The world continues to face the challenges of the pandemic caused by the novel coronavirus, SARS-CoV-2. Most people are familiar with the virus’s effects on the respiratory system, but what can COVID-19 do to your heart?
There is considerable emerging evidence that shows the novel coronavirus can have major effects on the cardiovascular system. While much about the virus remains unknown, we do know that individuals with pre-existing heart disease are at a higher risk of serious complications if they get infected with COVID-19.
We also know that individuals with pre-existing risk factors for heart disease such as high blood pressure, diabetes, obesity, and metabolic syndrome also appear to be at increased risk of infection with SARS-CoV-2, as well as worse health outcomes from the virus.
While the exact mechanisms through which Covid-19 affects the heart are not fully understood, there have been reports of the virus causing heart attacks, heart failure, and rhythm abnormalities. Several theories have been proposed and are being investigated in studies around the globe. It is thought that the virus can injure the heart directly, via viral infection of heart cells, or indirectly, as a result of a systemic inflammatory response or an increased propensity to form blood clots.
Inflammation certainly seems like a plausible theory in the setting of an overwhelming infection. Inflammation of the heart, known as myocarditis has been reported in many patients with COVID-19 and cardiovascular involvement. Any infection is taxing on the heart. Fever and inflammation spike the heart rate, increasing physical demands on the heart. If the lungs are infected, as is the case with SARS-CoV-2, oxygenation can become impaired and limit vital oxygen to the heart muscle.
WHAT IS IMMUNITY and WHY IS IT SO IMPORTANT?
Our immune system is designed to protect us in the face of infections and injury. Normal immune response to a virus involves the activation of several inflammatory pathways of the immune system. Cytokines are chemicals produced by several immune cells that influence the function of other cells, initiating an antiviral response. They recruit the white blood cells and other factors to the site of infection where they work to combat the infection. Cytokines can be anti-inflammatory or pro-inflammatory – both are necessary to mount an effective attack on a virus. The balance between the pro-inflammatory and anti-inflammatory cytokines is necessary for this response to work like a well-oiled machine. Cytokines are an essential part of a normal immune response. However, an exaggerated immune response and excessive cytokine production can result in severe tissue damage.
This exaggerated inflammatory response results in what is known as a “cytokine storm.” This is what has been implicated in the multi-organ system dysfunction seen in severe COVID-19 disease, with the heart being one affected organ.
WHY ARE CARDIAC PATIENTS AT HIGHER RISK?
Heart disease is an inflammatory disease. Individuals with pre-existing heart disease have some degree of underlying chronic inflammation which can lead to a dysregulated, dysfunctional immune system. COVID-19 can indirectly affect the heart by making existing heart conditions worse. The rapid worsening witnessed in hospitalized cardiac patients with COVID-19 is likely due to a combination of increased demands on the heart, low oxygen levels, increased propensity for blood clot formation, and marked inflammation. Chronic inflammation may also play a role in the increased risk of COVID severity in patients with diabetes, hypertension, and obesity.
There’s currently no way to know the long-term impact of the virus on the heart but a recent study from Germany using cardiac MRI found that out of 100 patients who had recovered from Covid-19, 78 patients (78%) had cardiac involvement and 60 (60%) had ongoing myocarditis, inflammation of the heart. These findings were independent of preexisting conditions, the severity of the initial disease, and the time from the original diagnosis. Of note, the median age of these patients was only 49 years old and the median time from diagnosis to MRI was 71 days.
The results of this study were released just days before news broke that 27-year-old Red Sox pitcher, Eduardo Rodriguez, would sit out the rest of the season after his doctors discovered inflammation in his heart after being infected with COVID-19.
TIME FOR ACTION
People around the globe who have or are at risk for heart disease (diabetes, obesity, hypertension, etc.) are eager to upgrade their health habits to build immunity so they’ll be ready to fend off the virus and prevent long-term complications in the event of another spike in infections. This is great news because living an anti-inflammatory lifestyle is something we can (and should) all do. Not only to prevent COVID-19, but to prevent and reverse all our chronic diseases that are linked to chronic inflammation. Perhaps a shift in health priorities could be one positive consequence to emerge from the current pandemic.
So, how do you boost your immunity?
Live an anti-inflammatory lifestyle. What we eat, what we do, what we think and feel can all influence the immune system.
A good place to start is with food. As Hippocrates, the father of modern medicine is known for saying, “All disease begins in the gut.” Although this pandemic has led many to indulge in less than healthy food habits, the FACT is that most chronic conditions, i.e. pre-existing conditions for COVID-19, are a result of our inflammatory diets. The gut houses two-thirds of the immune system. The microbiome (good bacteria in your gut) play an essential role in immune function. Your microbiome eats what you eat and what it needs (and you need) for optimal immune function are nutrients, not processed, sugary foods.
Here are a few thoughts on how to boost your immune system.
- Avoid inflammatory foods – SUGAR IS ENEMY #1. Other inflammatory foods include processed meats, fast food, store-bought bread, grain-fed meats, dairy, vegetable oils, and refined carbs such as candy, bread, pasta, pastries, some cereals, cookies, cakes, sugary soft drinks and all processed foods that contain added sugar or flour.
- Eat anti-inflammatory foods – Berries, fatty fish, vegetables (especially broccoli and other cruciferous vegetables), avocados, green tea, mushrooms, turmeric, extra-virgin olive oil, and dark chocolate.
- Practice mindfulness and Meditate – studies show a mindfulness-based meditation practice lowers pro-inflammatory cytokines!
- Walk in nature – Studies have shown that spending time in nature lowers markers of inflammation. Walking is a great exercise and also lowers inflammation. Walking in nature has also a de-stressing effect, boosts energy levels, reduces depression and anxiety, and helps memory.
- Get some sleep – Lack of adequate sleep (for most adults, 7-9 hours a night) triggers inflammation.
- Reduce toxins from your environment – We are all exposed to hundreds of thousands of toxic chemicals on a daily basis. There are chemicals in our food, our water, the air we breathe, the clothes we wear, and the products that we use. It is impossible to remove them all, but try to be conscious of what you’re exposing yourself to. Be on the lookout for pesticides, herbicides, and BPA found in canned foods and plastics. Another big one these days is radiofrequency (RF) exposure from wireless devices – consider an EMF protector for your smartphone.
Consider supplementing your diet with Vitamin D, Vitamin C, Zinc and Selenium
Keep in mind that SARS-Co-V-2 is highly contagious, so protect yourself and your loved ones. Maintain your distance and wear your masks.
What are the signs you should seek care?
If you have symptoms of a heart attack (chest pain), please call 911 and go to the emergency room. Do not hesitate to go for fear of contracting the coronavirus. Hospitals are doing everything they can to prevent transmission of the virus and if you are having a heart attack, getting timely emergency care is critical.
If you’ve recently been infected with COVID-19, you should monitor any lingering symptoms and check in with your doctor regularly.
Seek urgent care if you have:
- Trouble breathing
- Chest pain
- Unexplained swelling
- Extreme fatigue
- Fever
When the heart is at ease, the body is healthy.
Chinese proverb
Remember, “If you’ve got your health, you’ve got everything. When you do not have health, nothing else matters.”
― Augusten Burroughs, Dry