Patient Mike Camilleri works with physical therapist Beth Hughes in St. Louis, Mo., on March 1, 2023. Somehow, a mild case of COVID-19 set off a chain reaction that eventually left Camilleri with dangerous blood pressure spikes, a heartbeat that raced with slight exertion, and episodes of intense chest pain. (AP Photo/Angie Wang)
ST. LOUIS 鈥� Firefighter and paramedic Mike Camilleri once had no trouble hauling heavy gear up ladders. Now battling long COVID, he gingerly steps onto a treadmill to learn how his heart handles a simple walk.
鈥淭his is, like, not a tough-guy test so don鈥檛 fake it,鈥� warned Beth Hughes, a physical therapist at Washington University in St. Louis.
Somehow, a mild case of COVID-19 set off a chain reaction that eventually left Camilleri with dangerous blood pressure spikes, a heartbeat that raced with slight exertion, and episodes of intense chest pain.
He鈥檚 far from alone. How profound a toll COVID-19 has taken on the nation鈥檚 heart health is only starting to emerge, years into the pandemic.
鈥淲e are seeing effects on the heart and the vascular system that really outnumber, unfortunately, effects on other organ systems,鈥� said Dr. Susan Cheng, a cardiologist at Cedars-Sinai Medical Center in Los Angeles.
It鈥檚 not only an issue for long COVID patients like Camilleri. For up to a year after a case of COVID-19, people may be at increased risk of developing a new heart-related problem, anything from blood clots and irregular heartbeats to a heart attack 鈥� even if they initially seem to recover just fine.
Among the unknowns: Who鈥檚 most likely to experience these aftereffects? Are they reversible 鈥� or a warning sign of more heart disease later in life?
鈥淲e鈥檙e about to exit this pandemic as even a sicker nation鈥� because of virus-related heart trouble, said Washington University鈥檚 Dr. Ziyad Al-Aly, who helped sound the alarm about lingering health problems. The consequences, he added, 鈥渨ill likely reverberate for generations.鈥�
READ: Coronary heart diseases still top cause of death in PH; COVID-19 climbs up to 4th spot
Heart disease has long been the top killer in the nation and the world. But in the United States, heart-related death rates had fallen to record lows in 2019, just before the pandemic struck.
COVID-19 erased a decade of that progress, Cheng said.
Heart attack-caused deaths rose during every virus surge. Worse, young people aren鈥檛 supposed to have heart attacks but Cheng鈥檚 research documented a nearly 30% increase in heart attack deaths among 25- to 44-year-olds in the pandemic鈥檚 first two years.
An ominous sign the trouble may continue: High blood pressure is one of the biggest risks for heart disease and 鈥減eople鈥檚 blood pressure has actually measurably gone up over the course of the pandemic,鈥� she said.
Cardiovascular symptoms are part of what鈥檚 known as long COVID, the catchall term for dozens of health issues including fatigue and brain fog. The National Institutes of Health is beginning small studies of a few possible treatments for certain long COVID symptoms, including a heartbeat problem.
READ: Unvaccinated have higher risk of myocarditis due to COVID-19 鈥� expert
But Cheng said patients and doctors alike need to know that sometimes, cardiovascular trouble is the first or main symptom of damage the coronavirus left behind.
鈥淭hese are individuals who wouldn鈥檛 necessarily come to their doctor and say, 鈥業 have long COVID,鈥欌�� she said.
In St. Louis, Camilleri first developed shortness of breath and later a string of heart-related and other symptoms after a late 2020 bout of COVID-19. He tried different treatments from multiple doctors to no avail, until winding up at Washington University鈥檚 long COVID clinic.
鈥淔inally a turn in the right direction,鈥� said the 43-year-old Camilleri.
There, he saw Dr. Amanda Verma for worsening trouble with his blood pressure and heart rate. Verma is part of a cardiology team that studied a small group of patients with perplexing heart symptoms like Camilleri鈥檚, and found abnormalities in blood flow may be part of the problem.
How? Blood flow jumps when people move around and subsides during rest. But some long COVID patients don鈥檛 get enough of a drop during rest because the fight-or-flight system that controls stress reactions stays activated, Verma said.
READ: Vast study confirms rare heart risk from Moderna COVID-19 vaccine
Some also have trouble with the lining of their small blood vessels not dilating and constricting properly to move blood through, she added.
Hoping that helped explain some of Camilleri鈥檚 symptoms, Verma prescribed some heart medicines that dilate blood vessels and others to dampen that fight-or-flight response.
Back in the gym, Hughes, a physical therapist who works with long COVID patients, came up with a careful rehab plan after the treadmill test exposed erratic jumps in Camilleri鈥檚 heart rate.
鈥淲e鈥檇 see it worse if you were not on Dr. Verma鈥檚 meds,鈥� Hughes said, showing Camilleri exercises to do while lying down and monitoring his heart rate. 鈥淲e need to rewire your system鈥� to normalize that fight-or-flight response.
Camilleri said he noticed some improvement as Verma mixed and matched prescriptions based on his reactions. But then a second bout with COVID-19 in the spring caused even more health problems, a disability that forced him to retire.
READ: CDC: Heart inflammation cases in ages 16-24 鈥榟igher than expected鈥� after mRNA COVID-19 shots
How big is the post-COVID heart risk? To find out, Al-Aly analyzed medical records from a massive Veterans Administration database. People who鈥檇 survived COVID-19 early in the pandemic were more likely to experience abnormal heartbeats, blood clots, chest pain and palpitations, even heart attacks and strokes up to a year later compared to the uninfected. That includes even middle-aged people without prior signs of heart disease
Based on those findings, Al-Aly estimated 4 of every 100 people need care for some kind of heart-related symptom in the year after recovering from COVID-19.
Per person, that鈥檚 a small risk. But he said the pandemic鈥檚 sheer enormity means it added up to millions left with at least some cardiovascular symptom. While a reinfection might still cause trouble, Al-Aly鈥檚 now studying whether that overall risk dropped thanks to vaccination and milder coronavirus strains.
More recent research confirms the need to better understand and address these cardiac aftershocks. An analysis this spring of a large US insurance database found long COVID patients were about twice as likely to seek care for cardiovascular problems including blood clots, abnormal heartbeats or stroke in the year after infection, compared to similar patients who鈥檇 avoided COVID-19.
READ: 6-month-old baby with heart and lung problems beats COVID-19
A post-infection link to heart damage isn鈥檛 that surprising, Verma noted. She pointed to rheumatic fever, an inflammatory reaction to untreated strep throat 鈥� especially before antibiotics were common 鈥� that scars the heart鈥檚 valves.
鈥淚s this going to become the next rheumatic heart disease? We don鈥檛 know,鈥� she said.
But Al-Aly says there鈥檚 a simple take-home message: You can鈥檛 change your history of COVID-19 infections but if you鈥檝e ignored other heart risks 鈥� like high cholesterol or blood pressure, poorly controlled diabetes or smoking 鈥� now鈥檚 the time to change that.
鈥淭hese are the ones we can do something about. And I think they鈥檙e more important now than they were in 2019,鈥� he said.