always remember for more health tips and updates on the latest medical advancements and breakthroughs, follow us on your social channels. I'm Melanie Cole.