“Woke up at 3am with my heart rate racing at 170 beats per minute [it should have been about 60] and at a chaotic pace. I felt bad: passed out, sweaty, out of breath, panicked,” he says. It was March 2020, at the beginning of the pandemic, when little was known about the typical course of infection. But Xand’s training as a public health doctor left him in little doubt that he had developed atrial fibrillation, a dangerous heart rhythm disorder where abnormal electrical impulses cause an irregular and often rapid heartbeat. It can lead to stroke and, in extreme cases, heart failure. “I thought my heart rhythm problem was probably a result of the virus inflaming my heart,” he says. Realizing the seriousness of the situation he raced by taxi to University College London Hospital. Two weeks after contracting Covid TV, doctor Xand van Tulleken thought he was doing well when he suddenly took a turn for the worse. “Emergency doctors shocked my heart to temporarily stop it, allowing it to resume a normal rhythm, a process called cardioversion,” she adds. With his heart beating more normally, Xand was prescribed bisoprolol, a type of beta blocker – a drug that changes the heart’s response to nerve impulses, slowing its rate to reduce the risk of further heart rhythm problems. But he didn’t. “My heart went into atrial fibrillation several times after that, meaning I had to go through the cardioversion procedure repeatedly,” he says. A year after his initial infection, in 2021 Xand had to return to hospital for ablation, a procedure that uses frozen liquid nitrogen to “burn” heart tissue, creating scars that disrupt the electrical signals that cause irregular heartbeats. “The surgery took about 90 minutes and I was awake the whole time,” he recalls. “It wasn’t painful, but it certainly wasn’t pleasant. When they got to the point where they froze the heart tissue with liquid nitrogen in a balloon that passed through my artery, I had a sense of impending doom.” Xand now feels recovered, mercifully. But millions of fellow Brits have been left facing similarly dangerous and debilitating heart problems in the wake of Covid. Around 23 million Covid infections have been recorded in the UK, although it is estimated that many more cases have gone unreported because infected people were not tested. Two million people in the UK are living with prolonged Covid, according to figures from the Office for National Statistics (ONS) in June. He classified prolonged Covid as the presence of symptoms more than four weeks after being infected with the coronavirus. Xand’s training as a public health doctor left him in little doubt that he had developed atrial fibrillation, a dangerous heart rhythm disorder where abnormal electrical impulses cause an irregular and often rapid heartbeat. Fatigue is the most common, followed by breathlessness, loss of smell and difficulty concentrating, according to the ONS, but most worryingly there are also significant reports of long-term heart-related problems. In March, the potential scale of such problems was revealed by an article in the BMJ. The study of more than 47,000 people who had been hospitalized with Covid-19 showed that they were about three times more likely than uninfected people to experience serious cardiovascular problems within eight months of being taken to hospital. It’s not just people who are being treated that have been affected. A study in March of 150,000 Americans found that serious heart complications can occur in people who appear to have recovered from a mild infection. The report in the journal Nature Medicine, led by Dr Ziyad Al-Aly, an epidemiologist at Washington University in St Louis, US, found that people who had Covid faced a significantly increased risk of 20 conditions, including heart attacks and strokes. in the next 12 months. In patients admitted to intensive care, the risk of conditions such as myocarditis (inflammation of the heart that reduces its pumping ability) and blood clots in the lungs was at least 20 times higher than in uninfected people. But even those who hadn’t been hospitalized had an increased risk for several conditions, ranging from an 8 percent increase in heart attacks to a 247 percent increase in myocarditis. Scientists have long known that respiratory infections like the flu can trigger heart disease. This is because they cause inflammation, which plays an important role in cardiovascular disease. However, a Covid infection seems to cause a much higher incidence of problems and after much milder levels of initial illness. “It is not only surprising, but very important that the danger is evident even in them [who had mild infections],” says Dr. Al-Aly. “That’s what makes this potentially a serious public health problem.” But why? One possibility is that the virus’ spike protein – which it uses to invade human cells – can cause a burst of localized inflammation in heart tissue that is so intense it damages the muscles. Dr. Zhiqiang Lin, assistant professor of cardiology at the Masonic Medical Research Institute in New York, exposed human heart tissue in the lab to proteins from Covid-19 and HCoV-NL63, a coronavirus that infects the respiratory system without harming hearts. He found that Covid-19 triggers an immune response in heart cells, while the other coronavirus did not. He believes it causes excessive inflammation that destroys heart cells and causes myocarditis. However, Covid can also harm cardiovascular health in another way, according to a study from Houston Methodist Academic Medical Center in Texas, published in August. This found that patients with long-standing Covid heart symptoms may have twice the normal risk of having unhealthy endothelial cells, which line the inside of the heart and blood vessels. Endothelial cells play a key role in the dilation of the arteries and help blood to reach the heart when we do physically intense activities. Patients with unhealthy endothelial cells, a condition known as microvascular dysfunction, are at greater risk of heart failure and death. Dr Mouaz Al-Mallah, a cardiologist who co-authored the paper, explains in the journal JACC: Cardiovascular Imaging: “When a patient is exercising it takes more blood to the heart to be able to supply blood to the whole body… But in some patients with Covid, we noted that it is not increasing as much as it should. Scientists have long known that respiratory infections like the flu can trigger heart disease. This is because they cause inflammation, which plays an important role in cardiovascular disease. However, a Covid infection seems to cause a much higher incidence of problems and after much milder levels of initial illness Dr Al-Mallah’s team examined the hearts of nearly 400 long-term Covid patients. Scans showed they were twice as likely to have unhealthy endothelial cells inside the heart and blood vessels. “This may possibly explain why some patients have chest pain and shortness of breath because their heart is not getting this extra blood,” Dr. Al-Mallah wrote. However, not everyone is convinced that the risks are widespread. In a small study of 52 people, Professor Gerry McCann, a cardiac imaging specialist at the University of Leicester, found that people who had recovered from hospitalization with Covid-19 did not have a higher rate of heart disease than people who had similar underlying cardiovascular disease. conditions such as high blood pressure, but who were not infected with the virus. He is working on a larger study with about 1,200 participants. “The more data we collect, the less impressed we are with the degree of myocardial injury,” he told Good Health. “There is no doubt that Covid is associated with heart problems in hospitalized patients, although it is relatively uncommon. Those who are hospitalized tend to have other risk factors such as older age, obesity and pre-existing cardiovascular disease.’ He adds: “There are mixed reports on the extent of heart problems from researchers using imaging techniques. “Some of the abnormal findings are of uncertain clinical significance, and we are not sure how much of the changes are related to pre-existing conditions.” Other British researchers disagree that the extent of cardiovascular risks is overstated. Colin Berry, professor of cardiology and imaging at the University of Glasgow, said: “Professor McCann’s study has serious limitations because he only studied 52 patients. I would focus on much larger studies that have more statistical power, such as the American ones, which do show large-scale problems.” Professor Berry’s own study, published in Nature Medicine in May, involved 1,306 former Covid patients. It found that one in eight people hospitalized with the virus between May 2020 and March 2021 were later diagnosed with myocarditis. “Before Covid they were fit and healthy,” he says. “I think the damage is not just to the hearts of these patients but to their wider cardiovascular system. “It may also involve their blood vessels, which helps explain why so many Covid patients experience physical problems and loss of quality of life.” Dr David Strain, a senior clinical lecturer at the University of Exeter who specializes in viral infections, also believes that Professor McCann’s results may not represent the whole picture. “The patients he studied are generally followed up after they leave the hospital, when the main risk period has passed,” he says. “Beyond three months there seems to be a negligible risk of bad cardiovascular things happening.” Dr. Strain argues that most heart problems occur over a period of six to eight weeks…
