CORONAVIRUS UPDATE: As experts learn more about the novel coronavirus, news and information changes. For the latest on the COVID-19 pandemic, please visit the Centers for Disease Control and Prevention.

As the pandemic stretches on into its third year, researchers and healthcare providers continue to learn more about the lasting effects of COVID-19—including on your heart. COVID-19 a respiratory infection that affects many different areas of the body. One of those is the cardiovascular system. There are two major concerns: how existing heart problems impact risk of infection or complications, and how the virus can damage your heart.

Do heart conditions increase risk of infection with COVID-19?

“People with pre-existing heart conditions, such as coronary artery disease or a rhythm disorder, are not at higher risk for being infected by the coronavirus that causes COVID-19,” says William W. Li, MD, President of The Angiogenesis Foundation, and author of Eat to Beat Disease. Meaning, you’re not more likely to catch COVID-19 just because you have a cardiac problem.

“But if they become ill after infection, their heart condition may increase their risk of more serious complications from both diseases,” Dr. Li says.

Do people with heart conditions have a higher risk of developing a severe case of COVID-19?

Yes. If infected, those with pre-existing heart conditions—including heart failure, coronary artery disease, cardiomyopathies, and possibly high blood pressure—have a higher risk for severe COVID-19 illness, according to the U.S. Centers for Disease Control and Prevention (CDC). This affects your body in three main ways.

Decreased immune response: “The presence of an underlying heart condition decreases the body’s ability to withstand the stress of an infection—it’s a threat amplifier,” says Abisola Olulade, MD, a family medicine physician at Sharp Rees-Stealy Downtown in San Diego.

“People with heart conditions may have lower oxygen levels and weakened heart muscles. They may also have other comorbidities such as diabetes, hypertension (high blood pressure), and obesity, which also increase the risk of severe complications and death from COVID-19.”

Decreased circulation: “The virus settles in the airways and infects the lungs, where it interferes with the main function of the lung: getting oxygen to the blood,” Dr. Li says. “When oxygen levels are lowered with infection, this can worsen the risk of complications for people with pre-existing heart conditions where lower oxygen in the body can put a stress on the heart.”

Increased risk of lingering symptoms (sequelae or “long COVID”): Patients with underlying heart conditions “are also at risk of getting long-term post-acute COVID-19 symptoms,” according to Dr. Olulade. Basically, the co-existence of coronavirus and heart disease is potentially dangerous in the short and long term.

Does COVID-19 increase the risk of a heart attack?

The risk of heart attack (myocardial infarction) increased by three to eight times and the risk of stroke caused by a blood clot increased three to six times in the week after a COVID-19 diagnosis, according to a study published in The Lancet. The study also showed that the risk for heart attack and stroke decreased over time, but over exactly what time course remains unknown.

But vaccinations seem to provide a protective effect. According to a 2022 study, full vaccination against COVID-19 is linked to a significant reduction in acute myocardial infarction and stroke in individuals who later became infected with COVID-19. That means getting vaccinated is particularly important among individuals with pre-existing cardiovascular risk factors.

How does COVID affect the heart?

The reason that patients with underlying heart conditions face serious illness when they contract COVID-19 is because the virus has a negative effect on even previously healthy patient’s hearts.

A study published in JAMA Cardiology, found detectable virus in 24 of 39 hearts autopsied—likely even in the hearts of patients who had not been diagnosed with cardiovascular problems before or while they had COVID-19.

Another study published in JAMA Cardiology found that, “Cardiac MRIs in 100 people who had recovered from COVID-19 within the past two to three months showed cardiac involvement in 78% of patients and ongoing heart muscle inflammation in 60% of patients,” explains Dr. Olulade.

While more studies need to be done, it seems that COVID-19 can cause lasting heart inflammation and cardiovascular issues like arrhythmias in patients who might not have previously experienced any heart-related illness. Researchers have also found that individuals who had COVID-19 were at an increased risk of blood clots for almost a year after infection, increasing their risk of heart attack and stroke.

While much is still unknown about the long-term significance of COVID-19 complications, it can cause inflammation of the heart muscle (myocarditis), according to the CDC. This may result in “the inability of the heart to pump oxygen to the rest of the body, and abnormality in heart muscle rhythm (arrhythmia),” according to Dr. Olulade.

Can the COVID vaccine damage the heart?

There have been some cases of myocarditis and pericarditis after COVID-19 vaccination with mRNA COVID-19 vaccines (Pfizer or Moderna), more often after the second shot, and within a week of vaccination. Reports of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the heart’s outer lining) occur most often in adolescents and young males. Symptoms of these conditions include chest pain, shortness of breath, and a pounding or racing heart.

Typically, these cases respond well to treatment, and people are able to go back to their normal lives as symptoms improve. Treatment usually includes rest and heart medications, like ACE inhibitors. The CDC still recommends that everyone eligible be vaccinated and boosted. The benefits outweigh the rare risk of heart problems post-vaccination.

How do you know if COVID-19 is affecting your heart?

In the event of coronavirus heart damage, you may notice the following symptoms, according to Drs. Li, Siddiqui, and Olulade:

Heart palpitations (aka arrhythmia), that feel like pounding, racing, or fluttering heartbeats
Shortness of breath, especially when lying flat
Chest pain
Dizziness, lightheadedness, or feeling faint
Headaches
Swelling in the legs
Fluid retention in ankles

These may be a result of myocarditis caused by previous COVID-19 infection, or decreased oxygen from a current COVID-19 infection.

How to avoid heart problems after COVID

As the COVID-19 pandemic continues and new variants are identified, it’s crucial that everyone continues to take care of their mental and physical health. According to the American Heart Association, quarantine behaviors such as unhealthy eating, inactivity, increased alcohol consumption, and avoiding doctor’s offices are taking a toll on heart health that is likely to continue in upcoming years. If you have a history of heart problems, are at risk for cardiovascular disease, or live with a pre-existing heart condition, it’s even more important to take the following precautions during the pandemic to minimize cardiovascular risk.

1. Prevent infection: Wear a mask, social distance, and wash your hands thoroughly and regularly (use hand sanitizer if soap is not available). Disinfect high-traffic areas in your home regularly and stay up-to-date on your COVID-19 vaccines. Avoiding catching the virus is the best treatment.
2. Don’t wait to see your healthcare provider: “A lot of patients have been scared to seek care of their ongoing conditions which can lead to harmful effects,” Dr. Olulade says. “Remember that in addition to wearing a mask, social distancing, and washing your hands, taking care of your existing health conditions is one of the best things that you can do for your health.” The same advice applies if you start developing symptoms. Putting off a visit increases risk of a more serious condition down the line.
3. Maintain a healthy lifestyle: Since COVID-19 started spreading across the U.S., alcohol consumption has increased 14%. Adults are snacking 31% more. At the same time physical activity decreased 32.3% among those previously routinely active. On top of that, people are experiencing unprecedented levels of stress. All of those risk factors are bad for heart health—and physicians worry it’s increasing rates of heart disease. It’s critical to stay active, eat a heart-healthy diet, and focus on mental health if you’re at risk for, or already have a heart condition.

1. Manage your heart problems: “Controlling your heart conditions increases the chances of surviving a coronavirus infection,” Dr. Olulade advises. “Take your medications as prescribed, maintain a healthy weight, exercise, and get lots of sleep. Limit alcohol intake, and avoid smoking and vaping.” You should also eat a heart-healthy diet full of plant-based whole foods, fiber, and seafood. Avoid processed foods and high-sugar foods. Try to consume things that are good for your immunity, vascular system, and heart health.
1. Get vaccinated: If you haven’t already received your COVID-19 vaccine series, make an appointment to do so. In the meantime, make sure your other vaccinations are up-to-date, like the seasonal flu vaccine or shingles vaccine. Just be aware that certain immunizations require a waiting period prior to getting the COVID-19 shot.

When in doubt, call your healthcare provider. Many offices provide telehealth appointments to answer questions about your treatment plan, or the best way to manage coronavirus and heart disease symptoms.