Heart muscle inflammation as a long-term consequence after Covid-19


The coronavirus can attack various organs. (Image: leestat / iStock)

After a good six months of fighting the coronavirus and Covid-19, it is becoming more and more apparent how diverse the damage caused in the body by Sars-CoV-2 can be. Now doctors are reporting that the infection can also cause long-term effects on the heart. They detected Sars-CoV-2 in the heart tissue of two young men suspected of having myocarditis weeks after the infection, although the virus was no longer detectable in the two throats. Both patients had previously had a rather mild course of Covid-19 without being diagnosed. According to doctors, this suggests that the heart can also be affected after the acute infection.

Typically, severe coronavirus infection manifests itself through fever, shortness of breath, and pneumonia. But other organs such as the kidneys, the intestines or the nervous system can also be attacked and damaged by Sars-CoV-2 and the immune reaction triggered by the virus. Shortly after the outbreak of the pandemic, doctors also reported that the heart can also be affected in the course of Covid-19: In both China and northern Italy there were increased cases of Covid-19 patients with indications of damage and Inflammation of the heart muscle. Among other things, they had an elevated blood biomarker that is released by destroyed and dying heart muscle cells. This also occurred in some people affected when they barely showed typical Covid symptoms. Recently, researchers have also detected the coronavirus directly in tissue samples of the heart muscle in some affected Covid patients. Since then, it seems clear that the virus infection can also attack the heart. How this is done is still unclear.

Heart muscle inflammation weeks after infection

Initial case reports now suggest that such heart damage and myocarditis can still occur several weeks after the acute viral infection. Researchers working with Philip Wenzel from the Mainz University Medical Center examined two of these cases in more detail. They are two young men who were admitted with suspected acute myocarditis. “The patients were under 40 years of age, physically active, had a negative for SARS-CoV-2 in the nasopharyngeal swab and had a severe flu-like infection with us about four weeks prior to admission,” reports Wenzel. This suggested that the two men had suffered an undetected Covid 19 disease at the time. At the time of delivery, the coronavirus was no longer detectable via the usual throat swabs, as the doctors report.

Closer examinations and a biopsy of the heart muscle then confirmed that both men suffered from myocarditis. Numerous defense cells and signs of inflammation were detectable in her heart tissue. When the researchers subjected the removed heart tissue to a virus test using PCR, the result was positive: Sars-CoV-2 was detectable in the heart muscle in both patients. “The special thing about our cases was that the virus can be found in the heart muscle through myocardial biopsy, even if the actual Covid-19 disease has already been through or had a harmless course,” explains Wenzel. “Only after a clinically normal latency period did the patients come to us with the clinical suspicion of myocarditis.”

Young people are not immune to long-term consequences either

According to the scientists, this is the first evidence that the coronavirus can still be present in the heart even after surviving Covid-19 disease and possibly cause damage and inflammation there. “It is not yet known whether there is a causal connection between the development of myocardial inflammation and the presence of Sars-CoV-2 in the heart muscle, for example through prolonged proliferation in the tissue,” says Wenzel. Similar cases of subsequent myocarditis are also known from some other viral diseases. At the same time, these case reports confirm that an infection with the coronavirus can have various long-term consequences, the type and extent of which are only partially known. There are increasing reports of delayed onset of neuronal failure symptoms, rashes and other complications after an infection that has already been overcome.

“Our results also underline that even young and physically active people are at risk of developing such heart diseases,” emphasize Wenzel and his colleagues. Both of the patients studied were under 40 years of age and one of them was an active soccer player and cyclist. “Our results show that the cardiovascular involvement of COVID-19 can be enormously important and must be carefully treated and followed up,” says Wenzel’s colleague Thomas Münzel.

Source: Philip Wenzel (Universitätsmedizin Mainz) et al., Cardiovascular Research, doi: 10.1093 / cvr / cvaa160)

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