Masked physician holding up a stethoscope with a heart icon and heartbeat on it

Nearly two years since the COVID-19 pandemic settled in the United States, the medical community continues to analyze the impacts of COVID-19 on various bodily organs — notably the heart.

As such investigations ensue, one fact is becoming increasingly clear: the virus does affect the heart and especially its electrical system, thus disrupting the rhythm of the heart.

Kamal M. Kotak, MD, a cardiac electrophysiologist at Loma Linda University International Heart Institute, outlines the "why," "how," and "now what" for abnormal heart rhythms associated with COVID-19 infection.

Your cardiac conduction system

Your heart is a four-chambered muscular pump that runs on its own electrical system, known as the cardiac conduction system. Electricity starts from the top of the heart flowing to both the right ventricle that pumps blood to the lungs and the left ventricle pumping blood to the rest of the body. The system works like your own natural pacemaker.

Heart muscle cells can also create electricity independently of this cardiac conduction system in diseased states. COVID-19 can cause these cells to generate abnormal electricity, as well as create short circuits that lead to irregular heart rhythms, also known as arrhythmias, says Kotak.

Types of arrhythmias

Heart rhythm disorders or arrhythmias fall primarily into two subgroups: fast rhythms and slow rhythms.

  • Slow rhythms occur when the electricity flow in the heart is slowed or blocked altogether. Such blockages may resolve on their own, though. Kotak says some patients do end up needing a pacemaker if their heart rate is too low.
  • On the other hand, fast heart rhythms cause rapid heartbeat, palpitations, heart racing, fatigue, dizziness, and shortness of breath. The most common fast rhythm is called atrial fibrillation (AFib) and causes an irregular, chaotic rhythm in the upper part of the heart called the atrium. People with AFib are at higher risk of experiencing a stroke, Kotak says. Diagnosing and treating AFib with blood-thinners can prevent this risk of stroke. Medications and minimally invasive procedures such as ablation can further improve quality of life.

COVID-19 is also known to weaken heart function, precipitating abnormal rhythms from the lower parts of the heart known as premature ventricular contractions (PVC) and ventricular tachycardia (VT). These can be life-threatening and require a physician’s further evaluation and treatment.

Another cardiac syndrome that often arises after COVID infection is called postural orthostatic tachycardia syndrome (POTS), caused by an imbalance of the autonomic (or involuntary) nervous system. The imbalance can manifest as dizziness, palpitations, heart racing, and lightheadedness with posture change — standing up from sitting or lying down. Recognization and treatment are important since they can bear significant impacts on quality of life.

What to look for if you have been diagnosed with COVID-19

20-30% of patients hospitalized with a COVID-19 infection display cardiac issues, and arrhythmias have been associated with poor outcomes, Kotak says. Anyone can develop arrhythmia problems upon contracting a COVID-19 infection, he says, especially people with pre-existing heart disease or other chronic illneses.

Though symptoms of arrhythmias vary, the most common include: heart racing, fluttering, palpitations, skipped beats, fatigue, dizziness, or even loss of consciousness.

If you feel these symptoms, Kotak advises you to seek medical attention. Symptoms of arrhythmia or other cardiac effects of COVID-19 could linger for months after contracting COVID-19, so it is vital to get them checked and treated accordingly.

What to expect

First, you and your physician need to accurately characterize your symptoms to establish a correct diagnosis of COVID-19 related heart rhythm problems. It is also important to not to disregard symptoms on the account that you believe you are getting out of shape or that it is just COVID-19 or your anxiety. Regardless of what you may suspect, it is always better to have a physcian examine your symptoms. To achieve symptom-rhythm correlation, your doctor will recommend an electrocardiogram (EKG or ECG) test as well as a heart monitor.

A heart monitor is like a mini-EKG resembling a large sticker placed on your chest for several days (at times up to 30 days) to monitor your heart rhythm. When wearing the heart monitor, you can mark the time and nature of your symptoms on the monitoring devices. This allows your doctor to determine the exact nature of your heart rhythm issue causing your symptoms. It also allows provides insights into the overall health of your heart rhythm.

In addition, your doctor may request an ultrasound of your heart, called an echocardiogram, to make sure the structure and function of various heart chambers and valves remain preserved. Upon reaching a diagnosis, your physician will consider treatment among various therapies, medications, or minimally invasive procedure such as ablation.

Kotak says researchers, physicians, and patients are continuing to accumulate long-term data about COVID-19 and arrhythmias to know the overall prognosis. In the meantime, if you are a patient who suffered from a COVID-19 infection and continue to experience cardiovascular symptoms, experts at Loma Linda University’s COVID-19 Heart Clinic are at your service to evaluate and advise you on the appropriate tests and screenings for your health. If you or your family are concerned about COVID-19’s lingering effects on the heart, schedule an appointment with one of our experts by calling 1-800-468-5432.

Meet Our Providers

Kamal M. Kotak

Cardiologist

Specialties: internal medicine; clinical cardiac electrophysiology; cardiovascular disease

Learn more about this provider