The COVID-19 pandemic has raised awareness of certain conditions that may be caused by an infection with SARS-CoV-2, the virus that causes COVID-19. There is a growing concern that one serious complication of COVID-19 in some of those affected is myocarditis.
How Does Myocarditis Affect the Heart?
According to the Mayo Clinic, “Myocarditis is an inflammation of the heart muscle (myocardium)... [that] can affect… your heart's electrical system, reducing your heart's ability to pump and causing rapid or abnormal heart rhythms (arrhythmias). A viral infection usually causes myocarditis, but it can result from a reaction to a drug or be part of a more general inflammatory condition. Signs and symptoms include chest pain, fatigue, shortness of breath, and arrhythmias. Severe myocarditis weakens your heart so that the rest of your body doesn't get enough blood. Clots can form in your heart, leading to a stroke or heart attack.” The National Organization for Rare Disorders tells us that “In a majority of cases, the symptoms of myocarditis are preceded a few days to weeks by a flu-like illness.”
How Is Myocarditis Diagnosed?
The symptoms of myocarditis do not make it easy to discern from some other cardiac diseases. However, according to the Myocarditis Foundation, some “symptoms of heart failure, including shortness of breath, fatigue, inability to tolerate exercise, and associated with difficulty breathing while laying down/sleeping are common to many heart diseases besides myocarditis. One feature that distinguishes myocarditis from other causes of heart failure is that it often follows an upper respiratory or gastrointestinal infection and is due to a specific immune response against the heart itself.” Diagnosis may involve a physical exam, x-ray, electrocardiogram, echocardiogram, MRI, and blood tests for telltale proteins and antibodies. A biopsy can be performed when myocarditis is suspected, allowing heart tissue to be examined on the microscopic level for evidence whether a disease process is present.
Long Term Impact of Myocarditis
Harvard Health Publishing advises that the long-term impact of myocarditis is related to its source and the person’s preexisting health. Some good news is that “In generally healthy adults, uncomplicated viral myocarditis can clear up over the course of two or three weeks. Myocarditis can also linger for months before slowly resolving, and sometimes persists indefinitely.” The severity of the disease is linked to whether there is permanent damage to the heart muscle. Harvard offers that “More severe myocarditis can lead to heart failure by causing the heart muscle to balloon out and lose some of its strength or to become thick and stiff. Sometimes the failure is so severe that a heart transplant is needed. By interfering with the heart's tightly controlled pattern of electrical activity, myocarditis can also cause sudden death, or require the placement of a permanent pacemaker.”
Who Is Most Susceptible to Myocarditis?
In terms of who gets myocarditis, The National Organization for Rare Disorders tells readers that it is “most frequently diagnosed in younger adults between the ages of 20 and 40 years. Children seem to have a more severe presentation than adults with a greater proportion requiring temporary mechanical circulatory support. Men are generally more frequently affected than women, possibly due to effects of testosterone on the immune reaction to infection. The relative frequency of more common age-related cardiovascular diseases such as coronary artery disease may lead to under diagnosis in the elderly. Certain forms of myocarditis, such as cardiac sarcoidosis, are more common in black than white persons in the U.S. However, most forms of myocarditis have no known ethnic predisposition.”
COVID-19 and Myocarditis
Science Magazine tells us that researchers are currently investigating “Whether SARS-CoV-2, the virus that causes COVID-19, induces cardiac injury including myocarditis more often, or with greater severity, than other viruses…” The body’s immune response to this infection may raise the risk of cardiac inflammation. Runner’s World cautions readers that in the case of COVID-19, exercise while infected “can indeed make COVID-19 worse.” One of the possible reasons is that “intense activity during active infection—even if you’re showing no symptoms—may cause the virus to replicate at a faster rate.” Though we will continue learning about the impact of this disease and how to approach it in terms of exercise and rehabilitation, Runner’s World suggests a few precautions—(1) Stopping exercise completely for two weeks if diagnosed, and (2) Slowly easing back into activity after that two week period. As our experience with the pandemic continues, we will undoubtedly learn more about successfully accommodating it.
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COVID-19 Resources for The Healthcare Industry
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PLEASE NOTE: The information in the article excerpted here was considered current at the time of its publishing. However, the COVID-19 pandemic is an ever-evolving disaster due to new findings, data, and availability of resources. Please refer to the CDC website for the latest detailed information when you need it.