How to improve heart health after COVID-19

Before Jennifer Fagan contracted COVID-19 in March 2020, she considered herself a fitness enthusiast. She used to go running two or three times a week and almost every other day she took yoga classes with heat, a vigorous exercise. But several weeks after recovering from the early stages of the illness, she continued to experience excruciating chest pain and felt powerless all the time. In June, she started having palpitations. “I told my doctor that I felt like I was in the body of a 70- or 80-year-old person,” Fagan recalled.

She went to a cardiologist and a pulmonologist, but the specialists could not find any health problems in the initial tests carried out on this 48-year-old woman. So Fagan went back to his running routine. Then, in December 2020, she went into cardiac arrest after returning from a slow two-mile walk.

At first, neither her husband nor the EMS workers could figure out what had gone wrong. She was taken to the hospital, where doctors diagnosed her with a rare inflammation of the heart muscle known as myocarditis and implanted a defibrillator to stabilize her heart. But her heart problems did not end there. While she was in the hospital, Fagan started having bouts of extreme dizziness. And she has since experienced a host of covid symptoms ranging from fatigue to shortness of breath to rapid or irregular heartbeats.

Studies estimate that 10% to 30% of people infected with the coronavirus may develop long-term symptoms. And in a recent analysis of Department of Veterans Affairs health records for more than 150,000 people who contracted COVID-19, researchers found that Covid survivors were at “substantial” risk of developing cardiovascular disease for up to a year afterward. of their initial illness, even if their infections never brought them to the hospital. Compared to millions of other patients who were never infected, Covid survivors were 63 percent more likely to have a heart attack and 52 percent more likely to have a stroke. They also had a higher risk of heart failure, irregular heart rhythms, blood clots, and inflammatory disorders such as pericarditis and myocarditis.

The problem is that traditional medical tests to diagnose heart disease — such as EKGs, ultrasounds and other functional tests of the heart — often show that people who have had COVID-19 have no obvious heart damage. “When we do all these tests, they actually look pretty good,” says Ruwanthi Titano, a cardiologist at the Post-Covid Care Center at Mount Sinai Hospital in New York. As a result, doctors have had to reimagine how they diagnose and treat people with heart problems that persist long after a coronavirus infection.

If you have heart-related symptoms, whether it’s chest tightness or pain, shortness of breath, fast or skipped heartbeat, dizziness, or extreme fatigue, your healthcare provider may want to perform these basic tests to rule out any abnormalities or damage in the cardiovascular system, Titano said. But new studies suggest the culprit may be damage to nerve fibers that help control circulation. And this damage has a name: small fiber neuropathy.

Fortunately, the tools already exist to treat many types of post-Covid neuropathy. “People aren’t going to have to live with this for the rest of their lives,” said Salim Hayek, a cardiologist and co-director of Michigan Medicine’s Persistent COVID-19 Clinic in Ann Arbor. “The vast majority of the time, these symptoms, which range from palpitations to dizziness, resolve within six months of treatment.”

According to data collected by the Centers for Disease Control and Prevention, most people who recover from COVID-19 get better when they receive personalized physical and mental rehabilitation services.

Amy Ridgway, a physical therapist and manager of Emory Outpatient Rehabilitation in Partnership with Select Physical Therapy, said many persistent Covid patients can begin to see immediate improvement with a few simple breathing exercises. “One of the first things we teach is diaphragmatic breathing,” she said. Practicing deep abdominal breathing every day allows your lungs to absorb much-needed oxygen and is known to help reduce pain and anxiety. “It’s a great technique for anyone,” says Ridgway.

If you experience flare-ups of symptoms after any type of exertion, a therapist may recommend that you manage your daily activity levels or keep a diary to help you anticipate which activities may be too mentally or physically taxing. This self-monitoring technique, often used by those who suffer from chronic fatigue syndrome (also known as myalgic encephalomyelitis), assumes that people have a certain amount of energy that they can expend each day. So small tasks like showering or getting dressed can use less energy, while vacuuming or walking to the end of your driveway can drain your energy much faster, leading to something called post-exercise malaise.

Conserving energy throughout the day can help reduce post-Covid fatigue as patients recover, Ridgway said. “It’s a little bit of a different approach to treatment than a lot of other physical therapies, but we want to make sure we’re really doing everything we can to empower these patients.”

Doctors and therapists agree that people with persistent COVID need to return to exercising at a very slow pace, often starting with relearning basic aerobic conditioning and doing recumbent strength exercises before progressing to more intense upright movements. vertical. This may consist of trying to activate your core or core supine or lateral, perform balance exercises, or do seated cardio on a recumbent bike or rowing machine. Your doctor will likely monitor your heart rate, blood pressure, and oxygen levels while you do these exercises and make sure you don’t have skipping heartbeats or any other cardiovascular symptoms, Titano explains.

Over time, you may get comfortable trying an elliptical or walking on a treadmill. Your doctor or physical therapist may also ask you to count your steps or try to climb the stairs in your house a certain number of times a day. One of the goals Fagan’s cardiologist set was to walk 5,000 steps a day, a goal the specialist suggested in October 2021. “We’re now in March and finished to reach it,” he said.

Progress in controlling the symptoms of persistent covid can be excruciatingly slow, so it’s often encouraging to see improvement over time. People can track their data using a heart rate monitor on a smart watch, blood pressure monitor, or pulse oximeter if they have one at home. Health care providers may advise you to have a family member or friend help you use some of these devices, and to make sure you’re okay while doing any exercise. “It’s nice to be able to track progress,” says Fagan. “It helps me personally because progress is incredibly slow. You just don’t see it day to day. You don’t even see month to month. It is a rather annual progress”.

If you’re experiencing really debilitating symptoms that keep you from doing everyday tasks—like doing laundry, going to work, or taking care of your kids, for example—you may need the extra help of prescription medications and closer professional supervision of health, Hayek said. Depending on the individual’s risk of heart disease and current symptoms, some blood pressure medications, such as beta-blockers or calcium antagonists (also known as calcium channel blockers), can help relieve extreme dizziness and treat chest pain and abnormal heart rhythms, he said. And these medications can be tapered once cardiovascular symptoms subside.

However, adolescents and young children with persistent covid are not fit to take many cardiac drugs. When caring for young patients, Sindhu Mohandas, an infectious disease expert at Children’s Hospital Los Angeles, said she often recommends more lifestyle changes that, in addition to physical therapy, can help patients focus in school and recover. your sports endurance.

Lifestyle changes, such as managing daily energy stores or gradually increasing exercise capacity, may seem trivial, but they can have a big effect on reducing the long-term risk of stroke. heart attack or stroke, said Salim Virani, a cardiologist at Baylor College of Medicine in Houston. And health care providers are constantly learning more ways to help persistent Covid patients improve their health, he said.

As for Fagan, she is hopeful that working with her physical therapists and doctors will help her continue to regain her fitness and eventually return to normal life. Just last month, she was able to go to a restaurant with friends and then walk to a play at her daughter’s high school, which “was a big deal.”

“Sometimes there is no choice but to slow down,” he said. “And that’s fine.”

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