Two face masks

Older adults with heart disease face a double health whammy during the pandemic: Both their age and heart problems put them at higher risk for COVID-19 and its severe complications, such as the life-threatening lung injury called acute respiratory distress syndrome, blood clots, and kidney damage.

Cardiovascular disease (CVD) isn’t the only illness that hikes such risks, but it’s a leading one. Just having heart disease risk factors is a concern. For instance, a paper published last October in the Journal of the American College of Cardiology found that the elderly and people with high blood pressure, obesity, or type 2 diabetes were more susceptible to COVID-­19 infection, serious illness, and complications.

For those with preexisting heart disease, severe COVID-19 may also raise heart attack or stroke risks. It may boost the risk of arrhythmias—heartbeats that are too fast, too slow, or irregular—too. “Patients with existing heart issues may have structural changes to the heart or underlying electrical abnormalities that leave them more prone to arrhythmias during a severe infection, such as COVID-­19,” says Ruwanthi Titano, MD, a cardiologist at Mount Sinai Hospital in New York City. If you’re very ill with COVID-19, you’re more likely to develop blood clots because you’re less mobile, which allows blood flow to stagnate.

More on COVID-19

And, we’re learning, the virus may exacerbate some preexisting heart problems. “The acute inflammatory response caused by COVID-19 may worsen cardiac function, which is already compromised in people with heart disease,” says James A. de Lemos, MD, co-chair of the American Heart Association’s COVID-19 Registry Steering Committee and a professor of medicine at UT Southwestern Medical Center in Dallas. So, for instance, people with acute heart failure—where the heart is suddenly unable to pump sufficient blood to meet the body’s needs—have almost double the risk of dying if they contract COVID-19, according to a January 2021 study in ESC Heart Failure, a journal of the European Society of Cardiology.

Our understanding of the link between COVID-19 and the heart is still evolving. But experts say it’s particularly important right now to be mindful of your heart health. There’s much you can do. 

How COVID-19 Hurts the Heart

Because of its effects on the respiratory system, COVID-19 puts pressure on the heart, forcing it to work harder to pump blood throughout the body, says Mitchell Elkind, MD, a professor of neurology and epidemiology at Columbia University in New York City.

The virus may attack and weaken your heart muscle, too, and a study published last year in the journal JAMA Cardiology found that this can occur even in normally healthy people with a mild case of COVID-­19. When researchers performed cardiac MRIs on 100 people who’d recently recovered from the virus, they found that 76 percent had elevated troponin—a protein that indicates heart damage. Sixty percent also had heart inflammation, or myocarditis, which can cause chest pain, breathing problems, heart rhythm issues, and extremity swelling.

Some good news: “We suspect that for most people, this will be temporary and resolve on its own over time as the body’s immune response subsides,” de Lemos says. Whether this is likely for those with preexisting cardiovascular disease is not yet clear, says Joyce Oen-Hsiao, MD, a cardiologist at the Yale School of Medicine. This may depend, in part, on how scarred the heart is from problems like myocarditis, she says. 

Take Heart-Smart Steps

Getting the COVID-19 vaccine is the most important action you can take. “We have seen it is effective and very safe in a broad host of patients,” Titano says. Afterward, you’ll need to continue social distancing and wearing a mask, Oen-Hsiao says. You still have a small possibility of contracting COVID-19, and we don’t yet know whether vaccination prevents you from spreading the coronavirus to others.

Keep your medical appointments, whether in person (many facilities have safety protocols in place) or by telehealth. “We really still want our patients to check in with us every three to six months to make sure things like their blood pressure, cholesterol, and blood glucose levels are under control,” Oen-Hsiao says.

And take immediate steps if you suspect an emergency: A study published in January in the Journal of the American College of Cardiology found an increase in deaths due to ischemic heart disease and high blood pressure in some states after the pandemic began, possibly because people avoided doctors and hospitals for fear of COVID-19.

It’s also important to take your heart medication as directed. Early in the pandemic, concerns arose that blood pressure medications such as ACE inhibitors—like benazepril (Lotensin) or lisinopril (Prinivil, Zestril)—could make it easier for the virus to enter your cells. But a study published in October in the journal Nature Communications found that these drugs don’t increase infection risk.

Lifestyle steps remain essential, so work to consume a heart-healthy diet—one focused on produce, whole grains, healthy fats such as nuts and olive oil, and lean protein—and exercise regularly, says Nieca Goldberg, MD, a cardiologist at New York University. This may benefit you if you do become infected with COVID-19. For physical activity, consider walking at home or nearby, moving to a video, or joining a virtual exercise class. 

What If You Get COVID-19?

Alert your doctor and get tested if you suspect you have COVID-19. Mild symptoms, such as fever, can be treated at home with a pain reliever like acetaminophen (Tylenol and generic), fluids, and rest. It’s also wise to have a drugstore pulse oximeter, a small device that can check your blood oxygen levels, Goldberg says. If you experience shortness of breath or your home pulse oximeter shows that your blood oxygen level is 95 percent or under, it’s best to call your doctor immediately, she says.

And if you have significant trouble breathing, persistent chest pain or pressure, sudden confusion, or bluish lips or face, call 911. These may be signs of a complication like pneumonia. Some of these symptoms, along with dizziness, nausea, slurred speech, weakness on one side, and facial drooping on one side, may also be warning signs of heart attack or stroke.

With a mild case of COVID-19, you should feel better within about two to three weeks. But you may still become breathless when you exert yourself, even during simple tasks like washing dishes.

If breathlessness persists for more than three weeks, Titano advises calling your primary care physician. Though most people experience this simply because they’ve lost strength during COVID-19, “a subset may benefit from evaluations for issues such as myocarditis, heart rhythm irregularities, or heart failure,” Titano says. In such cases, your doctor may prescribe medications such as ACE inhibitors, beta blockers like metoprolol (Lopressor, Toprol-XL) or carvedilol (Coreg), or diuretics like furosemide (Lasix), and advise you on exercise (see box, below) and diet. “Most patients respond well to this, but it’s too early to tell if they’ll need to be on these medications permanently,” Goldberg says. 

Taking Back Your Health After COVID-19

After COVID-19, it’s important to start physical activity as soon as is safely possible. “People don’t realize the amount of cardiac deconditioning that can happen after just two to three weeks of illness, from prolonged bed rest and being so sedentary,” says cardiologist Ruwanthi Titano, MD.

Before you start exercising even lightly, though, get your primary care doctor’s okay. If you were hospitalized or had symptoms such as chest pain or extreme shortness of breath, you may also need to be evaluated by a cardiologist and do physical therapy (PT) to regain strength. If you’re in PT, your therapist will direct your regimen. Otherwise, start with something like walking. Go slowly and stop when you feel breathless. If standing exercise is too tiring, try something you can do while sitting or lying down, such as leg lifts. As you gain stamina, you can add more activities. 

Editor’s Note: A version of this article also appeared in the April 2021 issue of Consumer Reports On Health.