COVID-19 has had an unprecedented impact on healthcare, and one area of diagnosis and management that has been affected is imaging. Cardiac computed tomography (CT) and magnetic resonance imaging (MRI) are two imaging modalities that have been utilized in diagnosing and managing patients with myocardial injuries after COVID-19.
This article will explain how COVID-19 can affect the heart, the problems it can cause, the possible symptoms to look out for, and cardiovascular magnetic resonance (CMR) and cardiac CTs' role in diagnosing, evaluating, and managing patients with COVID-related heart problems.
Can COVID cause cardiac issues?
Although it is mainly a respiratory disease, COVID can cause cardiac issues. In this section, we’ll look at how COVID causes heart damage, discuss short and long-term cardiac issues caused by COVID, and outline the role of CMR and cardiac CT in the COVID era.
Cardiac problems caused by COVID
Heart damage from COVID can be temporary or long-lasting and can occur due to:
- Oxygen deficiency
- Inflammation of the heart
- Stress cardiomyopathy
Long- and short-term cardiac issues from COVID
Research into MRI and CT coronary angiography in survivors of COVID-19 noted that “there are increasing reports of persistent and prolonged multiorgan effects after acute COVID-19 illness”.
Immediately following COVID, people may find that, unrelated to exercise, their heart rate goes up and down. Heart palpitations, along with chest pain and shortness of breath, are normal complaints following COVID, although some of these symptoms could be related to spending more time inactive when ill.
In the long term, it may be a few years until the full picture of cardiac issues from severe COVID becomes clear. This study concluded that “further research is needed to establish the true extent of cardiac abnormalities in patients who have suffered severe COVID-19 and to determine whether this is likely to impact their long-term clinical outcome.”
The role played by CMR and cardiac CT in the COVID era
Given the presence of cardiac issues following COVID, imaging modalities like cardiac CT and MRI have played a huge role in evaluating myocardial abnormalities in patients with the virus. These modalities can also help to diagnose and assess recovering COVID patients whose cardiac abnormalities were caused by pre-existing cardiovascular disease.
Covid cardiac symptoms
We outlined some of the symptoms and cardiac problems associated with COVID earlier in this article, and now let’s look at them in a little more detail. Among the signs and symptoms of heart problems that may be caused by COVID are:
- Heart palpitations: a rapid heartbeat, with your heart rate varying between fast and slow, is commonly reported after COVID but could be due to several factors, such as inactivity and dehydration, or pre-existing heart issues
- Chest pain: discomfort in the chest is another symptom closely associated with the COVID recovery period, but it could also be a sign of a pre-existing heart issue.
- Dizziness: feeling dizzy or lightheaded has been linked to the acute phase of COVID, severe COVID, and the recovery period. It can also be a symptom of a fast or slow heartbeat and heart disease
- Shortness of breath: breathlessness is a common symptom of COVID, a respiratory infection. It can also be a sign of high-risk heart disease, especially when felt without chest pain
There are various heart problems that COVID has reportedly caused. The cardiac issues associated with COVID include:
- Oxygen deficiency: when less oxygen enters the bloodstream as a result of inflammation and fluid filling up air sacs in the lungs. This puts extra strain on the heart as it pumps blood around the body, while a lack of oxygen can also cause cell death and heart tissue damage
- Inflammation of the heart: also known as myocarditis. COVID can affect the inner surfaces of arteries and veins, causing inflammation and damage, as well as blood clots. This can disrupt blood flow
- Stress cardiomyopathy: a heart muscle disorder that prevents the heart from pumping blood effectively. This occurs due to the body releasing catecholamines (natural chemicals) when attacked by the virus, stunning the heart
- Heart attacks: while a type 1 heart attack (caused by a blockage from a blood clot in an artery) is rare during or following COVID, a type 2 heart attack is more common with the virus. This type of heart attack is typically caused by an oxygen demand problem
COVID-19 and cardiac CT
Cardiac CT has excelled in the COVID era and has benefited cardiac patients with COVID-19.
A study into cardiac CT amidst the COVID-19 pandemic identified advantages of cardiac CT for evaluating patients with:
- Possible myocardial injury versus myocardial infarction
- Acute chest pain
- Stable chest pain
- Possible intracardiac thrombus
- Valvular heart disease
The same study presented a summary of expert consensus statements and societal recommendations related to the use of cardiac CT during the COVID-19 pandemic. Among the recommendations are that cardiac CT can be used in COVID patients with certain symptoms to exclude obstructive CAD, concomitant CAD, and intracardiac thrombus.
COVID-19 and cardiac MRI
Cardiac MRI (CMR) has also proved a success during the COVID era. Using CMR, cardiac abnormalities such as elevated native T1 and T2 values, cardiac dysfunction, and late gadolinium enhancement were found in patients who had recovered from COVID.
Gadolinium- and manganese-enhanced MRI were seen to be particularly effective when utilized in this area, offering features such as myocardial T1 and T2 mapping. Cardiac MRI has been singled out as the most sensitive non-invasive imaging modality for the identification and characterization of myocardial abnormalities.
How does cardiac CT compare with cardiac MRI in the COVID-19 era?
We’ve seen that both cardiac CT and MRI have an important role to play in the COVID-19 era. Rather than either of the modalities being the ‘gold standard’ in this area, we should note that they play different roles. While cardiac CT has been shown to be effective in the evaluation of COVID patients with symptoms such as chest pain, allowing several conditions to be ruled out, cardiac MRI has proven especially useful for the identification and characterization of myocardial abnormalities.