SARS-CoV-2, the virus that causes COVID-19, affects various organs and systems in the body, including the cardiovascular system. What do we currently know about its impact on the heart? This feature looks at the latest research and reveals what cardiologists have observed in the hospital setting.

SARS-CoV-2 has exhibited the ability to impact more than the respiratory system. Since its emergence, people who have had COVID-19 also report symptoms affecting the brain, gastrointestinal system, and heart.

Observational and research data suggest that COVID-19 impacts the heart in hospitalized patients, those with mild cases of the disease, and people with no prior heart-related conditions. These heart-related issues may remain long after the illness has passed, regardless of whether the individual experienced a severe or mild case of COVID-19.

Doctors still do not fully understand how SARS-CoV-2 causes heart problems, the extent of these issues, or whether this aspect of the virus should cause extreme concern.

In this feature, we sift through the latest research to understand the impact COVID-19 has on the heart. We also spoke with one cardiologist from a hospital intensive care unit that has experienced a heavy influx of patients with COVID-19.

How SARS-CoV-2 attacks the heart

Scientists are just beginning to gather evidence of how SARS-CoV-2 affects the heart. There are two main theories, each involving different aspects of the virus and its impact on the cardiovascular system.

Firstly, inflammation caused by the body’s robust immune response during COVID-19 may play a role in provoking heart complications. This immune response can indirectly damage heart tissues by diminishing the heart’s blood supply and increasing the risk of heart inflammation.

Researchers also suspect that SARS-CoV-2 may cause heart tissue damage because of its distinct spike protein that can directly attach to and enter cardiac cells by binding with the heart’s angiotensin-converting enzyme 2 (ACE2) receptors.

Whether immune system-related or a result of SARS-CoV-2 directly attaching to receptors in the heart, research has revealed evidence of heart cell damage in people who have had COVID-19.

Scientists examining the hearts of people who died of COVID-19 early in the pandemic found evidence of blood clotting issues (microvascular thrombosis) and heart cell death (necrosis). Areas of muscle cell death occurred in 35% of the 40 hearts examined. The scientists also found blood clots in the capillaries, or small blood vessels, in the heart tissue.

Because of the lack of large-scale studies, it is necessary to carry out further investigation to fully uncover the mechanisms behind the impact of SARS-CoV-2 on the heart.

Treating COVID-19-related heart complications

Standard treatment for people hospitalized for COVID-19 generally includes remdesivir and dexamethasone. For the most part, this does not change for people with pre-existing heart conditions.

At Cedars-Sinai, individuals admitted to the hospital with pre-diagnosed heart problems receive typical cardiac therapies in addition to medications for COVID-19.

According to Dr. Goldhaber, treatment plans at the Cedars-Sinai medical intensive care unit (ICU) also incorporate anticoagulants: “We have a very low threshold [to use anticoagulants in] patients who are diagnosed with COVID-19 to prevent all COVID-related thrombosis. Those patients who got prophylactic anticoagulation were patients who didn’t have any cardiac symptoms at all.”

No matter the treatment regimen used, Dr. Goldhaber and his colleagues have found that, in general, patients with pre-existing cardiac conditions had to stay longer in the ICU than individuals without underlying heart problems.

Medical reference: Medical News Today