A cardiac electrophysiologist explains the “why,” “how,” and “now what.”

early two years after the COVID-19 pandemic started in the United States, the medical community continues to analyze the impacts of COVID-19 on various bodily organs — notably the heart.

As such investigations continue, one fact is becoming increasingly clear: the virus does affect the heart and especially its electrical system, disrupting the rhythm of the heart.

Kamal M. Kotak, a cardiac electrophysiologist at Loma Linda University International Heart Institute in Loma Linda, California, United States, recently outlined the “why,” “how,” and “now what” for abnormal heart rhythms associated with COVID-19 infection.

Your Cardiac Conduction System

The human heart is a four-chambered muscular pump that runs on its own electrical system, known as the cardiac conduction system. Electricity starts from the top of the heart, flowing to both the right ventricle that pumps blood to the lungs and the left ventricle pumping blood to the rest of the body. The system works like your own natural pacemaker.

Heart muscle cells can also create electricity independently of this cardiac conduction system in diseased states. COVID-19 can cause these cells to generate abnormal electricity and create short circuits that lead to irregular heart rhythms, also known as arrhythmias, Kotak said.

Types of Arrhythmias

Heart rhythm disorders or arrhythmias fall primarily into two subgroups: fast rhythms and slow rhythms.

Slow rhythms occur when the electricity flow in the heart is slowed or blocked altogether. Such blockages may resolve on their own, however. Kotak said some patients do end up needing a pacemaker if their heart rate is too low.

On the other hand, fast heart rhythms cause rapid heartbeat, palpitations, heart racing, fatigue, dizziness, and shortness of breath. The most common fast rhythm is called atrial fibrillation (AFib) and causes an irregular, chaotic rhythm in the upper part of the heart called the atrium. People with AFib are at higher risk of experiencing a stroke, Kotak said. Diagnosing and treating AFib with blood thinners can prevent this risk of stroke. Medications and minimally invasive procedures such as ablation can further improve quality of life.

COVID-19 is also known to weaken heart function, precipitating abnormal rhythms from the lower parts of the heart known as premature ventricular contractions (PVC) and ventricular tachycardia (VT). These can be life-threatening and require a physician’s further evaluation and treatment.

Another cardiac syndrome that often arises after COVID-19 infection is called postural orthostatic tachycardia syndrome (POTS), caused by an imbalance of the autonomic (or involuntary) nervous system. The imbalance can manifest as dizziness, palpitations, heart racing, and lightheadedness with posture change — standing up after sitting or lying down. Recognition and treatment are important since they can bear significant impacts on quality of life.

What to Look for if You Have Been Diagnosed with COVID-19

Twenty to thirty percent of patients hospitalized with a COVID-19 infection display cardiac issues, and arrhythmias have been associated with poor outcomes, Kotak said. Anyone can develop arrhythmia problems upon contracting a COVID-19 infection, he said, especially people with pre-existing heart disease or other chronic illnesses.

Though symptoms of arrhythmias vary, the most common include heart racing, fluttering, palpitations, skipped beats, fatigue, dizziness, or even loss of consciousness.

If you feel these symptoms, Kotak advises, you should seek medical attention. Symptoms of arrhythmia or other cardiac effects of COVID-19 could linger for months after contracting COVID-19, so it is vital to get them checked and treated accordingly.

What to Expect

First, you and your physician need to accurately characterize your symptoms to establish a correct diagnosis of COVID-19-related heart rhythm problems. It is also important not to disregard symptoms just because you believe you are out of shape or it’s just COVID-19 or your anxiety. Regardless of what you may suspect, it is always better to have a physician examine your symptoms. To achieve symptom-rhythm correlation, your doctor will recommend an electrocardiogram (EKG or ECG) test as well as a heart monitor.

A heart monitor is like a mini-EKG resembling a large sticker placed on your chest for several days (at times up to 30 days) to monitor your heart rhythm. When wearing the heart monitor, you can mark the time and nature of your symptoms on the monitoring devices. This allows your doctor to determine the exact nature of your heart rhythm issue causing your symptoms. It also provides insights into the overall health of your heart rhythm.

In addition, your doctor may request an ultrasound of your heart, called an echocardiogram, to make sure the structure and function of various heart chambers and valves remain preserved. Upon reaching a diagnosis, your physician will consider treatment among various therapies, medications, or minimally invasive procedures such as ablation.

“Researchers, physicians, and patients are continuing to accumulate long-term data about COVID-19 and arrhythmias to know the overall prognosis,” Kotak said.

The original version of this story was posted on the Loma Linda University Health news site.

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