“Despite initially being characterized primarily as a respiratory disease, more recent data have highlighted COVID-19 as a multiorgan disease which often affects other organs, such as the heart, with effects on the cardiovascular system appearing both in the acute phase and in the later stages of the disease. In fact, studies have shown that patients with pre-existing heart disease or risk factors for cardiovascular disease appear to experience more severe effects and have an increased risk of death,” he says. Dr. Ioannis Paleos Cardiologist, Director of Cardiac Magnetic Tomography departmentMetropolitan Hospital.

Which patients with cardiac problems belong to the so-called “vulnerable groups”?

• Patients with congestive heart failure
• Patients with severe pulmonary hypertension
• Patients with complex congenital heart diseases
• Patients with a recent myocardial infarction or severe coronary disease, (resulting from bypass surgery or stent placement)
• Patients with severe cardiomyopathy, such as dilated cardiomyopathy, hypertrophic obstructive cardiomyopathy, arrhythmogenic dysplasia, etc.

What symptoms does a patient with a heart attack from SARS-CoV-2 show?

Symptoms such as shortness of breath, chest pain and palpitations require evaluation by a cardiologist and the possibility of further investigation with specialized tests, e.g. cardiac magnetic resonance imaging.

What conditions can the COVID-19 infection cause in the heart?

SARS-CoV-2 infection can cause a wide range of cardiac problems, from mild such as tachycardia and palpitations which are the most common to severe but rarer such as acute myocardial infarction, acute myocarditis, acute pericarditis , acute heart failure, pulmonary embolism and deregulation of pre-existing heart failure.

What is acute myocarditis and how is it treated?

“Acute myocarditis is an acute myocardial damage that is created either by the toxicity of the virus, or by the body’s immune response to the virus (acute inflammation of the heart muscle).

Usually, it occurs after a respiratory infection, causing chest pain, and abnormalities in the electrocardiogram and blood tests (increased troponin levels) are seen during the checkup.

The mechanism leading to heart damage is complex, with the body’s systemic inflammatory response playing an important role and with disturbances in the immune system manifesting during the course of the disease.

The most suitable examination for the diagnosis of acute myocarditis is the magnetic resonance imaging of the heart.

Treatment of the condition involves management of the underlying disease COVID-19 with the available treatments and the administration of special cardiac treatment in the presence of myocardial damage.

This treatment may include drugs that lower blood pressure and heart rate, also have antiarrhythmic activity, such as β-blockers, and drugs with proven anti-fibrotic activity, such as angiotensin-converting enzyme inhibitors. At the same time, it is necessary to observe rest and avoid strenuous work and sports for 3-6 months after the diagnosis of acute myocarditis, while regular follow-up by a cardiologist is also necessary.

Returning to sports after an acute myocarditis is recommended after 3-6 months, after a complete cardiac check-up, which includes blood and cardiology tests and an MRI of the heart.

After this time, if there are no symptoms, markers of inflammation and myocardial damage (troponin) are normal, and the function of the heart, as seen on cardiac triplex and cardiac magnetic resonance imaging, shows no problem, such as evidence of myocardial edema or myocardial fibrosis , then the normal return to exercise is allowed,” explains Dr. Palios and continues:

What is acute pericarditis and how is it treated?

“Acute pericarditis is an inflammatory condition of the pericardium that is usually caused after respiratory infection by viruses, bacteria or autoimmune diseases. It can cause chest pain, fever, fatigue and difficulty breathing, while more rarely more severe cases can lead to complications such as heart tamponade.

Diagnosis of acute pericarditis is made by clinical examination, electrocardiogram, chest x-ray or CT scan, echocardiogram, cardiac MRI and blood tests, and rarely a pericardial puncture may be necessary to obtain fluid.

Treatment includes the use of anti-inflammatory drugs and symptom management. “Usually, aspirin or non-steroidal anti-inflammatory drugs are recommended, and less commonly cortisone and colchicine,” he adds.

What heart checks should I have after getting sick with COVID-19?

“After getting sick from COVID-19, if there are symptoms, it is necessary to visit a cardiologist. First, the doctor will perform the classic tests, such as clinical evaluation, electrocardiogram and heart triplex. However, more specialized tests such as troponin blood test and cardiac MRI may be ordered to diagnose or rule out the diagnosis of acute myocarditis,” he says.

How much does cardiac MRI help in the diagnosis and treatment of the effects of COVID-19?

“MRI of the heart offers high-resolution images allowing detailed examination of the heart’s anatomy and function. It is an easy, quick, painless, safe examination, without the use of ionizing radiation, with very high diagnostic accuracy”, concludes Dr. Palios.

*The Metropolitan Hospital has a specialized cardiac MRI department with internationally recognized and certified physicians from the European Association of Cardiovascular Imaging (EACVI) and the World Society of Cardiac Magnetic Imaging (SCMR) to perform and analyze cardiac MRI examinations. This department is part of a fully equipped and organized Cardiology Clinic, certified according to ISO. It has gained trust in Greece for the specialization and treatment of difficult cardiac cases, for 15 years. With highly specialized scientific and nursing staff and advanced equipment, the cardiology clinic provides 24-hour services, dealing with even the most demanding cases, while it is considered one of the best in Europe and has treated thousands of patients.