Zaza
Soriano, 32, a software engineer from Millersville, Md., who works for a
NASA subcontractor, got covid right before Christmas despite being
fully vaccinated and boosted, and since then, her blood pressure has
remained very high with the bottom number, or diastolic pressure when
the heart rests between beats sometimes as high as 110 when it should be
lower than 80. She also has brain fog and her joints ache.
"It's so frustrating we still know so little about why this is happening," she said.
Ziyad
Al-Aly, an assistant professor of medicine at Washington University and
a Veterans Affairs physician who co-authored the Nature Medicine study,
describes the pandemic as an earthquake. "When the earth stops shaking
and the dust settles, we will have to be able to deal with the aftermath
on heart and other organ systems," he said.
"Governments around the world need to pay attention," Al-Aly emphasized. "We are not sufficiently prepared."
- - -
Heart
disease is the planet's No. 1 killer, responsible for 17.9 million
deaths, or a third of the total each year before the pandemic, and
there's already growing evidence of the outsize impact the coronavirus
is having on our long-term health.
Multiple studies suggest that
Americans' collective blood pressures has jumped since the crisis began.
According to a December study in the journal Circulation, for example,
the average blood pressure among a half-million U.S. adults studied from
April to December 2020 went up each month for both of the numbers
measured by monitors.
The Centers for Disease Control and
Prevention as of this month had logged more than 1 million excess deaths
or deaths since the start of the pandemic that are beyond what we would
have expected in normal times. While most of those were directly caused
by the virus, there were also an additional 30,000 deaths due to
ischemic heart disease and nearly 62,000 additional deaths due to
hypertensive disease.
When the coronavirus first hit the United
States in 2020, doctors were surprised by the heart involvement in cases
they saw: professional athletes with signs of myocarditis or hardening
of the heart walls; patients dying from their illness with hundreds of
tiny clots in major organs; children rushed to emergency rooms with an
inflammatory reaction involving cardiac complications.
Many of
those presentations turned out to be rare or rarely serious. But they
led researchers to an important discovery: that SARS-CoV-2 could
directly attack the heart and blood vessels, in addition to the lungs.
Myocarditis
has mostly been a transient issue, impacting activity or becoming
life-threatening in only a small minority of cases; the clotting is more
widespread but something that usually can be controlled with blood
thinners; and the pediatric inflammatory syndrome has affected only
about 6,400 children out of millions of cases, as of January.
The
idea that infections increase cardiovascular risk is not new. It has
been documented in cases of influenza and other viruses as well. But in
coronavirus, that impact seems "enhanced," said Antonio Abbate, a
professor of cardiology at the VCU Pauley Heart Center. And the early
and obvious cases, he said, should serve "as a kind of warning" for the
type of longer-term cases we may see into the future.
Indeed, as
the months since their infections have turned into years, people who
initially had mild or even some asymptomatic coronavirus cases are
pouring into cardiology practices across the country.
At Memorial
Hermann-Texas Medical Center in Houston, Abhijeet Dhoble, an associate
professor of cardiovascular medicine, said they are seeing an increase
in arrhythmia, an abnormality in the timing of the heartbeat, and
cardiomyopathy, a heart muscle disease. The patients, who previously had
covid, range in age from their 30s to 70s and many had no previous
heart disease.
"We are seeing the same patterns at university clinics and the hospital," he said.
Two
different processes may be at play, according to David Goff, director
of the National Heart, Lung and Blood Institute's division of
cardiovascular sciences. The virus may inflict direct damage to the
heart muscle cells, some of which could die, resulting in a weaker heart
that does not pump as well. Another possibility is that after causing
damage to blood vessels through clots and inflammation, the healing
process involves scarring that stiffens vessels throughout the body,
increasing the work of the heart.
"It could lead over time to failure of the heart to be able to keep up with extra work," he explained.
- - -
David
Systrom, a pulmonary and critical care doctor at Brigham and Women's
Hospital in Boston, said he believes blood vessel damage may be
responsible for one of the most common and frustrating symptoms of long
covid - fatigue.
Systrom and his colleagues recruited 20 people
who were having trouble exercising. Ten had long covid. The other half
had not been infected with the virus. He inserted catheters into their
veins to provide test information before putting them on stationary
bikes and took a number of detailed measurements. The study was
published in the journal Chest in January.
In the long covid
group, he found that they had normal lung function and at peak exercise,
their oxygen levels were normal even as they were short of breath. What
was abnormal was that some veins and arteries did not appear to be
delivering oxygen efficiently to the muscles.
He theorized this
could be due to a malfunction in the body's autonomic nervous system,
which controls involuntary actions such as the rate at which the heart
beats, or the widening or narrowing of blood vessels.
"When
exercising, it acts like a traffic cop that distributes blood flow to
muscles away from organ systems like the kidney and gut that don't need
it. But when that is dysfunctional, what results is inadequate oxygen
extraction," he said. That may lead to the feeling of overwhelming
exhaustion that covid long haulers are experiencing.
The overall
the message from providers is that "covid by itself is a risk factor for
heart disease" like obesity, diabetes, or high blood pressure,
according to Saurabh Rajpal, a cardiologist at Ohio State University
Wexner Medical Center.
"This is a virus that really knocks people
down," agreed Nicole Bhave, a cardiologist with Michigan Medicine and
member of the American College of Cardiology's science committee. "Even
young, healthy people don't often feel very normal for weeks to months,
and it's a real challenge to distinguish what's just your body slowly
healing versus a new pathological problem."
"People experiencing
what appear to be heart issues should have a "a low threshold for seeing
their primary care doctor," she said.
- - -
Unexplained high blood pressure has been a common symptom after covid infection.
Lindsay
Polega, 28, an attorney from St. Petersburg, Fla., had never had any
medical issues before covid. She had been an all-state swimmer in high
school and ran, swam or otherwise exercised an hour or more every day
since. But after two bouts with covid, the first in early 2020 and the
second in spring 2021, she's been having what doctors call "hypertensive
spikes" that result in shooting pains in her chest that make her shaky
and weak. During those incidents, which sometimes occur a few times a
day, her blood pressure has gone as high as 210/153 - far above the
120/80, that is considered normal.
One incident happened during a
light Pilates class and she had to go to the emergency room. Other
times, it has happened while walking. "Sometimes I'll just be on the
couch," she said.
Each specialist she saw referred her to another -
endocrinology, immunology, cardiology, neurology. Finally, she found
herself at a long-covid clinic where the doctor theorized the issue may
be with her adrenal gland. Scientists have documented that the virus can
target the adrenal glands, which produce hormones that help regulate
blood pressure among other essential functions. Polega was put on a
heavy-duty blood pressure drug called eplerenone that's typically used
in patients after a heart attack, and it has helped to reduce but not
eliminate the episodes.
The scariest part for Polega is that women
taking eplerenone are cautioned against pregnancy due to research in
animals showing low birth weights and other potential dangers. Polega
and her boyfriend of six years had recently purchased a house together,
and were talking about starting a family soon.
"That's a big thing to have taken away at my age - my future," she said.
Of
all the symptoms of long covid, among the most baffling have been
erratic heart rates and skipped heartbeats with no clear cause.
Tiffany
Brakefield, a 36-year-old pharmacy tech from Bonita Springs, Fla., who
had covid in June 2020, said the spikes are so unpredictable that she
found herself having to sit down on the floor at Walmart during a recent
shopping excursion.
"I felt like I was going to fall down, and
all I could do was wait for it to calm down on its own," she said. Her
doctors had put her on a heart medication, metoprolol, but it has not
helped.
Rick Templeton, a 52-year-old community college instructor
in Lynchburg, Va., felt chest tightness along with a racing heart rate,
but in his case it disappeared five to six months after his infection
in September 2020, and doctors never knew why it happened because his
test results were normal.
Rajpal, the cardiologist in Ohio, said a large majority of his post-covid cases are similarly vexing.
"The
most common type of long haulers we are seeing have shortness of
breath, chest discomfort, and fast heart rate. But when we investigate
them for heart disease they come back as normal," he said.
Goff,
the NIH scientist, said the presentation looks similar to a condition
known as POTS, or postural orthostatic tachycardia syndrome, in which
symptoms such as lightheadedness and heart rate changes are related to
reduced blood volume, typically worsened by changing positions. A body
of emerging evidence suggests that for many people, it could be a
post-viral syndrome.
He said the unstable heart rate for many
post-covid patients "can be quite serious and debilitating, and can
really interfere with ordinary day-to-day activities." Doctors can use
blood pressure medications to try to stabilize heart rates but because
they depress blood pressures at the same time, they can be tricky to
use.
Murphy, the Ohio long covid patient, said that when her heart
rate soars, which happens several times an hour, she said "it feels
like a hamster in my chest."
Her troubles began on Sept. 5, when
she and her teenage daughter tested positive for the virus. Her daughter
got over her illness in a few days. Murphy was acutely ill for about
three weeks, and many of her symptoms never went away.
The
44-year-old single mom says she's extraordinarily weak and has trouble
with her memory sometimes. Before she was infected, she worked 12-hour
days as a day care provider, a waitress and a cashier. Now she's lucky
if she can last three to four hours at her job as a DoorDash driver.
She's
tried to stay active by taking walks but sometimes "when I take steps,
it'll be like stars." When she saw the cardiologist, she passed out
during the stress test on the treadmill.
"I constantly live in fear I'm going to have a heart attack or stroke," she said.
After
all her heart tests came back fine except for her EKG, which showed the
jumping heart rate, her doctors referred her to the Cleveland Clinic's
long covid group. She hopes they will help her find answers.
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