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Medicine

'Covid-19 Is Creating a Wave of Heart Disease' 163

Haider Warraich, a cardiologist, writing for the New York Times: An intriguing new study from Germany offers a glimpse into how SARS-CoV-2 affects the heart. Researchers studied 100 individuals, with a median age of just 49, who had recovered from Covid-19. Most were asymptomatic or had mild symptoms. An average of two months after they received the diagnosis, the researchers performed M.R.I. scans of their hearts and made some alarming discoveries: Nearly 80 percent had persistent abnormalities and 60 percent had evidence of myocarditis. The degree of myocarditis was not explained by the severity of the initial illness.

Though the study has some flaws, and the generalizability and significance of its findings not fully known, it makes clear that in young patients who had seemingly overcome SARS-CoV-2 it's fairly common for the heart to be affected. We may be seeing only the beginning of the damage. Researchers are still figuring out how SARS-CoV-2 causes myocarditis -- whether it's through the virus directly injuring the heart or whether it's from the virulent immune reaction that it stimulates. It's possible that part of the success of immunosuppressant medications such as the steroid dexamethasone in treating sick Covid-19 patients comes from their preventing inflammatory damage to the heart. Such steroids are commonly used to treat cases of myocarditis. Despite treatment, more severe forms of Covid-19-associated myocarditis can lead to permanent damage of the heart -- which, in turn, can lead to heart failure.
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'Covid-19 Is Creating a Wave of Heart Disease'

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  • How many others? (Score:5, Interesting)

    by MikeDataLink ( 536925 ) on Tuesday August 18, 2020 @03:19PM (#60415551) Homepage Journal

    I continue to wonder how many common diseases are actually caused by viruses. We just don't link them together because they haven't been researched like COVID19.

    I mean if you get the one of the many common colds at 22, and then at 44 you have kidney failure, it would be very hard to every figure out that the virus 22 years ago caused it.

    • by NFN_NLN ( 633283 ) on Tuesday August 18, 2020 @03:26PM (#60415593)

      > I mean if you get the one of the many common colds at 22, and then at 44 you have kidney failure, it would be very hard to every figure out that the virus 22 years ago caused it.

      Wait until they find out that same viral infection helped lesson your arterial plaque and pushed your potential heart attack out from 42 to 65.

      https://3.bp.blogspot.com/-if0... [blogspot.com]

      • > I mean if you get the one of the many common colds at 22, and then at 44 you have kidney failure, it would be very hard to every figure out that the virus 22 years ago caused it.

        Wait until they find out that same viral infection helped lesson your arterial plaque and pushed your potential heart attack out from 42 to 65.

        Interesting thought. If that's true, then that seems somewhat similar to the idea of good vs. bad bacteria, in terms of the effect that the bacteria has on human health. Like you suggest, for either bacteria or viruses, it may be very challenging to show long-term causal effect.

        • It's like you need an entirely different science based on statistical outcomes to understand it. Perhaps we could call it epidemiology.
          • by sycodon ( 149926 )

            The people who have recovered from Covid will likely be watched very closely, far closer than any other person.

            You will undoubtedly find conditions that would have otherwise gone unnoticed.

            These studies mean nothing unless the populations are randomly selected and contain people that who had and did not have Covid.

            • by Rei ( 128717 )

              To be fair, there is more reason than usual to be concerned about COVID-19 with respect to the heart. While we think of it as a disease of the lungs (as that's its primary mode of spread), its infection vector is the ACE2 receptor, which is actually a surface enzyme having to do with blood pressure regulation. So it tends to be common in tissues having to do with processing blood in some way or another - lungs, blood vessels, kidneys, intestines, and yes, the heart. For example, the temporary anosmia it ca

              • by Rei ( 128717 )

                It does make me wonder if I was infected with an ACE2-targeting virus as a child, too. COVID-19 appears to be causing a significant wave of Kawasaki disease, a rare disease which I happened to have as a child. Initially I was somewhat reserved about the conclusions of a COVID-Kawasaki linkage, but the evidence seems strong, with a dramatic increases in cases even as overall hospitalizations from other causes go down. It's long been suspected that Kawasaki disease might be the result of an unknown, usually

                • by makomk ( 752139 )

                  Quite possibly. There's some clinical evidence linking Kawasaki disease to one of the "common cold" human coronaviruses, though no-one has been able to figure this out for sure and the common cold is obviously not nearly as high a research priority as something like Covid-19.

                  • by Rei ( 128717 )

                    It was weird when I got it. I remember waking up one day for school, and finding that I practically couldn't walk without help. My mother initially assumed I was faking or exaggerating until she took my temperature, wherein she rushed me to the hospital. I was the "case of the month" at the time, with one team of doctors after the next trying to figure out what was wrong, each with their own theories, until eventually settling on Kawasaki disease. At its peak all of my blood vessels were visibly inflamed an

      • by ceoyoyo ( 59147 )

        There's some evidence that herpes virus infections can be beneficial. Herpes and other other viruses that can take up residence in your cells have some immunomodulatory effects. On the other hand, when it goes wrong, it might be responsible for some autoimmune disorders. There's also evidence that a reasonable parasite load might be good for you.

        • Re:How many others? (Score:4, Informative)

          by godel_56 ( 1287256 ) on Tuesday August 18, 2020 @07:37PM (#60416641)

          There's some evidence that herpes virus infections can be beneficial. Herpes and other other viruses that can take up residence in your cells have some immunomodulatory effects. On the other hand, when it goes wrong, it might be responsible for some autoimmune disorders..

          And a number of the herpes viruses are notorious cancer causing oncoviruses, especially HPV-16 and HPV-18. Australia gives every kid, male or female, a free inoculation against nine of the worst HPV viruses when the child reaches puberty. The cancers involved are cervical cancer, anal cancer and more recently mouth, tongue and throat cancers. The last three have grown massively since the uptick in oral sex as a cultural practice over the last few decades.

          In Australia a test for active HPV virus has replaced the previous cervical cancer screening test.

          The information that you've posted may be correct but I worry about some moronic anti-vaxxer jumping on it to try to prove that HPV vaccines are bad for you.

          • Err, HPV != herpes.
            • by ceoyoyo ( 59147 )

              Makes the OP's comment about anti-vaxxers conflating different viruses a bit unfortunate, hey?

              • Not really. Both virus types are known to cause warts. When someone "got herpes Saturday night from Sally" might actually have gotten HPV and would be better off having read GGP's post about HPV vaccines and cancer.

                • Donâ(TM)t worry, most herpes simplex infections are asymptomatic. Most people have one or more without knowing it.

                  And you most likely got it from your mom.

          • by gtall ( 79522 )

            Ah, the Ozzies had it correct. In the U.S., the religious nutjobs decided that HPV vaccines would make little whores out of their little girls and campaigned against universal vaccination against HPV....he's Funny G-d.

        • by NFN_NLN ( 633283 )

          > There's also evidence that a reasonable parasite load might be good for you.

          But who has time to jerk off all those parasites though?

    • a myocarditis is not surprising - this is why one should slow down with sports during a cold, because it can cause myocarditis. afair it is the second most common cause of sudden cardiac death in athletes

    • by Dixie_Flatline ( 5077 ) <vincent.jan.goh@g m a i l . c om> on Tuesday August 18, 2020 @03:54PM (#60415707) Homepage

      It's an interesting question, to be sure. I'm sure that it happens more than we think.

      In this case, it makes a lot of sense. COVID-19 has a lot of aspects of a vascular disease [medium.com]. It creates blood clots [thelancet.com] in a lot of different organs [thelancet.com], including the lungs.

      The lungs are the main battleground of the disease—the clots in your lungs are why O2 doesn't diffuse into your blood as easily—but it really just attacks anything with an ACE2 receptor.

      I'm not a doctor, but I really can't stress enough how little you should eff with this infection. I have a friend that got it quite early on, and only now, 4 months later, can she run for 15 minutes without stopping. She had trouble doing anything for more than a few minutes without being tired for weeks. I have no desire to explore the long term effects of this disease, myself. I'm staying in until there's a vaccine and better treatments.

      • In this case, it makes a lot of sense. COVID-19 has a lot of aspects of a vascular disease

        FYI, Dr. Anthony Fauci also happens to be one of the world's leading experts on vasculitis. The rheumatology research he did back in the 70's was considered a breakthrough that dramatically improved the survival rates of patients with vasculitic diseases such as polyarteritis nodosa, granulomatosis with polyangiitis (Wegener's disease), and lymphomatoid granulomatosis.

      • by gtall ( 79522 )

        Even with a vaccine, you'd still need to steer clear. Vaccines are rarely 100% effective. And we won't know how long any one vaccine will work to ward off the virus. The effects on our society won't be going away any time soon no matter what Faux News says.

    • I continue to wonder how many common diseases are actually caused by viruses. We just don't link them together because they haven't been researched like COVID19.

      Probably many more that we know. We do know that viruses and bacteria are definitely responsible for some cancers. Heliobacter is provably tied to various gastrointestinal ailments, including stomach cancer. HPV is tied to cervical and a number of other cancers. Hepatitis is tied to liver cancer. It's pretty clear the action of various microbes can have all sorts of nasty consequences down the line.

    • by phantomfive ( 622387 ) on Tuesday August 18, 2020 @05:10PM (#60416039) Journal
      Myocarditis is a swollen heart muscle, and common with many viruses. It is a result of the immune system being active in the region of the heart (it can also be the result of a faulty valve, so don't brush it off). Most of the time it goes away on its own eventually, once the virus is taken care of.

      Myocarditis is an expected symptom here, so we shouldn't be surprised or panic. It's something worth watching and doing further research, but it's not likely to cause any long-term damage.
      • by ffkom ( 3519199 )
        Just to mention one of the many papers published on Myocarditis after Influenza: http://citeseerx.ist.psu.edu/v... [psu.edu]
      • by HiThere ( 15173 )

        And the paper explicitly says this isn't proof of permanent effects. But this *was* two months after symptoms had cleared. And they didn't (or I haven't heard of) a follow up study 4 moths after symptoms had cleared, or 6 months afterwards.

        So it's not proof of anything dire...but it sure isn't the converse.

        • The paper doesn't rule out bunions as a long-term side-effect of COVID, either. So what?

          A more reasonable way to interpret this is, that if you are a doctor treating COVID patients, you should be sure to double-check that the heart is ok.
      • sometimes months after infection. That's what people are worried about.

        A little while you're young? No biggie? Lingering into your 60s? Now we've got a problem.
  • it's going to be "interesting times".

    For one thing it's going to massively change our politics. The Boomers had about 20 years left as the dominant voting block and COVID is likely to shave that in half. It'll mean a much younger voting public.

    Then there's the economics. I suppose it'll be good for House prices & Social Security. But it means a lot of spending power leaving our economy because they tend to be on the higher end of the pay scale and have more college degrees (since college was muc
  • I'm not sure this word, "intriguing" means what you think it means. :-/

    • intrigue
      verb
      gerund or present participle: intriguing /intr/
      1.
      arouse the curiosity or interest of; fascinate.
      "I was intrigued by your question"

      What's wrong with the usage in the summary?

      • I stand corrected!

        However, I don't find it curious, interesting or fascinating...but rather a little frightening.

  • If they didn't perform a scan before COVID-19 then they don't know if those abnormalities were present previously. Medicine has an odd problem with "normal," because they generally don't scan people who aren't sick; their data baselines tend to be based on sick people.

    Maybe these issues are present in the general population and nobody noticed.

    • by skids ( 119237 )

      Medicine has an odd problem with "normal," because they generally don't scan people who aren't sick

      I'm all for establishing baselines with aggressive empirical data collection.

      However medicine also does a lot of testing that turns up negative results because they are thrashing around trying to find causes for symptoms. In this case it might be sufficient to re-rerun the experiment by locating people who have had negative heart scans and then caught COVID-19. If they can find them. My (uninformed) impression is that the lack of a trustworthy way to privately store health care data but still allow acad

    • Prior scans aren't necessary to know that something's wrong with a lot of the infected, even those that survive. Maybe you heard, overactive clotting factors are a common symptom in covid-19. In dozens of cases, autopsies have found cells producing clotting factors within the heart and other organs--locations where these cells shouldn't be present.
      • by HiThere ( 15173 )

        Wrong. You can't prove anything that way, you need a control group.

        OTOH, there's too many things to check them all out in a formal way, that's EXPENSIVE. So you run small, informal, tests to find out what places to run more formal studies. This one ran up a red flag saying "This needs to be studied carefully.". Most of the time they don't find anything serious, and we can sure hope that's what happens this time.

        • by sjames ( 1099 )

          I x-ray 100 people who were hit by a train and find rib fractures. Can I conclude that being hit by a train causes rib fractures without a control group, or will you just assume everyone has a few fractured ribs?

    • According to a 5-second Internet search, the incidence of myocarditis in the general population is "estimated between 10 to 20 cases per 100,000 persons". So if 60% of this cohort has it, it's a very dramatic anomaly and can't be explained by random chance.

      • by ceoyoyo ( 59147 )

        Sure. Except it's very common after a common cold or flu.

        You know how your nose gets red when you've got a cold? That's basically what myocarditis is, except in the heart. If it's severe, it's a problem. If it's mild, it clears up and you're fine. But the degree of severity is a much more subtle thing than someone looking at an MRI and checking yes or no.

        There's also the issue that this was not a randomized, blinded study. These sorts of things are extremely vulnerable to observer bias.

        Things like this are

        • by sjames ( 1099 )

          This study was exactly to see if it's worth doing more extensive and expensive follow-up studies. Results say yes.

          Note that the study did not claim that COVID and only COVID can have these effects.

          The entire pre-COVID population that has ever been scanned is the control group.

          • by ceoyoyo ( 59147 )

            It's very dangerous to use a "control group" that's not acquired for the purpose. You should never do it, or trust anyone who does.

            Upon reading the study, it turns out they did have a control group. The headline finding, "nearly 80%" with an abnormal cardiac MRI, is actually 78% had a particular type of abnormal finding. 40% of the risk factor matched controls also did.

            There's likely selection bias, but it seems reasonable that there's some impact of COVID on the heart. But again, these findings could easil

    • Of course not. The medical community are complete morons and you're the only smart person. In fact I nominate you to head up the CDC.

  • by cirby ( 2599 ) on Tuesday August 18, 2020 @03:52PM (#60415705)

    It's possible that people who have susceptibility to certain heart problems are also more susceptible to COVID infections.

    There's already some evidence that blood type can influence COVID susceptibility (Type A makes you 45% more likely to catch it and develop severe symptoms, Type O makes you 35% less likely). And yeah, that's a massive difference.

    We also know that blood type affects heart disease risk in general, with Type O having the lowest risk factor, and AB having the highest.

    • Don't forget women are less likely to have sever symptoms.

      See also, https://www.thesun.co.uk/news/... [thesun.co.uk]

      C-19 takes fat to replicate. Fat in any organ is bad. Don't take my word for this, just DuckDuckGo "Fatty liver Covid-19".

      It's *really* bad to have fatty liver and get it. My personal opinion, here. It's probably bad to get C-19 if you have any organs with a lot of fat that they shouldn't have.

      The UK is pushing a diet, because they looked at the data and see what is going on.

    • by MrL0G1C ( 867445 )

      You're assuming some people won't catch COVID-19, there is no evidence that that is true and it is unlikely that anyone is immune since the virus is novel.

    • It's possible that people who have susceptibility to certain heart problems are also more susceptible to COVID infections.

      That is a great leap which warrants investigation, but Occam's razor says you went to the doctor because you broke your leg rather than you broke your leg because you wanted to go to the doctor.

      COVID infections number in the many millions. If there were a distinct pattern for pre-existing disposition then we'd have seen one by now based on demographic trends alone. On the flip side it is well known that viruses and the immune system cause havoc on the bodies. This isn't even unique to COVID, look up pericar

  • Add it to the list (Score:5, Insightful)

    by swillden ( 191260 ) <shawn-ds@willden.org> on Tuesday August 18, 2020 @04:39PM (#60415883) Journal

    Last week we saw a /. article about research showing that COVID patients had high levels of MRI-observable brain damage (55%), also uncorrelated with the severity of COVID symptoms. A while ago there was an article about similar kidney damage.

    Many researchers are arguing that COVID-19 should be classified as a vascular disease, not a pulmonary disease, because it causes damage throughout the vascular system and therefore in organs, which have lots of blood vessels. The lungs are the first and most immediately-obvious organs to be traumatized, but hearts, kidneys, brains soon follow. I guess we should assume that everything else is probably damaged as well, but the nature of other organs' operation is either less critical to life (e.g. gall bladder) or more tolerant of damage (e.g. liver).

    The bottom line is that COVID-19 is nasty shit, even for healthy people who are all but guaranteed to survive. It wouldn't shock me if 30 years from now life insurance companies want to know if you had COVID because people who had it die 10 years younger than those who didn't.

    • Last week we saw a /. article about research showing that COVID patients had high levels of MRI-observable brain damage (55%)

      Citation?

      A while ago there was an article about similar kidney damage.

      Citation?

      Many researchers are arguing that COVID-19 should be classified as a vascular disease, not a pulmonary disease, because it causes damage throughout the vascular system and therefore in organs, which have lots of blood vessels. The lungs are the first and most immediately-obvious organs to be traumatized, but hearts, kidneys, brains soon follow. I guess we should assume that everything else is probably damaged as well, but the nature of other organs' operation is either less critical to life (e.g. gall bladder) or more tolerant of damage (e.g. liver).

      Many? Citation?

  • by feranick ( 858651 ) on Tuesday August 18, 2020 @04:50PM (#60415919)
    I can't start to list how many people that used to disregard covid as flu-like disease, that now are just fully disregarding social norms (masks, distancing), because: "I am strong and young and never had anything in my life, in fact I may even got it and went through it". A rough awakening seems lurking for the next few years.
    • Myocarditis is a symptom of a flu-like disease. This result portends no long-term problems.

      Wear your mask anyway.
    • that now are just fully disregarding social norms (masks, distancing)

      Masks and distancing are disregarding societal norms, you useless fuckwit.

      • by linuxguy ( 98493 )
        > Masks and distancing are disregarding societal norms, you useless fuckwit.

        It is OK to disagree with someone in an online forum, but you took no time to get your panties in a wad.

        I am guessing, a Trump voter. Say it ain't so.
      • I can see from your nickname, that you are happy to be a clone of the propaganda cult. Be safe out there.
    • by HiThere ( 15173 )

      You are taking this study more seriously than it deserves. It may well be correct, but the damage not permanent. This is explicitly stated in the paper itself.

      This is a report of something that needs to be checked out carefully, with a proper sized group and a proper control group. And there need to be follow ups, probably monthly a year or so after the virus clears. It would also be good if they checked kidney function and evidence for strokes, as there have been warning signs for those, also.

      • OK, so it's OK if someone will not operational for, say, a year? You will lose your job, your capacity to function, etc. Long terms doesn't mean forever, it just means what it means, you don't know when it ends, and while we don't know it will be permanent, in some case we know it might. Think of the mental aspects that come from it. Those can be akin of PTSD, very long term.
  • Hardly surprising (Score:5, Interesting)

    by The Grim Reefer ( 1162755 ) on Tuesday August 18, 2020 @05:05PM (#60416001)

    This is hardly surprising. Having a cold often times causes myocarditis. Probably most of the time actually. A flu, such as Covid-19 is just about a guarantee that the patient will have it.

    It's also well known (in the cardiology community) that you should not exercise or even elevate your heart-rate when you have myocarditis. Doing so has a high risk of causing permanent damage to the myocardium. The risk probably goes up with age, but even young healthy people are at risk.

    I remember 15 years ago seeing an exam from a 22 year old Marine who had the flu and couldn't get over the fatigue. It ended up that he kept working out and caused enough damage to his heart that his LV EF (heart function) was only 12%. I think in the end it recovered to around 20%. But he should have had an LV EF of around 70%.

    Full disclosure, I know two of the authors on this paper.

    • by chr1973 ( 711475 )

      Out of curiosity, what is considered an elevated heart rate in the context of mycarditis (or having the flu)? 100 bpm? 120 bpm? 140 bpm?

  • I guess they'd better start pumping money into research on cloning/growing hearts from stem cells. If they hurry up and get it working they could start mass growing replacement hearts.
  • Covid also increased the chance of heart disease and obesity in those that didn't get it.
    (People being physically inactive during the lockdown, and unable to go to the gym etc.

  • by joh ( 27088 )

    That's me. In March I got a slight fever, throat pain, loss of smell, some coughing. Went away after ten days. I was in home office and hardly did anything back then but a while later I noticed some serious weakness and persisting shortness of breath. Now I'm diagnosed with Atrial fibrillation and Myocarditis. Even climbing a single flight of stairs is hard work now. Well, at least I have antibodies now and can't get Corona again! But honestly I would have preferred to never have caught it.

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