Long Covid and your Heart Health

Long Covid can affect the heart in a variety of ways. The most common symptom is heart palpitations, which are usually described as a quickening of the heartbeat which is typically made worse with standing, and improved with sitting and lying. Other symptoms that patients appear to experience, include difficulty in breathing, light-headedness and dizziness, fatigue, nausea, and inability to concentrate or focus (brain fog).

Many of the symptoms experienced in Long Covid are also seen in patients with autonomic dysfunction. Through mechanisms that are still unknown, Covid infection appears to influence the body’s autonomic nervous response in a negative way. One way to think of the autonomic nervous system, is that this is the bit of the brain that controls all the automatic functions, which includes setting the appropriate level for blood pressure, heart rate, peristalsis (or gut movement), sweating, or temperature regulation. Essentially these are all the subconscious activities that take place and are typically very finely automatically regulated in day-to-day life, such that we simply do not have to think about these bodily functions in day-to-day existence.

However, after an infection with Covid, the autonomic nervous system may achieve a different set point. For example, it may cause patients who were previously fit and well within normal blood pressure, to have a slightly low blood pressure, which may be just above the normal range, but which becomes abnormal for that particular patient. Long Covid appears to affect a higher proportion of patients who have previously been extremely fit and well, and even highly athletic (participating in long-distance endurance events) with a healthy cardiovascular profile, relative to other diseases. One potential explanation for this, is with a period of physical deconditioning during the acute Covid illness, the volume of blood reduces and hence the autonomic nervous system set points which control the blood pressure and heart rate become slightly dysregulated. Other theories include the lack of effective vasoconstriction (where vessels, particularly in the lower limbs, are made to squeeze in response to adrenaline, to return blood to the heart), and this lack of adequate blood volume return to the heart triggers the adrenaline reaction that remains high in various states, accounting for some of the symptoms of autonomic dysfunction in Long Covid.

My top tips for Long Covid recovery are as follows:

1. Gain an understanding by educating yourself on Long Covid, consider watching previous webinars, for example with previous Long Covid patients.
2. Buy yourself a home blood pressure monitor with an upper arm cuff (for example the Omron M2 can be purchased for under £50 online). Know your blood pressure and heart rate values and test these both whilst seated and after standing up taking repeated measurements for at least 7 minutes after standing to see whether your heart rate does rise but more than 30 beats a minute associated with reproduction of your typical symptoms. If your blood pressure is low (<110/80) and you have clear and consistent symptoms associated with a heart rate rise by more than 20 bpm after standing, then consider increasing your fluid intake aiming for 2 1/2 to 3 L a day, as well as increasing salt intake aiming for 1 to 2 teaspoons a day (5-10g), and also consider procuring some grade 2 graded compression stockings which should go all the way to your waist. These simple initial conservative strategies can already make a big impact on improving the symptom profile from a low blood pressure state.
3. Learn to breathe. In a relaxed and slow manner. The ideal breath is 1 that expands your chest by using the diaphragm muscle and typically results in the in breath, leading to your abdomen pushing outwards. This is also known as a belly breath or diaphragmatic breath. Importantly slow your breathing down consciously and aim to take a breath in and 5 seconds and breath out in 5 seconds making a total of 6 breaths a minute. Do this in a mindful way focusing on the breath coming in and out rather than any other symptoms that appear to manifest during this exercise. In time, slowing of the breath, practised regularly for at least 10 minutes 2-3 times each day will bring about improvements in the autonomic nervous system, down regulating the adrenaline (or fight or flight response), and up regulating the vagus (the rest and recover response).
4. Be kind to yourself. Reset your expectations. Engage with friends and family, and wider communities who are supportive, nurturing and calming. There are many such Long Covid recovery groups (e.g. Suzy Bolt’s gentle yoga for Long Covid Recovery), which provide regular touch points on a daily or weekly basis via zoom, which allow regularly engagement with a community of like-minded people who have Long Covid, just like you. Know that this too, shall pass.

1. Interview with Consultant Cardiologist Dr Boon Lim and Consultant Geriatrician Dr Melanie Dani.
2. Suzy Bolt, COVID-19 
3. Interview 2: Consultants Dr Boon Lim and Dr Melanie Dani share their thoughts 
4. COVID-19