Many who are on the mend from COVID-19 may have noticed a confusing symptom plaguing them for weeks: a sudden, unexplained spiking of their heart rate.
For some people, it’s a brief, uncomfortable reminder of the acute phase of illness while they work back towards their usual level of fitness.
But heart palpitations and confusing spikes in heart rate are also one of the most common symptoms plaguing those with long COVID, a little-understood condition that can linger for months or even years after a person first contracted the virus.
While this cardiac symptom doesn’t appear to stem from long-term damage to the heart, experts say, spiking heart rates can provide anxiety and discomfort for thousands of Canadians, disrupting their lives and activities.
“Think of your body as an automatic car,” Dr. Angela Cheung told CTVNews.ca. “And there’s disturbance there, meaning it’s not responding appropriately or it’s taking longer to respond appropriately. So that’s really what’s happening.”
So how do you tell the difference between a temporary issue and a larger problem that needs medical advice?
HIGH HEART RATE AFTER COVID-19
Patients dealing with cardiac symptoms of long COVID is something that Dr. Ian Paterson sees a lot.
Paterson, a cardiologist and professor at the University of Alberta, works at the Mazankowski Alberta Heart Institute, where he has had many patients referred to him because of their cardiac issues following COVID-19 infections.
“Palpitations or erratic heart beat, yeah, that would rank up there as one of the more common symptoms that I get asked to provide advice about,” he told CTVNews.ca in a phone interview, adding that chest pain is another common symptom he is asked about.
“Some patients have these spikes in their heart rate, often the spikes happen with minimal activity.”
Last summer, Paterson helped the Canadian Cardiovascular Society to create a primer for physicians to help in treating long COVID patients with cardiac symptoms.
For some patients who experience spiking heart rates in the first few weeks after illness, this may not be a precursor of long COVID, but a part of the healing process.
“If a patient was quite ill and was on bedrest for several weeks, then the body rapidly loses muscle mass and you lose a good amount of your fitness,” Paterson said. “And so when you exert yourself, you will have higher heart rates with exertion and even at rest, because you’re just not at the same level of fitness that you were before your illness.”
Vancouver resident Angela Inglis believes this is what happened to her.
The 41-year-old fell ill with COVID-19 around Jan. 21. Her entire family caught the virus through her son’s daycare, and battled the illness for around two weeks at home.
But after the intense stage of sickness passed, another issue arose: an uneasily high heart rate.
“When I started to try to work out again, which was probably too soon, I noticed that I felt like my heart was beating faster than the energy I was exerting,” she told CTVNews.ca. “So I felt like I was getting heart palpitations.”
She even felt like her heart was racing when she tried to fall asleep.
“I wasn’t sure if it was anxiety or if it was something to be more concerned about.”
She was able to get in touch with Paterson to explain her symptoms in mid-February. He reassured her that she was missing some of the accompanying symptoms that might indicate a larger problem, and that her symptoms were common.
“It’s helpful to know that what I had experienced is not necessarily outside of the ordinary for COVID and that, it doesn’t mean there’s something wrong with my heart,” she said.
Now, around a month since she first caught COVID-19, she says her heart rate feels like it is returning to normal.
But for many people, their cardiac symptoms don’t go away in a month.
Instead it becomes part of long COVID, a condition which can impact multiple organ systems and includes a wide range of symptoms.
“In terms of the frequency in long COVID, my understanding of the literature is about 25 to, let’s say, 30 per cent of patients with long COVID syndrome will have chest pain and/or palpitation type symptoms,” Paterson said.
“[And] long COVID appears to happen just as common in people that had mild initial cases of COVID compared to hospitalized patients. So it’s not more common in the people who are hospitalized.”
HIGH HEART RATE AND LONG COVID
Long COVID is considered by some physicians and guidelines to be any symptoms that extend beyond four weeks after a person has caught COVID-19.
But in October, WHO came out with a clinical case definition, stating that symptoms were part of long COVID only if they extended past three months since the first onset of COVID-19.
“The most common [symptoms of long COVID] are fatigue, brain fog, tachycardia or fast heart rate, shortness of breath and sleep disturbances. Those are the top five,” Cheung told CTVNews.ca in a phone interview.
Cheung, a professor at the University for Toronto and senior scientist at the University Health Network, is co-lead on The Canadian COVID-19 Prospective Cohort Study (CANCOV), a Canadian project looking to research outcomes up to two years after contracting COVID-19.
“There are many cardiac things that can happen post COVID,” she said. “What I would call inappropriate sinus tachycardia is something that we do see.”
Inappropriate sinus tachycardia (IST) is when the heart beats very quickly without a clear reason.
She said that most heart rate issues seen in long COVID patients are probably IST, but some appear to be more similar to another condition.
“We don’t understand fully why, but some patients with post COVID syndrome are at risk for developing cardiac dysautonomia, and another condition called POTS, which stands for postal orthostatic tachycardia syndrome,” Paterson said.
“And that’s fancy words for meaning your heart rate shoots up when you stand, when you get up to a standing position or when you exert yourself, you have inappropriate increases in heart rate.”
POTS isn’t just an elevated heart rate — it also involves abnormal blood flow throughout the body. Patients experiencing symptoms of POTS are often diagnosed with IST if they don’t fulfill all the criteria of POTS, Cheung said.
It’s known that COVID-19 affects the cardiovascular system. The virus increases the risk of developing myocarditis, an inflammation of the heart, and studies have suggested that those who have recovered from COVID-19 are at a higher risk for heart attack and stroke.
But scientists aren’t 100 per cent sure yet why these cardiac symptoms arise and persist in long COVID patients.
“COVID affects our autonomic nervous system,” Cheung said. “And so there’s a bit of an imbalance in the autonomic nervous system and there’s decreased parasympathetic activity which may explain this phenomenon.”
A review of the major studies on long COVID and the cardiovascular system which was published this month in the European Heart Journal listed a number of factors that may play into ongoing cardiac issues, including that there could be injury to tiny blood vessels in the heart causing stress, or that there could be a chronic inflammatory response.
“The most prevailing theory is it’s somehow caused by a low level of ongoing inflammation that people have following their illness, that the body, for some reason, in, in these patients, […] the inflammation was activated after their illness,” Paterson explained.
“And it just is persisting much, much longer than it should.”
He said that some blood tests can show evidence that the immune system is still active at a level it shouldn’t be.
“We measure something called CRP or D-dimers,” Paterson said, explaining that high levels of these in the body can be markers for long COVID.
Not every long COVID case has these markers, he cautioned, but “in some cases we do see these markers in terms of the specific cardiac issues.”
THE ROAD TO RECOVERY
The good news for those who might be experiencing jumps in their heart rate after COVID-19 is that it’s not a life-threatening issue or necessarily indicative of underlying heart damage.
“That’s the first thing I tell the patient. I’d say, ‘Yes, what you’re having is uncomfortable. Yes, you’re getting tired more easily, but this is something which should improve over time and is not life threatening,’” Paterson said.
“We’ll often also send these patients for a heart ultrasound and in all the cases that I’ve been involved with, their heart function has been normal.”
Paterson said that with his patients who have POTS, hydration is important, and sometimes they are told to wear compression garments such as stockings in order to help their blood circulation and return blood to their heart.
While treating long COVID is still a field with a lot of “trial and error,” physical therapy is involved in many treatment plans for these cardiac symptoms, he said.
“In many centers in Canada and really throughout the world, there have become specialized exercise programs for patients with long COVID that really have become personalized for these patients, depending on the symptoms that they’re having,” he said.
“What I’ve been doing is I’ve been referring patients to these more specialized physiotherapy groups.”
One type of physical therapy that people with cardiac dysautonomia might do is to slowly move from exercise lying in a recumbent position to a standing position over a period of time to help the body adjust, he said.
“I have had some patients that I follow up with and for the most part, the symptoms seems to improve,” Paterson said. “It can take a while and that’s what I usually warn them is depending on their level of disability, it can take [months].”
He said in a handful of cases the patient said they only started feeling close to normal after six months of dealing with these symptoms.
Both Cheung and Paterson said that when we talk about these cardiac symptoms with long COVID, it’s important not to spread alarm.
“What I would say about cardiac issues in long COVID is these are real issues that these patients have and at the same time, I think these are treatable issues and I wouldn’t view them as life threatening,” Paterson said, reiterating that there hasn’t been a connection found between spiking heart rates in long COVID and underlying heart damage.
“I think with the right help, people can improve from these issues.”
But at the same time, it’s important to educate people and provide support to those who may be struggling with these symptoms and feeling unsure if they’re overreacting or not.
“If your heart was going very quickly, yes, you would feel lightheaded and in a severe case, you could pass out,” Paterson said. “Does it affect people’s day to day living and what they’re able to do? Absolutely.”
Cheung said if a person is experiencing persistent chest pain after COVID-19, they shouldn’t wait until three months have passed to reach out to a medical professional about long COVID.
With milder symptoms such as a high heart rate, a person could try to rest, go slowly when returning to physical activity, and see if the issue is continuing beyond the few weeks it might take to regain physical fitness.
Inglis said it was helpful to her to reach out for advice even though only a few weeks had passed since she contracted COVID-19.
“It was certainly feeding into anxiety,” she said of her heart palpitations, adding that she recommended people ask their doctor about their concerns.
Most people with long COVID will have more than one symptom, Cheung said.
“A lot of people not only have cardiac symptoms, they also have brain fog and they also have fatigue,” she said.
“Some of these things that we’re talking about [with long COVID], we’re not talking about weeks, we’re talking about months to years. So some people have had it for two years and really don’t want that, right. It’s very debilitating. It affects quality of life.”
MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.
There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.
The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.
Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.
Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.
Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.
“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.
Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.
But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.
That includes his own teenage daughter.
“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.
It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.
“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”
___
AP data journalist Kasturi Pananjady contributed to this report.
___
The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
How a sperm and egg fuse together has long been a mystery.
New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.
“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.
The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.
Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.
It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.
Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.
Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.
The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.
The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.
___
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.
The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.
The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.
The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.
“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.
When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.
“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.
“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.
The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.
Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.
The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.
“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.
They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.
“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”
This report by The Canadian Press was first published Oct. 17, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
