Yeshiva University Journal of Medicine and Dentistry

Abstract

 

Symptoms and infection of  COVID-19 virus have been observed to vary among carrier patients. While a majority of cases possess short term symptoms such as loss of taste, congestion, fatigue, etc, COVID-19 can cause long lasting symptoms beyond the infectious period. This is clinically known as post-COVID-syndrome (PCS). PCS can lead to cardiovascular complications, especially in individuals with pre-existing heart issues. Exercise is a well known combatant of cardiovascular disease and can be used to minimize the degree of the symptoms. Exercise also has the ability to prevent COVID-19 symptoms as a whole by strengthening the cardiovascular and immune system. 

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Introduction

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In December of 2019, the COVID-19 pandemic, also known as SARS CoV-2, took the world by storm and began infecting millions of people. COVID-19 is a highly transmissible disease that infects the respiratory system with the ability to affect other major systems of the body.1 Those who have been infected severely enough suffer long lasting symptoms, a phenomenon called post-COVID-syndrome. Depending on the severity of infection and the individual, long lasting effects vary from loss of taste and smell to chronic fatigue and headaches. There has also been a reported impact on the cardiovascular system of those who suffer from post-COVID-syndrome, including chest tightness, palpitations, syncope, dysautonomia, hypotension and other heart related illnesses.2 While treatment for select issues is available, research shows that those involved in daily physical exercise reduce their likelihood of developing cardiovascular issues when infected with COVID-19, as well as reduce the severity of their symptoms if they do occur.2

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post-COVID-syndrome

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According to the United Kingdom National Health Service, post-COVID-syndrome (PCS) is defined as “unexplained, persisting signs or symptoms over 12 weeks, developed during or after the COVID-19 infection.”2 The symptoms for post-COVID-syndrome are numerous and wide-ranging. Studies have shown that people with PCS continue to suffer from a multitude of ailments including severe body ashes, migraines, and chronic fatigue even months after being infected.3 An online survey reported more than 200 lasting symptoms among people who have experienced PCS.2

 

Post-COVID syndrome is a relatively common occurrence. A study that began in April 2020 by the UK’s Office for National Statistics showed that 13.7% of people who tested positive for COVID-19 between April 26, 2020 and March 6, 2021 continued to show symptoms after 12 weeks.2 This signifies that although most people overcome the effects of COVID-19, a significant number of people do not. The numbers are staggering when considering those who were hospitalized with COVID. A revealing study indicated that up to 87% of people who were once hospitalized with COVID-19 show long lasting symptoms.4

When a metal implant is placed within a bone, it must first be stabilized by the bone itself and proceed with osseointegration5, which is when the bone tissue fuses onto the metal implant anchoring it into the original bone, another term for this phenomenon is “biological fixation.”6 However, when the bone is osteoporotic, there is a  25%  bone mass decrease and its regeneration7 and osseointegration abilities plummet.8 This results in a major increase in marrow space which makes the bone fragile and it is no longer strong enough to support a metal implant.7 Unfortunately, fracture reconstructive habilitation has become a great challenge for surgeons.9

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Unfortunately, there are many questions yet to be answered regarding this condition regarding the causes and possible treatments. Medical professionals are still trying to determine  its cause and why matters such as severity of infection do not directly correlate to the severity of the syndrome. For example, non-hospitalized COVID victims have reported lasting effects. In a study published in September 2021 on non-hospitalized COVID-19 victims, 30% reported fatigue and 37% reported cognitive impairment after infection.4 Post-COVID-syndrome has also been shown to be a severe risk on those with cardiovascular issues and has the ability to cause the development of heart conditions as well.

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post-COVID-syndrome

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In order to fight infection, the immune system must act quickly in order to minimize both direct and indirect damage to the heart. The beginning stage of myocarditis begins with viral replication and direct damage to the muscular tissue of the heart. When this occurs, the virus is recognized by host factors called pattern recognition receptors (PRRs). These factors stimulate the production of antiviral proteins that initiate the immune response and heart tissue repair. Firstly, the innate immune system attacks with neutrophils, natural killer cells and macrophages. This is followed later on by the response of the adaptive immune system. The second stage of myocarditis consists of immune-mediated damage. This happens as a result of “cardio modulatory cytokines by immune cells, from the release of cytotoxic molecules that damage healthy cells, or from the presence of cardiac autoantibodies.”5 Depending on the severity of infection as well as the individual, the disease may be resolved or continue into a more severe, chronic phase.

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COVID-19 and Myocardial Infarction

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COVID-19 has the ability to disrupt functions of the body. Among the functions interrupted, the cardiovascular system stands out because of COVID-19’s harmful effects. Firstly, it is important to understand how COVID-19 accesses the cells. The ACE2 protein is a cardioprotective transmembrane protein which is found in great amounts in the myocardial tissue. The COVID-19 virus attaches to the ACE2 receptor to gain access to the cell, and downregulates its expression.6 A study performed on mice infected with the human strain of SARS-CoV was conducted to examine ACE2 protein expression in the hearts of those infected. The study found that the presence of SARS-CoV in the heart was associated with the reduction of ACE2 protein expression.7

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Due to COVID-19’s ability to attack the heart, many people continue to suffer from COVID-related heart issues. This has the ability to complicate pre-existing diseases and oftentimes can worsen them. Patients with Congestive Heart Failure (CHF) are particularly vulnerable to complications. CHF occurs when the heart cannot properly pump blood to the body due to weaknesses in the heart muscle.8 In some cases, there is an excess pooling of blood in certain parts of the body such as the legs, belly or even the lungs.9 As of 2017, approximately 5.7 million people in the United States were reported to have CHF with estimates of the US reaching 8 million by 2030.8 There is no singular cause for CHF, but those who smoke and drink regularly, or do not maintain a healthy diet and weight are more likely to develop CHF.9

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With regard to COVID-19 and CHF, mortality rates and hospitalization time for people with both were observed to be higher than those without CHF. During a study conducted in 2021 at Mount Sinai Hospital systems in New York, a total of 6,439 patients were admitted to the hospital due to COVID-19, 422 of them with a history of CHF. Compared to the COVID-19 patients without a history of CHF, those with a history had higher systolic blood pressure and lower oxygen saturation. They also were at a greater risk for mechanical ventilation and on average spent two more days in the hospital than those without a history of CHF.10 This indicates that COVID-19 has the ability to complicate pre-existing heart conditions and put some people at a greater risk of developing lasting effects.

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COVID-19 has the ability to attack the heart, causing or contributing to heart related problems. But the effects of COVID-19 are not just related to CHF. There is also a direct relationship between people with cardiac diseases and mortality and morbidity (2). In order to avoid these issues, it is very important for people to put themselves out of risk of heart related diseases. While screening for diseases is a start, it may come too late in certain cases. A well studied aid to preventing heart disease, however, is exercise. Unlike screening, exercise can never come too late and has immediate benefits. Exercise can protect against cardiovascular disease as well as the effects of COVID-19.

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Exercise Improves Cardiovascular Health

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One of the most universally accepted ideas is that exercise has tremendous health benefits and can improve many aspects of physical health, including the cardiovascular system (Figure 1). Numerous studies have shown that daily physical exercise contributes to a healthier heart.2 However, even with the evidence from these studies, many people are unable to start doing such exercise. According to the Center for Disease Control and Prevention (CDC), less than 25% of the adult population in the United States perform daily exercise.2 This means that people are putting themselves at a higher risk of cardiovascular issues because they are not strengthening their heart, regardless of whether or not they contract COVID-19. If they do contract the disease, there is an even higher risk of developing issues because they might have a weaker cardiovascular system due to their physical inactivity .