For patients who have recovered from Covid-19, the desire to return to normal life can be overwhelming. But before jumping back into your usual routine, specifically your usual exercise routine, doctors are urging survivors of Covid-19 to have their hearts checked first.
“We know that patients that had Covid-19, depending on medication treatments and severity of disease, have experienced a lot of inflammatory and clotting phenomenon in hearts and lungs that could impair blood flow to those organs,” said Dr Thomas Gut, associate chair of medicine at Staten Island University Hospital.
“If you were to start becoming active again, and the heart and lungs start demanding more output, you can run into issues because of it,” Gut said. That is, while we typically associate Covid-19 with pulmonary symptoms, the cardiac side effects are just as important to be aware of. Exercising with heart issues related to Covid-19 can lead to irregular heartbeats or sudden cardiac death.
Covid-19 and the heart
Nearly a quarter of people hospitalized with Covid-19 develop myocardial injury or injury to the heart tissue. People with Covid-19 have also developed thromboembolic disease or blood clots and arrhythmias. “We’re concerned about the heart because there is a lot of data that has come out in people hospitalized with Covid-19 that demonstrates heart muscle involvement with the virus,” said Dr. Sean Heffron, assistant professor at the Department of Medicine at NYU Grossman School of Medicine.
“With that knowledge, we’re concerned about long-term implications of Covid-19 infections on heart structure and function, and safety of exercise after infection,” Heffron said. Starting to exercise too quickly, or taking on too much too soon, without being aware of the condition of your heart can have negative effects. This is due to the long-term effects of Covid-19, which are still being researched.
“The body, heart, and lungs operate off of demand,” Gut said. “The body needs more blood flow and oxygen [while exercising], which signals the heart and lungs to pump harder. In a setting where the heart or lungs are limited or damaged, the heart or lungs can cause harm to themselves trying to exert just to maintain oxygenation and blood flow to all the organs,” he said.
Who needs to be tested?
Who has to be tested and what type of test is recommended depend on each individual and their specific symptoms or severity of diagnosis. Research from late October issued advice for “return to play” for competitive sports athletes, high school athletes, and recreational masters athletes, who are over the age of 35 and train for particular competitions. The research advised talking with your doctor and having heart screenings. These tests, recommended for athletes who had moderate to severe Covid-19, include:
Electrocardiograms (EKG or ECG). This records the electrical signals in your heart. It’s a good way to test for arrhythmias. Echocardiograms. This uses sound waves to produce images of your heart, like a sonogram. It’s used to detect problems with the valves or chambers of the heart. Troponin blood tests. This measures the levels of troponin T or troponin I proteins in the blood. These proteins are released when the heart muscle has been damaged. MRI: Magnetic resonance imaging creates detailed images of the organs, including the heart. It tests size and function, extent of damage, structural problems, or inflammation.
For patients who had mild cases of Covid-19 or were asymptomatic, heart screening isn’t considered imperative. “The more severe an illness has occurred in an individual, the more cautious we are about getting them back into their routine,” said Dr. Sahadeo Ramnauth, cardiologist with NewYork-Presbyterian Medical Group Queens.
“Those who have been hospitalized or intubated would indicate more serious illness. The more severe the illness, the more cautious we are,” Ramnauth said.
