Here’s the background: Myocarditis appears to result from the direct infection of the virus attacking the heart, or possibly as a consequence of the
inflammation triggered by the body’s overly aggressive immune response. And it is not age-specific: In
The Lancet, doctors recently reported on an 11-year-old child with multisystem inflammatory syndrome (MIS-C)—a rare illness—who died of myocarditis and heart failure. At autopsy, pathologists were able to identify coronavirus particles present in the child’s cardiac tissue, helping to explain the virus’ direct involvement in her death.
In fact, researchers are reporting the presence of viral protein in the actual heart muscle, of six deceased patients. Of note is the fact that these patients were documented to have died of lung failure, having had neither clinical signs of heart involvement, nor a prior history of cardiac disease.
Ossama Samuel, associate chief of cardiology at Mount Sinai Beth Israel in New York, told me about a cluster of younger adults developing myocarditis, some of them a month or so after they had recovered from COVID-19. One patient, who developed myocarditis four weeks after believing he had recovered from the virus, responded to a course of steroid treatment only to develop a recurrence in the form of pericarditis (an inflammation of the sac surrounding the heart). A second patient, in her 40s, now has reduced heart function from myocarditis, and a third—an athletic man in his 40s—is experiencing recurring and dangerous ventricular heart rhythms, necessitating that he wear a
LifeVest defibrillator for protection.
His MRI also demonstrates fibrosis and scarring of his heart muscle, which may be permanent, and he may ultimately require placement of a permanent defibrillator.
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According to some reports, as many as
7 percent of deaths from COVID-19 may result from myocarditis. (Others feel that estimate is too high.) The arrhythmia that sometimes accompanies it is also worrisome, and researchers have found that to be fairly
common among COVID-19 patients.
In J.N.’s case, he noticed his heart racing on several occasions into the 130 beats per minute range. And while the prevalence of this in virus patients is not known exactly, a study found that ventricular arrhythmias occurred in 78 percent of patients without COVID-19, with up to 30 percent of them experiencing serious arrhythmias 27 months later.
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Any such cardiac sequelae lingering weeks to months after the fact is clearly concerning, and we’re seeing more evidence of it. A German
study found that 78 percent of recovered COVID-19 patients, the majority of whom had only mild to moderate symptoms, demonstrated cardiac involvement more than two months after their initial diagnoses.
Six in 10 were found to have persistent myocardial inflammation. While emphasizing that individual patients need not be nervous, lead investigator Elike Nagel added in an e-mail, “My personal take is that COVID will increase the incidence of heart failure over the next decades.”
