Don't worry about your heart after COVID
Do you remember early on in the pandemic when there were all kinds of reports about the damage COVID can do to your heart?
These reports weren’t just from the news media, but was also described in major medical journals more than once. I even wrote about it in my newsletter after getting a concerned email from a colleague.
The concern here came from autopsy and MRI studies that looked at the hearts of people who had been infected with COVID and found evidence of inflammation and viral invasion.
At the time, the concern wasn’t so much about what the people studied were experiencing at the time (which wasn’t much in terms of symptoms), but what the long term consequences might be.
I wrote at the time about the questions that we should be asking about these patients:
How does this cardiac damage evolve over a longer time frame?
Do these patients have increased risk of congestive heart failure? Of death from cardiac causes?
Does treating patients with cardio-protective medications like beta blockers reduce the cardiac damage from Covid?
What is the long term functional status of these patients? Are their lives limited by cardiac dysfunction?
Fortunately, the answers that we’ve been getting to these questions are quite reassuring about our health, even if they’re a disturbing reflection of how scientific news is communicated to the public.
The concern about COVID induced heart damage prompted a lot of unnecessary testing
When these studies originally made the news, there were calls for more widespread screening before letting athletes go back to playing.
I personally saw about a dozen college athletes in my practice who needed “clearance” after COVID to go back to playing sports even though they were feeling perfectly normal.
Can you imagine a college asking a 20 year old basketball player to see a cardiologist for clearance after getting the flu? Or a bad cold? Or even something more serious, like mono?
But as I’ve joked before, COVID is a disease that can damage any organ system of a person infected but only attacks the brain of doctors and policy makers.
From my own experience, I know that if you see a bunch of healthy people, you’re going to have some abnormal test results. So a couple of the athletes that I saw had slightly abnormal EKGs or elevated blood pressure readings that spurred additional testing.
And because I’m a minimalist physician by nature - meaning I tend to do less testing and invasive treatment than many of my colleagues based on my clinical judgment - I can only imagine what the experience of young, healthy people across the country might have been after their COVID infections.
There was so much concern about over-testing after these media reports that a group of prominent cardiologists wrote a letter to numerous professional societies advocating against widespread screening in these patients because of the potential for unnecessary downstream testing.
Luckily, it seems like COVID heart isn’t really a thing
There have now been a handful of different studies looking at the impact of COVID on the heart - and the findings should make you breathe a sigh of relief.
This one looked at over 19,000 athletes with COVID and found less than 1% of these patients had any abnormal cardiac testing (blood tests, EKGs, or echocardiograms) but zero of them had cardiac complications that we would care about - heart attacks, abnormal heart beats, or heart failure.
This study looked at healthcare workers both with and without COVID and sent them for cardiac testing. They found that the frequency of cardiac abnormalities on MRI and blood tests were the same in the COVID group as the group without COVID infection.
Here’s another one looking at professional athletes with COVID who all got cardiac MRIs. They found about half of one percent had abnormalities on MRI and zero had any clinically relevant cardiovascular events.
The bottom line here is that people who aren’t super sick with COVID just don’t seem to have cardiovascular effects at a higher rate than normal people.
I don’t think that COVID heart is a thing.
If you’ve had COVID, you don’t need to be cleared by a cardiologist to return to work, or to the gym, or to having sex. You can just go on living your life as though you recovered from an illness that doesn’t have long term cardiovascular impact.
Public messaging about COVID heart was just like public messaging about COVID -fearmongering and ineffective
In May of 2021, it shouldn’t be surprising that much about our public health messaging shouts loudly about the scary potential impact and then whimpers quietly when the scary things don’t pan out.
I’m not just talking about people on cable news or Twitter - well respected cardiologists from Harvard Medical School wrote opinion pieces in the New York Times about the coming epidemic of COVID-related heart disease.
They almost cancelled the entire college football season based on the preliminary reports early in the pandemic.
The disturbing relationship between public attention and how scary the medical report is - the more fearmongering you are, the more attention you get - leads to perverse incentives among medical communicators.
That’s one of the reasons I started writing this newsletter - to try to communicate about how to think like a doctor and a scientist as medical news comes at you like drinking from a firehose.
It’s hard to communicate nuance and caution patience, it’s even harder to publicly declare, “I don’t know” or “the study that just made the news wasn’t high quality enough for us to draw any conclusions so we should just wait before changing all our policies.”
We’ve learned a lot about COVID and public health messaging over the past year. Luckily, we’ve also learned that COVID heart just isn’t a thing to worry about.
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