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Breathlessness, Long COVID and the Heart



For anyone, like myself, who is still breathless on exertion more than one year after your acute Covid-19 infection - please at some point read this press release from the European Society of Cardiology "Breathlessness in patients with long COVID may signal heart problems" 9 Dec 2021.


I am still breathless on exertion - lifting a box, carrying shopping, walking, when trying to have a conversation. I have had numerous ECG's and ECHO's of my heart and so far my only diagnosis is dysfunctional breathing. I have had several sessions of private physiotherapy for this and at rest by breathing is correct - abdominal, through the nose, quiet and slow. The minute I try any to do any type of exertion I feel like someone who has smoked 20 a day. BUT my lungs feel healthy???

Personally I have felt for a very long time that "something else is going on". Postural Orthostatic Tachycardia Syndrome has frequently been described as a disability akin to Chronic Obstructive Pulmonary Disease or Heart Failure and I am now beginning to wonder if the latter is actually true?


A small study has suggested that COVID-19 patients who continue to be short of breath during physical activity one year after recovering from the infection may have suffered heart damage.

The research is presented today at EuroEcho 2021, a scientific congress of the European Society of Cardiology (ESC).

“The findings could help to explain why some patients with long COVID still experience breathlessness one year later and indicate that it might be linked to a decrease in heart performance,” said study author Dr. Maria-Luiza Luchian of University Hospital Brussels, Belgium.

There is increasing evidence of cardiovascular complications due to COVID-19 and of long-lasting symptoms such as dyspnoea (shortness of breath), known as long COVID. This study investigated whether subclinical heart abnormalities were more common in long COVID patients with dyspnoea – thereby potentially explaining the reason for their symptoms.

The study included 66 patients without previous heart or lung disease who were hospitalised with COVID-19 between March and April 2020 at University Hospital Brussels. At one-year after hospital discharge, spirometry (lung function tests) together with chest computed tomography (CT scan) were used to assess lung function and possible sequela of COVID-19.


Cardiac ultrasound was performed to examine heart function and included a new imaging technique called myocardial work which provides more precise information on heart function than previous methods.

The average age of participants was 50 years and 67% were men. At one year, 23 patients (35%) had shortness of breath during effort.

The researchers examined the association between imaging measures of heart function and shortness of breath at one year after adjusting for age and gender.


The analysis showed that abnormal heart function was independently and significantly associated with persistent dyspnoea. Cardiac imaging revealed poorer heart performance in patients with versus without dyspnoea at one year after hospitalisation due to COVID-19.

Dr. Luchian said: “Our study shows that more than a third of COVID-19 patients with no history of heart or lung disease had persistent dyspnoea on effort a year after discharge from hospital. When looking in detail at heart function by cardiac ultrasound, we observed subtle abnormalities that might explain the continued breathlessness.”


Myocardial work could be a new echocardiographic tool for early identification of heart function abnormalities in patients with long COVID-19, who might need more frequent and long-term cardiac surveillance.

This is a small study so larger studies will be needed including different COVID-19 variants and the impact of vaccination. These are needed to confirm our results on the long-term evolution and possible cardiac consequences of this disease.


I wanted to find out what this "myocardial work" on an ECHO was. Unfortunately Dr Luchian has not published her paper yet she has only presented it at the EuroEcho conference titled:

Persistent dyspnea 1 year after COVID - 19 infection in apparently healthy subjects: a potential indicator of subclinical cardiac dysfunction

I have however found out a little:

Myocardial work (MW) is a novel technique used in the advanced assessment of left ventricular function. In the past few years, this invasive measure has evolved to become a more attainable noninvasive technique. MW has benefits over left ventricular ejection fraction (LVEF) and global longitudinal strain by speckle-tracking echocardiography (GLS) as it includes the afterload-dependent limitation and dynamic myocardial contraction in relationship to various loading conditions.

Roughly translated MW is superior to traditional ways of assessing how hard the left ventricle of the heart is working and is able to pick up heart problems before they become more apparent.


Left-sided heart failure symptoms include:

  • Awakening at night with shortness of breath - for the first 12 months

  • Shortness of breath during exercise or when lying flat - double yes

  • Chronic coughing or wheezing - yes

  • Difficulty concentrating - triple yes

  • Fatigue - triple yes

  • Fluid retention causing swelling, or edema, in the ankles, legs and/or feet - yes

  • Lack of appetite and nausea - occasionally yes


Hmmm - I have several of the above already. Again it just goes to show that the severity of Long COVID is being missed because THE BEST INVESTIGATIONS FOR IT ARE NOT BEING DONE. It is institutional gaslighting.

The next time I have a follow up ECHO I shall be asking for my Myocardial Work to be calculated! If I have mild heart failure at least I will have some validation.


References

https://www.escardio.org/The-ESC/Press-Office/Press-releases/breathlessness-in-patients-with-long-covid-may-signal-heart-problems

https://www.sciencedirect.com/science/article/abs/pii/S0894731721004302

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