Cardiac problems are usually not among the most prominent features of COVID-19. But they are common enough, and potentially serious enough, that most people admitted to the hospital with COVID-19 are now being screened for heart muscle injury, and cardiologists often become part of their care team.
In many patients, heart involvement with COVID-19 is a relatively subtle condition, while in others it produces major and possibly fatal complications. While there are several potential causes of COVID-19-related heart muscle injury, the specific cause in a particular individual is often difficult to identify. Treatment is supportive and general rather than specific to COVID-19.
Verywell / Alex Dos Diaz
Prevalence of Heart Muscle Injury From COVID-19
Early studies have found that, among people sick enough to be hospitalized with COVID-19, evidence of cardiac muscle injury can be found in 8% to 12%. In people with milder forms of COVID-19, there is no evidence of heart muscle injury.
In most people with COVID-19 who have a detectable heart muscle injury, any resulting cardiac issues tend to be minor.
Symptoms
Causes and Risk Factors
The majority of people who develop heart muscle damage from COVID-19 have significantpre-existing medical conditionsthat predispose them to cardiac disease, includingcoronary artery disease, diabetes, obesity, or hypertension.
No single cause has been identified. There are several potential mechanisms that might produce this heart damage, and it is likely that all of them may play a role to one extent or another. These include:
Diagnosing Heart Muscle Injury From COVID-19
The most useful screening test is to measure blood levels oftroponin. Troponin is a cardiac protein that is important for muscle contraction. Injured heart cells leak troponin into the bloodstream, so elevated troponin blood levels are an important indication that cardiac cell damage is occurring.
In addition to blood troponin levels, anelectrocardiogram (ECG)and chest X-ray can also help screen for cardiac disease. If screening tests do suggest a heart problem, anechocardiogramcan be helpful in determining the presence and the nature of any cardiac involvement with COVID-19. Invasive cardiac procedures, such as aheart catheterization, are avoided whenever possible in COVID-19 patients who are seriously ill.
Often, an abnormal troponin test is the only manifestation of cardiac muscle damage in people ill with COVID-19. But whether or not there are other symptoms of a cardiac problem, elevated troponin levels in patients hospitalized with COVID-19 are associated with an increased risk of mortality.
In some patients with elevated troponin levels, heart muscle injury is extensive enough to produce more obvious cardiac disease, which can complicate COVID-19 recovery.
Heart Failure
If the heart muscle is damaged severely enough, heart failure can occur. Heart failure is a serious problem in anyone; in a person ill with COVID-19, it is particularly dangerous.
In studies from Wuhan, China, heart failure was a prominent feature in many patients who became critically ill with COVID-19. In fact, heart failure was diagnosed in approximately half the patients with COVID-19 who died during their hospitalization. The large majority of patients diagnosed with heart failure during their illness had no prior history of heart failure, indicating that their cardiac problems apparently arose as a result of COVID-19.
Heart Attack
Heart attacks (myocardial infarctions)are also fairly common in people hospitalized with COVID-19. This is not unexpected, because it has long been known that influenza and other illnesses that cause pneumonia are associated with a higher risk of heart attacks.
There are at least two ways COVID-19 can trigger a heart attack:
Arrhythmia
Several types of arrhythmias may occur in people hospitalized with COVID-19, but the most prominent areatrial fibrillationandventricular tachycardia. In particular, these patients may develop a dangerous form of ventricular tachycardia called"torsades de pointes," or TdP.
TdP is seen when a QT interval is prolonged. (The QT interval is measured on the ECG, and represents the length of time it takes for electrolytes to cross back and forth across a cardiac cell membrane when a heart cell is stimulated to beat.) Because of the severity and complexity of their illness, the QT interval is often prolonged in people who are seriously ill with COVID-19.
Some of the medications that may be used to treat COVID-19 in a hospital setting, likehydroxychloroquineandazithromycin, can also prolong the QT interval, increasing the risk of TdP.
What to Know About Long QT Syndrome (LQTS)
Treatment
Heart Failure Treatment
When it is acute, heart failure treatment requires excellent fluid management (to keep excess fluid out of the lungs), restoring normal blood oxygen levels, and identifying underlying conditions amenable to treatment (such as cardiac ischemia).
Heart Attack Treatment
Acute heart attacks are generally treated the same in people with COVID-19 as they are in anyone else, with the exception that cardiologists are more likely to usefibrinolytic therapy(“clot busters”) as primary therapy instead ofstents. Surgery, like angioplasty, will be performed if the artery is totally blocked. Different types of medications may be administered, including medication to break up a clot (thrombolytic therapy), antiplatelet medications, blood thinners, beta-blockers, ACE inhibitors, and statins.
Cardiac Arrhythmia Treatment
Cardiac arrhythmias are also managed just as they are in people without COVID-19—from prescription drugs to pacemakers and ablation procedures. Anyone who is critically ill is prone to arrhythmias, and great emphasis should be placed on prevention. This means paying careful attention to fluid management, blood oxygenation, electrolyte balance, and avoiding (whenever possible) drugs that are known to prolong the QT interval on an electrocardiogram.
Seriously ill patients with COVID-19 will be placed on a cardiac monitor so that any acute arrhythmias can be dealt with quickly.
A Word From Verywell
Screening tests for heart injury should be performed in anyone admitted to the hospital with COVID-19. If such evidence is found, careful cardiac monitoring should be instituted.
The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit ourcoronavirus news page.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lippi G, Lavie CJ, Sanchis-Gomar F.Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis.Prog Cardiovasc Dis.2020. doi:10.1016/j.pcad.2020.03.001Clerkin KJ, Fried JA, Raikhelkar J, et al.Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease.Circulation. 2020. doi:10.1161/CIRCULATIONAHA.120.046941Zeng JH, Liu YX, Yuan J, et al.First case of COVID-19 complicated with fulminant myocarditis: a case report and insights.Infection. 2020. doi:10.1007/s15010-020-01424-5Thygesen K, Alpert JS, Jaffe AS, et al.Fourth Universal Definition of Myocardial Infarction (2018).J Am Coll Cardiol.2018; 72:2231. doi:10.1016/j.jacc.2018.08.1038Shi S, Qin M, Shen B, et al.Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China.JAMA Cardiol. 2020. doi:10.1001/jamacardio.2020.0950Zhou F, Yu T, Du R, et al.Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.Lancet.2020; 395:1054. doi:10.1016/S0140-6736(20)30566-3Fried JA, Ramasubbu K, Bhatt R, et al.The Variety of Cardiovascular Presentations of COVID-19.Circulation. 2020. doi:10.1161/CIRCULATIONAHA.120.04716Haeusler IL, Chan XHS, Guérin PJ, White NJ.The arrhythmogenic cardiotoxicity of the quinoline and structurally related antimalarial drugs: a systematic review.BMC Med. 2018; 16:200. doi:10.1186/s12916-018-1188-2European Society of Cardiology.ESC Guidance for the Diagnosis and Management of CV Disease During the COVID-19 Pandemic.European Society of Cardiology, 21 April 2020.Lakkireddy DR, Chung MK, Gopinathannair R, et al.Guidance for Cardiac Electrophysiology During the Coronavirus (COVID-19) Pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association.Circulation. 2020. doi:10.1161/CIRCULATIONAHA.120.047063
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lippi G, Lavie CJ, Sanchis-Gomar F.Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis.Prog Cardiovasc Dis.2020. doi:10.1016/j.pcad.2020.03.001Clerkin KJ, Fried JA, Raikhelkar J, et al.Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease.Circulation. 2020. doi:10.1161/CIRCULATIONAHA.120.046941Zeng JH, Liu YX, Yuan J, et al.First case of COVID-19 complicated with fulminant myocarditis: a case report and insights.Infection. 2020. doi:10.1007/s15010-020-01424-5Thygesen K, Alpert JS, Jaffe AS, et al.Fourth Universal Definition of Myocardial Infarction (2018).J Am Coll Cardiol.2018; 72:2231. doi:10.1016/j.jacc.2018.08.1038Shi S, Qin M, Shen B, et al.Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China.JAMA Cardiol. 2020. doi:10.1001/jamacardio.2020.0950Zhou F, Yu T, Du R, et al.Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.Lancet.2020; 395:1054. doi:10.1016/S0140-6736(20)30566-3Fried JA, Ramasubbu K, Bhatt R, et al.The Variety of Cardiovascular Presentations of COVID-19.Circulation. 2020. doi:10.1161/CIRCULATIONAHA.120.04716Haeusler IL, Chan XHS, Guérin PJ, White NJ.The arrhythmogenic cardiotoxicity of the quinoline and structurally related antimalarial drugs: a systematic review.BMC Med. 2018; 16:200. doi:10.1186/s12916-018-1188-2European Society of Cardiology.ESC Guidance for the Diagnosis and Management of CV Disease During the COVID-19 Pandemic.European Society of Cardiology, 21 April 2020.Lakkireddy DR, Chung MK, Gopinathannair R, et al.Guidance for Cardiac Electrophysiology During the Coronavirus (COVID-19) Pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association.Circulation. 2020. doi:10.1161/CIRCULATIONAHA.120.047063
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Lippi G, Lavie CJ, Sanchis-Gomar F.Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis.Prog Cardiovasc Dis.2020. doi:10.1016/j.pcad.2020.03.001Clerkin KJ, Fried JA, Raikhelkar J, et al.Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease.Circulation. 2020. doi:10.1161/CIRCULATIONAHA.120.046941Zeng JH, Liu YX, Yuan J, et al.First case of COVID-19 complicated with fulminant myocarditis: a case report and insights.Infection. 2020. doi:10.1007/s15010-020-01424-5Thygesen K, Alpert JS, Jaffe AS, et al.Fourth Universal Definition of Myocardial Infarction (2018).J Am Coll Cardiol.2018; 72:2231. doi:10.1016/j.jacc.2018.08.1038Shi S, Qin M, Shen B, et al.Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China.JAMA Cardiol. 2020. doi:10.1001/jamacardio.2020.0950Zhou F, Yu T, Du R, et al.Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.Lancet.2020; 395:1054. doi:10.1016/S0140-6736(20)30566-3Fried JA, Ramasubbu K, Bhatt R, et al.The Variety of Cardiovascular Presentations of COVID-19.Circulation. 2020. doi:10.1161/CIRCULATIONAHA.120.04716Haeusler IL, Chan XHS, Guérin PJ, White NJ.The arrhythmogenic cardiotoxicity of the quinoline and structurally related antimalarial drugs: a systematic review.BMC Med. 2018; 16:200. doi:10.1186/s12916-018-1188-2European Society of Cardiology.ESC Guidance for the Diagnosis and Management of CV Disease During the COVID-19 Pandemic.European Society of Cardiology, 21 April 2020.Lakkireddy DR, Chung MK, Gopinathannair R, et al.Guidance for Cardiac Electrophysiology During the Coronavirus (COVID-19) Pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association.Circulation. 2020. doi:10.1161/CIRCULATIONAHA.120.047063
Lippi G, Lavie CJ, Sanchis-Gomar F.Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis.Prog Cardiovasc Dis.2020. doi:10.1016/j.pcad.2020.03.001
Clerkin KJ, Fried JA, Raikhelkar J, et al.Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease.Circulation. 2020. doi:10.1161/CIRCULATIONAHA.120.046941
Zeng JH, Liu YX, Yuan J, et al.First case of COVID-19 complicated with fulminant myocarditis: a case report and insights.Infection. 2020. doi:10.1007/s15010-020-01424-5
Thygesen K, Alpert JS, Jaffe AS, et al.Fourth Universal Definition of Myocardial Infarction (2018).J Am Coll Cardiol.2018; 72:2231. doi:10.1016/j.jacc.2018.08.1038
Shi S, Qin M, Shen B, et al.Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China.JAMA Cardiol. 2020. doi:10.1001/jamacardio.2020.0950
Zhou F, Yu T, Du R, et al.Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.Lancet.2020; 395:1054. doi:10.1016/S0140-6736(20)30566-3
Fried JA, Ramasubbu K, Bhatt R, et al.The Variety of Cardiovascular Presentations of COVID-19.Circulation. 2020. doi:10.1161/CIRCULATIONAHA.120.04716
Haeusler IL, Chan XHS, Guérin PJ, White NJ.The arrhythmogenic cardiotoxicity of the quinoline and structurally related antimalarial drugs: a systematic review.BMC Med. 2018; 16:200. doi:10.1186/s12916-018-1188-2
European Society of Cardiology.ESC Guidance for the Diagnosis and Management of CV Disease During the COVID-19 Pandemic.European Society of Cardiology, 21 April 2020.
Lakkireddy DR, Chung MK, Gopinathannair R, et al.Guidance for Cardiac Electrophysiology During the Coronavirus (COVID-19) Pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association.Circulation. 2020. doi:10.1161/CIRCULATIONAHA.120.047063
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