
Mysterious heart damage, not just lung troubles, befalling Covid-19 patients - branko_d
https://khn.org/news/mysterious-heart-damage-not-just-lung-troubles-befalling-covid-19-patients/
======
dcolkitt
This headline is definitely a lot scarier than the actual body of the study.

The most likely cause of the heart damage by far is the systemic inflammation
induced by pneumonia. We know this because pneumonia patients of all types
often have heart strain afterwards[1]. But that damage is very rarely
permanent as the risk subsides back to baseline given enough time.

Until we see evidence of heart issues in patients without pneumonia
complications, we shouldn't be any more scared of covid-19 as we were before.
In particular young and healthy people still have very little risk from
infection. Patients who recover without serious complications should not be
afraid of hidden heart damage.

[1] [https://www.health.harvard.edu/heart-health/heart-attack-
ris...](https://www.health.harvard.edu/heart-health/heart-attack-risk-rises-
after-a-bout-of-pneumonia)

~~~
paulsutter
Hospitalization rates for people aged 20-44 are in the range of 15% to 20%.
You might want to read up on the experience of COVID-19 hospitalization before
you decide that there's little risk from infection.

[https://www.statista.com/statistics/1105402/covid-
hospitaliz...](https://www.statista.com/statistics/1105402/covid-
hospitalization-rates-us-by-age-group/)

~~~
btilly
That is percentage of confirmed cases that wind up with hospitalization.

However we mostly don't try to confirm cases if it won't affect the care we
give. We just tell them to self-isolate. We therefore will not have good
statistics on what percentage of cases are confirmed until after the immediate
crisis is over and we test to see how many have antibodies.

So your figure is, "Of young people who have it severely enough to get tested,
15-20% get hospitalized." This says nothing about what fraction of cases are
severe enough to get tested.

Also note that we undercount deaths. If a person dies and was never confirmed
to have COVID-19, they are also not counted as a COVID-19 death. Nobody knows
how big this undercount factor is.

~~~
scott_s
All good points. But paulsutter's message remains: young people are at
significant risk. Yes, the risk for older people and those with pre-existing
conditions in higher. But the parent poster's characterization of the risk for
young people as "very little" is dangerous.

~~~
m4rtink
This is also why I don't really like that some propose various "herd immunity"
schemes - we simply don't know what the virus actually does to people in
practice, even if it does not outright kill them. So it seems very
irresponsible to propose schemes like that at this point in time.

~~~
Fjolsvith
Exactly. I know I'm waiting until they have herd immunity available for
everyone.

------
jacquesm
So, I've been battling this bug for the last three weeks or so, probably
caught it on the way back from my last job in Finland. I expected an empty
plane instead it was packed like it was the last train out of San Fernando and
everybody was scared there never would be another one.

After a week or so symptoms started in spite of having self-isolated already
after the flight, so that's why I figure that is where I caught it, no
positive confirmation because tests are still pretty rare around here but all
the symptoms are present. At least I hope that I did not infect anybody else
by taking that precaution. One thing I noticed (besides the hacking cough that
does not seem to want to go away) was a pretty highly elevated heartrate at
rest. Up to 20% higher than normal.

I already had some lung damage to my right lung due to an earlier pneumonia,
but also played saxophone which does a good job of teaching you how to breathe
properly and may improve your lungcapacity a bit.

The last couple of weeks have been a continuous rodeo of improvement and
falling back again, today is the first day that I have a bit more energy,
other than that the time over the last weeks was mostly spent sleeping.

Today is the first time I've seen my heart rate at rest below 60, and I take
that as a very good sign that I'm on the tail end of this.

Wouldn't wish this on my worst enemy.

If you can avoid this bug you really should. I totally believe that if I had
had a worse general condition that I may have ended up in the hospital, and
given the extra strain on the heart I find the heart damage not so much
mysterious as logical. After all, if your lung capacity decreases due to fluid
in your lungs then your heart and chest muscles will have to work harder
(possibly _much_ harder) to get your blood O2 levels to saturation (if they
still can...).

~~~
MrBuddyCasino
There is a hypothesis [0] that the virus attacks red blood cells and impacts
their capacity to transport O2, and that the lung damage is actually caused by
that, and not directly by the virus. Elevated heart rate makes a lot of sense.

[0] see thread and linked paper:
[https://twitter.com/yishan/status/1244717172871409666](https://twitter.com/yishan/status/1244717172871409666)

~~~
jakogut
> There is a theory [0] (unproven!)

Would it be more appropriate then to call it a hypothesis?

~~~
branko_d
No, "theory" is simply a provable "hypothesis". Doesn't have to be proven,
just provable.

The thing is, a theory can never be completely proven. We can never completely
discount the possibility of making a new observation or experiment that
disproves the theory (hence "falsifiability").

That's why, for example, the "germ theory" is a correct term, even though its
probability of being correct is so close to 100% that we could just call it
the "truth".

------
throwanem
Random speculation aside, if you (like me) are currently at the tail end of
COVID-19 and beginning your convalescence from it, it's wise to assume you
have some degree of myocarditis and behave accordingly - that is, as best you
can, avoid activities that may strain your heart and circulatory system for a
couple weeks to a month following end of active COVID-19 symptoms.

I'm not a doctor, and this isn't medical advice, but it isn't alarmism either.
It's well known that pneumonias, however caused, tend to be rough on the
heart. So it's just common sense to regard this pneumonia the same way.

Look at it this way. If you aren't at risk, but assume that you are, the worst
that happens is nothing. If you _are_ at risk, and assume that you _aren 't_,
you may well not be so lucky. So, especially when you may not be able to rely
on the usual degree of hospital support - better safe than sorry.

------
guscost
One factor to consider: Some folks will be absolutely _terrified_ to learn
they have this disease, which may have real effects. An example:
[https://en.m.wikipedia.org/wiki/Voodoo_death](https://en.m.wikipedia.org/wiki/Voodoo_death)

“These data suggest that vagus contributes to severe emotional states and may
be related to emotional states of immobilization, such as extreme terror.
Unfortunately, this immobilization technique is potentially life-threatening
for mammals (but not for reptiles). Mammals would undergo states of
bradycardia or hypoxia as an over-activation of parasympathetic vagus system.
The organs of the oxygen-hungry mammal are deprived of oxygen due to lack of
blood flow, and the animal dies.”

~~~
graeme
That implies a low heart rate causing death, correct?

If so, this would be an easy hypothesis to test based on heart rate.

But also, do the rats in voodoo death have heart damage? These covid patients
do. If the rats don’t, then you’re quite off track.

~~~
guscost
It's just one example of a heart-related effect, that's all. Considering that
we're all here reading another hypothesis that this is the first-ever
respiratory pathogen to _infect the heart_ , it doesn't seem that much of a
stretch.

We totally should research whether fear can lead to physical heart damage, but
I would bet that "stress in general" is the source of this damage, not only
emotional stress. See:

[https://www.medicalnewstoday.com/articles/295664](https://www.medicalnewstoday.com/articles/295664)

[https://www.medicalnewstoday.com/articles/317478](https://www.medicalnewstoday.com/articles/317478)

------
411111111111111
let me preface this by mentioning that i havent been tested for covid-19.

two weeks ago i've been having real issues breathing. it felt like my upper
body was borderline paralyzed and i had to really force myself to fully
breathe in. this wasn't constant but happened every day for several hours
each. especially at night.

i got worried that i might have the virus so i checked my temperature and
oxygen blood saturation as well as my pulse.

temperature was fine (36.6°C-37.2°C), blood saturation was in the normal
range, however it dropped from 97-100 when i wasnt having any issues to 94-97.
my pulse rate however went from usually ~75-80 to >110 whenever i had
breathing problems.

it went away last week.. or so i though. i had another episode of that this
morning, it was only for 3 hours today, however. it seems to be going away,
but if it actually was (or is) the virus... it seems plausible to me.

but i'm a person without any medical knowledge so ... listen to the people
actually treating the patients, not random armchair specialists like they're
frequent on hacker news -- especially in threads about covid-19.

~~~
Cthulhu_
You could be having panic attacks; based on the fact you've got numbers, it
sounds to me like you're actively monitoring your own blood saturation, which
already implies you may be worrying too much about things like that. Don't
underestimate the effects of worry and stress. If it's temporary and you don't
have other symptoms then you probably don't have the virus.

~~~
henearkr
I'm not a doctor, but each time I hear about a possible diagnostic about panic
attacks, it feels like somebody tells a patient having a rhinovirus "your
symptoms are explained by the runny-nose illness!". I.e. just stating the
symptom (sympathetic/parasympathetic system going weird, heart too fast, etc)
but phrasing it as if it was found to be the cause.

~~~
thomashobohm
I mean, panic attacks have no "real" cause by definition. They are your body
overreacting in response to a perceived threat that isn't really there; they
are a type of cognitive distortion. If a panic attack was in response to a
"real" cause, it wouldn't be a panic attack, it would be a normal response to
a threat.

~~~
henearkr
I know, but look, it is not the correct behavior of the body, right? So
obviously something is wrong, and I find it hard to believe that the problem
is from the mind if the patient is not himself stating it. In most cases, if
he has an anxiety problem, he would straightly start by talking about it, like
"I have been in wrong terms with my neighbors for years, and now just thinking
they are next door is hurting my chest and making me hard to breathe"...

I admit that in some cases the problem origin could have been repressed, but
this is not very common.

~~~
SketchySeaBeast
> "I have been in wrong terms with my neighbors for years, and now just
> thinking they are next door is hurting my chest and making me hard to
> breathe"...

Not at all. Anxiety is hearing the boss music in a video game and not seeing
any enemies. I'll often find myself so tense I'm holding my breath with no
ability to rationalize why I'm in that state. It's a real bastard.

~~~
henearkr
You're right. So (I agree with you but from here I'm trying to think about
some path to search an explanation) maybe could it be explained by some long-
term learning of the body-mind connection under repeated stress situations
(like being in a crowd while being self-conscious), and then it repeats itself
without the obvious stimulus?

What I resent, actually, is when physicians are presented with a package of
somatic symptoms and sympathetic/parasympathetic symptoms, and readily discard
the somatic part in order to jump to the "panic attack" conclusion.

------
throwawaylalala
Scroll down to figure 1. Non survivors end up with cardiac and kidney injury.
Interesting that this might shine light on the cause.

[https://www.thelancet.com/journals/lancet/article/PIIS0140-6...](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(20\)30566-3/fulltext?fbclid=IwAR3Hyjh3ax53XAGCxWpC3aNWx1k8_VEPxiOlfptMkVUinaN_MWHodgsIy1k)

~~~
daxorid
Thanks. Specifically, from your citation:

"In addition, angiotensin converting enzyme 2, the receptor for SARS-CoV-2, is
expressed on myocytes and vascular endothelial cells, so there is at least
theoretical potential possibility of direct cardiac involvement by the virus"

The most sane hypothesis I've seen is that the virus will attack any cell with
the ACE2 receptor, including the heart and kidneys:

"Angiotensin converting enzyme 2 (ACE2) is an enzyme attached to the outer
surface (cell membranes) of cells in the lungs, arteries, heart, kidney, and
intestines."

This would require the virus to enter the bloodstream from the lungs, which is
possible after sufficient alveolar damage.

ref: [https://en.wikipedia.org/wiki/Angiotensin-
converting_enzyme_...](https://en.wikipedia.org/wiki/Angiotensin-
converting_enzyme_2)

As an aside, although Wikipedia doesn't mention it, testicular cells also
express ACE2, leading to some worry about downstream fertility effects:

[https://www.medrxiv.org/content/10.1101/2020.02.12.20022418v...](https://www.medrxiv.org/content/10.1101/2020.02.12.20022418v1)

~~~
krooj
Interesting point about the ACE2 receptors in the GI tract. I wonder if that's
why certain infections present with GI symptoms?

------
carlsborg
There is a paper circulating that claims that the virus impedes red blood
cells leading to organ failure including lungs, and not the other way round.

~~~
nanl2053
Do you have a link?

~~~
friedegg
[https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surf...](https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173)

Among the speculation is that a blood transfusion may be a viable treatment.

------
jpxw
Disclaimer: I’m not a medical professional.

My understanding is that myocarditis is a possible, albeit rare, complication
of many viral illnesses?

Additionally, respiratory failure causes a massive strain on the heart, so
it’s not hugely surprising that many patients would have heart complications.

It would be interesting to know how many patients without respiratory distress
develop these cardiac symptoms.

------
PaulHoule
There are ACE-2 receptors all over the heart.

~~~
panax
[https://www.youtube.com/watch?v=jAW6VBWTiAA#t=36m](https://www.youtube.com/watch?v=jAW6VBWTiAA#t=36m)

ACE2 is also found in several other organs in which they are seeing multiple
organ failure with this virus so it likely is can bind to them and contribute
to damage in these organs including the heart but as OP says there are
multiple ways the heart could be affected

Loss of ACE2 receptors in the heart can cause impaired heart function

[https://www.youtube.com/watch?v=jAW6VBWTiAA#t=8m](https://www.youtube.com/watch?v=jAW6VBWTiAA#t=8m)

~~~
PaulHoule
Also there is a close connection between the heart, kidney, kidneys and other
organs.

For instance, ACE1 and ACE2 receptors are involved in a complex hormonal
system that manages your blood volume, blood pressure, etc. Antihypertensive
drugs target this system at different points. (ACE inhibitor drugs such as
Lisinopril target the ACE1 receptor and don't bind much to ACE2 at all)

Liver failure can present with symptoms similar to asthma because if your
kidneys can't get rid of water, the water will leak out of your lungs.

I had a friend who passed away last year from a bacterial infection that got
to his heart. We all have bacteria that live on our skin without problems, but
if you get a wound they can get into your blood and go to your heart.

He had heart valve damage which is bad because if your heart valves work
improperly, it can damage your blood the way you can 'damage' cream by
whipping it. This can cause clots to go into your lungs or your brain with bad
results either way.

He had open heart surgery but they had a hard time restarting his heart and he
was in a coma for a few months before they removed his feeding tube.

One reason why penicillin was a miracle was that all sorts of people who got
even minor wounds (e.g. soldiers, children, farmers, ...) would progress like
that before WWII.

------
sharph
Was reverse causation considered? Those with some heart damage are more likely
to be tested and hospitalized for COVID-19?

~~~
jpxw
Article addresses this

------
m0zg
There's a growing body of evidence that C19 attacks hemoglobin in the blood,
with the effects similar to malaria (where the parasite uses hemoglobin as a
nutrient source): blood with depleted hemoglobin simply can't carry as much
oxygen, so people start gasping for air, their lungs swell, and then pneumonia
kills them. Crucially, gasping for air seems to happen well before the onset
of pneumonia. This also explains why diabetics are more severely affected.

If that's the case, ventilators aren't going to help if you use air in them,
without supplemental oxygen: even if you pump air into the patient's lungs,
their blood simply won't be able to carry sufficient oxygen. You need to
supplement with oxygen.

It also explains why (hydroxy)chloroquine helps: if it stops/reduces depletion
of hemoglobin (which it does [*]), the patient may never progress to
pneumonia, because their blood is able to carry sufficient oxygen.

For those who already have pneumonia, supplemental oxygen would be vital if
they also have C19. Standard ARDS treatment protocol will not work well.

[https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surf...](https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173)

------
nestlequ1k
It's not "mysterious". Myocarditis is a common result of viral infections of
any kind, and can persist for weeks after recovering from the virus itself.

------
_bxg1
I wish these articles would be more specific about what they mean by "pre-
existing heart conditions". I have slightly high blood pressure which has been
known to enter hypertension territory before (by like 1 point), but I think
mostly stays a bit below there. Never know how worried I should be.

------
bryanrasmussen
is this 1 in 5 in people who are otherwise asymptomatic as well? I guess not,
or we would be seeing a lot more dead but I wonder if there are any heart
attacks occurring in otherwise asymptomatic people and not being marked down
as Covid-19 related.

~~~
ludamad
I just had a family friend die of a heart attack with no covid symptoms -
definitely a scary time

~~~
juliushuijnk
A (distant) friend shared he lost his wife to hearth attack a couple of weeks
ago out of the blue. I figure(d) it was random.

------
eaxitect
This might be the reason: Covid-19 attacks the 1-beta chain of hemoglobin to
inhibit human heme metabolism link:
[https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surf...](https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173)

------
dharma1
ACE2 (the entry point for the virus in the lungs) is expressed in the heart
too, so it makes sense that the virus could attack the heart directly.

It could also be a side effect of chloroquine.

Frustrating how little we know at this point.

------
cowpig
There's so much blind speculation in this comment section. The kind that's
intriguing and fun when it's about engineering/math/whatever, but dangerous
when it's about the health effects of an ongoing pandemic.

I hope moderators do something about it.

~~~
jpxw
Can you explain how exactly it is “dangerous”?

~~~
freehunter
Speculation on treatments for Covid-19 has already killed people:
[https://ktla.com/news/arizona-man-dies-after-taking-form-
of-...](https://ktla.com/news/arizona-man-dies-after-taking-form-of-
chloroquine-used-for-aquariums-in-apparent-attempt-to-treat-coronavirus/amp/)

~~~
Cthulhu_
Speculation is fine; this guy died from self-medicating. There is a
difference. We shouldn't resort to censoring to protect stupid people.

------
BFatts
It's interesting that the chloroquine has possibly been linked to cardiac
arrest. Is is chloroquine, or possibly the virus that is causing? Or maybe
both in combination?

------
rightbyte
I wonder if the patients get too much hydroxychloroquine. It can couse heart
failures.

