What are the symptoms?

Over the past 18months we have seen an increasing number of patients who have developed some lingering symptoms following a Covid 19 infection.

Some of these have been described under the umbrella term “Long Covid”, although to date there is no clear consensus amongst the scientific community this actually means. Sometimes this condition has been described as “post Covid Syndrome” or, in the American press, “Covid Long Haulers”.

Nevertheless, patients describe feeling much more short of breath, having palpitations or heart flutters, dizziness, and chest pain. These patients are commonly referred to their cardiologist for further investigation. Some symptoms may overlap with those of “post viral fatigue syndrome”. Other common symptoms include extreme tiredness (fatigue), problems with memory, joint pains, rashes, anxiety, and feeling sick. A good summary of Long Covid symptoms is found on the NHS website.

What cardiac tests do we do for patients with suspected Long Covid affecting the heart?

With these symptoms, the minimum set of cardiac tests we will need are an ECG, echo, lung function tests, chest X ray, and a cardiac patch monitor. I may also advise you to have some blood tests depending upon what has already been done. I can then give you a clearer idea of the diagnosis, and organise further tests such as a CT scan of the heart (CTCA: CT coronary angiogram) or lungs (CTPA:  CT pulmonary angiogram), and cardiac MRI scan. Thereafter I may refer you to another expert if and when appropriate.

What is the evidence supporting the impact on the heart in people with Long Covid?

We are continually learning about the potential long-term effects of Covid upon the heart and blood vessels (cardiovascular system).

Recently, in the Journal Nature Medicine, a study of more than 153,000 individuals with Covid 19 was undertaken, to estimate the risks ad 1-year burdens of a set of cardiovascular outcomes. The study showed that beyond the first 30 days of infection, people with covid 19 showed an increased risk of stroke, heart rhythm disorders, inflammations of the heart and heart lining (myocarditis and pericarditis),  ischaemic heart disease (problems with the blood supply to the heart), heart failure, and blood clot formation ( pulmonary embolism, deep vein thrombosis, and superficial vein thrombosis). These risks were greater regardless of age, race, sex, and other cardiovascular risk factors such as obesity, diabetes, chronic kidney disease, and high lipids. They were also higher in people who did not have any cardiovascular disease before covid 19 exposure.  The study investigators concluded that “care pathways of people who survived an acute episode of Covid 19 should include attention to cardiovascular health and diseases.”