{"id":62633,"date":"2022-02-23T07:44:14","date_gmt":"2022-02-23T14:44:14","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=62633"},"modified":"2024-07-18T14:37:21","modified_gmt":"2024-07-18T20:37:21","slug":"chest-pain-after-covid-among-concerning-symptoms","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/chest-pain-after-covid-among-concerning-symptoms\/","title":{"rendered":"Chest pain after COVID-19 among concerning symptoms"},"content":{"rendered":"
<\/div>
\"Cardiologists
Cardiologists urge patients who experience chest pain after recovering from COVID 19 to seek medical care. Photo by Getty Images.<\/figcaption><\/figure>\n

Chest pain after COVID-19 is among the concerning symptoms cardiologists are seeing, even as hospitalizations from the latest surge of COVID-19 cases recede.<\/p>\n

Many recover initially from COVID-19 only to suffer weeks later from sometimes confounding symptoms that can affect all parts of the body. These individuals are the victims of long COVID, defined by the CDC<\/a> as conditions patients experience four or more weeks after recovering from a COVID-19 infection.<\/p>\n

Long COVID patients, or \u201clong haulers,\u201d battle symptoms that include chest pain, chronic fatigue, brain fog, shortness of breath, nerve problems, anxiety and depression, joint and muscle pain and more. They therefore benefit from multidisciplinary care, which is available at the UCHealth Post-COVID Clinic<\/a>.<\/p>\n

UCHealth Today spoke with Dr. Natasha Altman<\/a>, an advanced heart failure and transplant cardiology specialist with the Heart Failure Clinic<\/a> at UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus<\/a>. Altman provides heart care for long COVID patients at the Post-COVID Clinic.<\/p>\n

What are the most common symptoms you see in long COVID patients?<\/strong><\/h2>\n

\u201cThe most common are chest pain, abnormally high heart rates, heart palpitations, shortness of breath and difficulty doing the same exercises people were doing prior to having COVID,\u201d Altman said.<\/p>\n

Do you have a sense of the prevalence of long COVID?<\/strong><\/h2>\n
\"profile
Dr. Natasha Altman provides care for long COVID patients with heart-related symptoms through the UCHealth Post-COVID Clinic.<\/figcaption><\/figure>\n

\u201cIt is hard to estimate an overall prevalence in the era of the omicron variant,\u201d Altman said. She said she sees five to six patients a week with a variety of post-COVID cardiac symptoms.<\/p>\n

Does everyone with cardiac-related post-COVID issues have long COVID?<\/strong><\/h2>\n

No. \u201cCOVID in patients with underlying heart disease is a known risk factor for complications,\u201d Altman said. \u201cThese patients are at a higher risk of hospitalization, persistent illness and potentially death.\u201d Altman added that people with a preexisting heart condition \u2013 heart failure and coronary artery disease, for example \u2013 generally have \u201ca rough course\u201d of recovery from COVID-19 and can be at greater risk for lung disease, blood clots and heart attacks.<\/p>\n

Given that prospect, it\u2019s vital for all people with any condition that heightens the high risk of complications from COVID<\/a> to get vaccinated, Altman said.<\/p>\n

Are you seeing patients who had mild to moderate COVID symptoms but show signs of long COVID?<\/strong><\/h2>\n

Yes. \u201cI have seen patients with very mild symptoms who weeks later started to develop chest pain, heart palpitations and difficulty breathing with exertion,\u201d Altman said. \u201cSome of these are people in their 20s and 30s who were perfectly healthy before COVID \u2013 mountain bikers and hikers who are now completely debilitated. These are the patients who can really benefit from seeing us in the multidisciplinary clinic. We can help to determine how much of the problem is heart- and lung-related, how much is deconditioning, how much is related to other potential issues. We try to piece it all together.\u201d<\/p>\n

Altman emphasized that younger people who are healthy are at lower risk of developing severe complications after COVID. \u201cBut we don\u2019t how many of those folks and which ones are going to develop long-term symptoms,\u201d she said. Vaccination, while not 100% effective, offers further protection against those uncertainties. Simply put, \u201cTrying to avoid infection overall is preferable,\u201d Altman said.<\/p>\n

What has been the biggest challenge in helping patients with long COVID?<\/strong><\/h2>\n

\u201cIt\u2019s younger people who are completely exhausted after a minimal amount of exertion,\u201d Altman said. A simple walk or five minutes on an exercise bike can leave people fatigued, short of breath and complaining of chest pain. \u201cThey are just completely wiped out, and that takes a long time to get better,\u201d Altman added.<\/p>\n

There are no shortcuts to helping patients with the problem. \u201cWe first make sure that we rule out any other underlying causes of their symptoms,\u201d Altman said. \u201cFor example, we want to ensure that they don\u2019t have inflammation of their heart, that their lungs are working well, and that they have no heart rhythm problems.\u201d<\/p>\n

If patients clear those tests, a difficult path sometimes lies before them. \u201cThey may have a persistent disability that takes a long time to get through,\u201d Altman said. \u201cI do have a number of patients who continue to struggle with that. It\u2019s an uphill battle, made easier by working with a group of focused specialists like what we have assembled in the Post-COVID clinic at the University of Colorado Hospital.\u201d<\/p>\n

How can you help these chronically fatigued long COVID patients?<\/strong><\/h2>\n

The multidisciplinary approach of the UCHealth Post-COVID Clinic is key to addressing chronic fatigue, as well as the array of other long COVID health issues, Altman said. For chronically fatigued patients, she works with specialists from physical therapy, physical medicine and rehabilitation, pulmonary rehabilitation and others, depending on each patient\u2019s specific symptoms and complaints.<\/p>\n

\u201cThe problem isn\u2019t cardiac-specific,\u201d she said. \u201cIt\u2019s kind of a whole-body problem.\u201d<\/p>\n

A \u201cconsensus guidance statement\u201d co-authored by Dr. William Niehaus<\/a>, assistant professor of Physical Medicine and Rehabilitation<\/a> at CU (and a provider in the UCHealth Post-COVID Clinic) underscores her point. Niehaus and his colleagues maintain that treating fatigue in long COVID requires addressing problems like inadequate sleep and nutrition; infectious and autoimmune diseases; and heart, lung and nerve disorders. They also recommend developing strategies to help patients return to activity gradually; conserve their energy; eat healthy foods; stay hydrated; and follow, if necessary, a regimen of medications and herbal and vitamin supplements.<\/p>\n

Can long COVID patients help themselves through chronic fatigue?<\/strong><\/h2>\n

Yes. Altman recommends staying active and exercising \u2013 but within boundaries. A good way to start is with recumbent biking and rowing, which helps to exercise the heart while reducing strain on the joints and muscles.<\/p>\n

\u201cStart out with very low-intensity exercise and resistance,\u201d Altman said. \u201cIf you\u2019re wiped out after five minutes, try two and slowly increase the time and resistance that you can tolerate.\u201d She added that it\u2019s a mistake for chronically fatigued patients to believe that they can simply push their way through it.<\/p>\n

\u201cPeople tend to exercise hard, then crash and have a huge setback,\u201d Altman said. \u201cKnow your limitations and recognize those warning signs of when you are going to crash.\u201d<\/p>\n

It\u2019s also important to stay hydrated with three to four liters a day of fluid (unless you have heart failure) while avoiding alcohol and caffeine and modestly increasing salt intake (unless you have high blood pressure).<\/p>\n

What is myocarditis and is it connected with long COVID?<\/strong><\/h2>\n

Myocarditis is inflammation of the heart muscle, or myocardium. It has many causes, but one is infection from viruses, including influenza, adenovirus (those responsible for colds, bronchitis, pneumonia and other illnesses) and SARS-CoV-2, which causes COVID-19. In severe cases, myocarditis can lead to heart failure and irregular heart rhythms.<\/p>\n

Altman noted that the heart has receptors — ACE2 (angiotensin-converting enzyme 2) \u2013 to which the SARS-CoV-2 protein binds. \u201cThat may be an easier way for the virus to get into the heart muscle,\u201d Altman said.<\/p>\n

However, Altman said it is \u201crare\u201d for COVID-19 patients to develop myocarditis, a conclusion supported by CDC research<\/a>. It\u2019s even rarer to see myocarditis in patients post-COVID, although it occurs occasionally. \u201cWe aren\u2019t entirely sure why it happens,\u201d she said. Altman is also the clinical principal investigator of a study<\/a> examining the effects of the SARS-COV-2 virus on the hearts of critically ill COVID-19 patients. She added that she has done a number of cardiac MRIs, the \u201cgold standard\u201d for diagnosing myocarditis and has found the instances of it \u201crather low\u201d in COVID-19 patients.<\/p>\n

I also see something called POTS associated with long COVID. What is that?<\/strong><\/h2>\n

POTS is short for postural orthostatic tachycardia syndrome<\/a>, a mouthful for a condition that causes a variety of symptoms \u2013 changes in blood pressure and heart rate, lightheadedness, brain fog and fainting, among others \u2013 when a person stands up after lying down. The symptoms of POTS are similar to those of orthostatic intolerance<\/a>, the difference being that the key symptom of POTS is a rapidly increased heart rate when a person stands up. Orthostatic intolerance generally causes blood pressure to drop during the transition to standing.<\/p>\n

Altman said some long COVID patients do not have POTS \u201cper se,\u201d but do suffer from some of its symptoms, particularly an elevated heart rate when they stand up. More broadly, she said COVID-19 seems sometimes to disrupt the autonomic nervous system \u2013 the one that governs bodily functions like heart rate and blood pressure.<\/p>\n

Are there ways to help with POTS symptoms?<\/strong><\/h2>\n

Yes. It\u2019s important that patients get plenty of fluids to increase their blood volume, Altman said, and avoid alcohol and caffeine, which dehydrate. These steps help to prevent large shifts in blood when a person stands up after lying down. Patients can help themselves with low-intensity, recumbent exercise, gradually increased over time. Altman said she also recommends compression garments, which can help to redistribute blood flow and lower heart rate.<\/p>\n

What are some of the lessons learned about diagnosing and treating long COVID?<\/strong><\/h2>\n

One major lesson: long COVID is consistently inconsistent. \u201cIt\u2019s not predictable who is going to have long COVID. We\u2019ve seen patients across the board,\u201d Altman said. \u201cWe\u2019ve also seen very different symptoms and presentations and learned to develop patient-specific treatment regimens.\u201d<\/p>\n

It follows that she and her colleagues no longer see long haul COVID as a single entity, Altman added. A patient with chronic fatigue will need different services than one with, say, abnormal heart rhythms. That highlights again the benefits of a multidisciplinary clinic and approach to care.<\/p>\n

\u201cWe think about patients in the big picture,\u201d Altman said. \u201cWe have gotten good at sorting out each patient\u2019s symptoms and then developing a personalized plan based on our findings.\u201d<\/p>\n

Is more research on long COVID and cardiac-related symptoms, such as chest pain after COVID, underway?<\/strong><\/h2>\n

Yes. An important one in which Altman is involved is a large National Institutes of Health study of long COVID called RECOVER<\/a>. Among other efforts, RECOVER aims to recruit 17,000 patients across the United States to study not only long COVID patients but also those who recovered without long COVID and healthy controls. University of Colorado Anschutz Medical Campus is part of a consortium with the University of Utah, Intermountain Healthcare, University of New Mexico and Denver Health and Hospitals involved in the initiative.<\/p>\n

Finally, when should I be concerned about post-COVID symptoms, such as chest pain?<\/strong><\/h2>\n

An increase in heart rate in and of itself is not \u201chorribly concerning,\u201d Altman said. \u201cBut if you have any persistent problems like chest pain, shortness of breath, or feeling faint, those need to be checked out.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Chest pain after COVID-19 is among the concerning symptoms cardiologists are seeing, even as hospitalizations from the latest surge of COVID-19 cases recede. Many recover initially from COVID-19 only to suffer weeks later from sometimes confounding symptoms that can affect all parts of the body. These individuals are the victims of long COVID, defined by […]<\/p>\n","protected":false},"author":2143,"featured_media":62753,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[4859,4860,9069,3512],"class_list":["post-62633","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-coronavirus","tag-covid-19","tag-covid-19-vaccine","tag-heart-and-vascular-care-cardiovascular"],"acf":[],"yoast_head":"\nChest pain after COVID among concerning symptoms - 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