When should you worry about your heart health post-COVID-19?

For those who had COVID-19, lingering heart problems can complicate their recovery. UAB experts address common concerns that people have with their heart health after COVID-19.
Written by: Tehreem Khan
Media contact: Anna Jones

Heart stethescope streamFor those who had COVID-19, lingering heart problems can complicate their recovery. UAB experts address common concerns that people have with their heart health after COVID-19. Although most people with COVID-19 fully recover within days or weeks of infection, some suffer from post-COVID symptoms long after. According to the American Heart Association, a growing number of studies suggest many COVID-19 survivors experience some type of heart damage after their diagnosis of COVID, including dizziness, accelerated heart rate, chest pain, shortness of breath, brain fog and fatigue.

Gilbert Perry, M.D., professor of medicine in the University of Alabama at Birmingham’s Division of Cardiovascular Disease and cardiologist in the UAB Cardiovascular Institute, provides insight on when these symptoms should become a concern and how they should be addressed.

Is there anything that can help alleviate muscle fatigue and heaviness during exercise?

Muscle aches are a very common symptom after COVID-19. A wide variety of problems can cause muscle aches and fatigue, including prolonged bed rest, inactivity and severe inflammation during the early stages of COVID-19.

“Your doctor can do bloodwork to determine if there is ongoing, active muscle breakdown,” Perry said. “Physical rehabilitation and regular exercise can help rebuild muscle loss and improve exercise capacity.”

Is it normal to have an accelerated heartrate and chest pain, even if your cardiac MRI was normal?

There are many causes of chest pain, but a rapid heart rate is common in post-COVID patients. Causes of rapid heart rate can include being out of shape due to prolonged illness and too much bed rest. Some patients develop an abnormal rise in heart rate upon standing, caused by an abnormality in the autonomic nervous system, which is not related to COVID-19.

“If the MRI was normal, then heart injury due to COVID is likely not the cause of your chest pain,” Perry said. “Your physician will need to get a careful description of the type of chest pain you are having to determine if you need additional testing for other causes of chest pain. If your heart rate is gradually coming down each time you walk or run, that’s a sign that you are getting better.”

My heart races quickly after any exertion, and I tire quickly. How can I build my endurance back up?

Perry advises that people try to ease into exercise again after recovery. Mild levels of exercise such as walking can help. If your heart races when you stand up, trying recumbent exercise machines such as a rowing machine, or a semi-recumbent bicycle can help. Most patients report significant improvement after six to 12 weeks using this approach.

“Every week or two, increase the amount of exercise time until you can exercise comfortably for 30-45 minutes daily,” Perry said. “After that, you can also increase the intensity of the exercise.”

At what point should heart palpitations concern me after having COVID-19?

Heart palpitations are feelings that the heart is pounding, fluttering or beating irregularly. They are most concerning in patients with known or suspected heart injury or who have a weak heart muscle.

“Many patients feel palpitations even when their heart rhythm is normal; in these cases, a normal telemetry study can be very reassuring,” Perry said. “A telemetry monitor can record heart rhythm and help determine if palpitations represent an abnormal heartbeat.” 

What is the most common heart-rhythm complaint? How long does it take for them to subside, if at all?

UAB Medicine experts have created a video series to help people better understand and manage post-COVID symptoms, which are sometimes called “long COVID” or “post-COVID syndrome. Learn more here.

“The most common heart rhythm complaint I hear from patients is heart pounding or racing,” Perry said. “Symptoms can improve by exercising in a reclined position and staying hydrated in patients who have a heart rate increase and dizziness upon standing.”

In a small number of patients with evidence of heart injury, abnormal beats from the heart’s main pumping chambers are seen.

“This can be a serious condition in people with heart injury, and it requires an evaluation by a cardiologist — especially before resuming vigorous exercise,” Perry said.

Should I see a specialist if my resting heart rate is lower than it was before contracting COVID-19?

In general, a low resting heart rate is healthy. 

“You might ask your primary care doctor to order an ECG test. You also might want to check your heart rate to see if it increases normally when you exert yourself. If the ECG shows that the rhythm is normal and your heart rate increases with exercise, then you don’t need to be worried about it,” Perry said.

Minimal exertion to treat “brain fog” causes a spike in my heart rate. Should I continue to exercise?

In general, exercise is thought to be good for brain function, and it also may help with anxiety or depression, both of which can affect thinking and concentration in some post-COVID patients. 

“A heart rate of 90-110 beats per minute is not a concern as long as you otherwise feel well during exertion. Your doctor or a physical rehab specialist can help you create an exercise plan that suits you, including setting a heart rate range to expect during exercise,” Perry said. “If you exercise regularly, you should see your heart rate during exertion come down over time.”

Chest pain, or shortness of breath not due to a lung problem, may indicate a higher risk of heart problems. In such cases, patients may benefit from further testing, especially if the symptoms continue.

Learn more about UAB Medicine’s Post-COVID program here.