Janet Shapiro, MD, an ICU physician at Mount Sinai Morningside Hospital in New York City, had just come back to work after a relatively mild course of COVID-19. She had lost her sense of smell and taste, and for a few days had a low-grade temperature and cough.
But as she was rounding, she noticed she still wasn’t feeling right. She was short of breath and her heart was often pounding.
“I would walk down the hall and my heart would race,” Shapiro told MedPage Today. “I just didn’t have the stamina.”
She tried to ignore her symptoms for a few days before deciding to go for an echocardiogram. It revealed an ejection fraction of 45%, indicative of mild dysfunction — a figure that was way down from her normal ejection fraction of about 65%, she said.
“I could see I wasn’t having normal contractions,” Shapiro told MedPage Today.
She didn’t have underlying heart disease. The experience, which she wrote about for JAMA Cardiology, reinforced recent reports that call attention to the disease’s impact on the heart, which in many cases may be silent.
Last month, two German studies published in the same journal found evidence of long-lasting cardiac effects, even in patients who never developed overt cardiac disease during their infection.
One, an autopsy study, found viral infection in the hearts of deceased COVID-19 patients who were never diagnosed with myocarditis during their illness. The other study found that most patients who had recovered from COVID showed abnormal cardiac MRI findings consistent with active inflammation more than 2 months after diagnosis.
The latter study’s findings suggest that “significant cardiac involvement occurs independently of the severity of original presentation and persists beyond the period of acute presentation,” the authors wrote.
Even the Big Ten college athletic association cited myocarditis risk in cancelling its fall football season — at least 15 players at member schools were diagnosed with the condition following bouts with COVID-19.
Shapiro said patients who have symptoms that suggest cardiac involvement, such as chest pain, should be screened for it, though she acknowledged that not all patients with COVID-19 will have access to that type of care — especially not patients who aren’t sick enough to be hospitalized.
“If people are in a state where COVID is surging, and they’re going to their [primary care] doctor’s office, cardiac issues may be underdiagnosed,” she told MedPage Today.
In her case, Shapiro started a 5-day course of prednisone, and took off work for another week.
Since the etiology of cardiac effects aren’t always clear in COVID, she didn’t know whether steroids would have an effect, “but I was happy to take them,” as the hospital had used them early on and they did appear to help, she said.
“My physician thought I should take [prednisone] even longer [than 5 days] because I still had some chest discomfort for another week, but overall, it did make me feel a lot better.”
Shapiro also had intermittent echocardiograms to make sure her condition wasn’t getting worse.
“You worry about arrhythmias,” she said. “I definitely felt the fear.”
The experience gave her a renewed empathy for the patient experience, she said. When her treating physician suggested she be admitted for telemetry monitoring after the echocardiogram, she declined.
“What struck us all was the isolation of it,” she said. “If you came into the hospital in March and April, you couldn’t have a visitor…. The idea of being alone here — I felt I’d rather watch myself at home.”
Shapiro says it took at least two and a half months from her illness onset in March to feel completely herself again, though she still has not regained her sense of taste and smell.
A final stress echocardiogram confirmed that her heart was functioning normally: “I still cannot taste my food. But I completed my stress echocardiogram, achieving three stages of the Bruce protocol, and I feel better than ever,” she wrote in JAMA Cardiology.
“Having this makes you appreciate what [COVID] is,” Shapiro told MedPage Today. “We saw so much death and so many critically ill patients. I can’t help but feel lucky to make it through.”