«Irregular heartbeat after Covid: do tests need to be done?»

I am a 36 year old woman and my last electrocardiogram, dating back three months ago, indicated excellent cardiac health. I have never suffered from heart disease. I regularly exercise, I don't smoke or drink and I follow a healthy diet. I am not subjected to psychological stress. I am not taking any medications, apart from cholecalciferol for vitamin D deficiency (prescribed by my general practitioner). Three weeks ago I had Covid (mild form: one day of fever and three of cold-like symptoms). Once the infection disappeared, I started to notice, especially while I was at rest and never while carrying out physical activity, an irregularity in my heartbeat, like a “dip in my heart” or a stronger beat every now and then. The symptom still persists. Should I worry? Carry out investigations?

He replies Fabrizio TundoDepartment of Arrhythmology, Monzino Cardiology Center, Milan (GO TO THE FORUM)

The symptoms you described suggest the appearance of extrasystoles, i.e anticipated and/or excessive heart beats (extrasystole indicates the presence of an “extra systole”, or one more cardiac contraction) which are typically perceived as an alteration of the heartbeat described in a subjective and variable way by affected patients (“heart pounding”, “flickering”). Extrasystole in itself is not indicative of a cardiac pathology and may be a transient alteration of the heartbeat with no clinical relevance. In rarer cases, extrasystole can represent an alarm bell for a cardiac alteration and for this reason, especially if practicing sports, However, it may be useful to carry out some basic checks. However, the fact that she is a young woman with a healthy lifestyle makes the latter situation quite unlikely.

Vaccine and infection

The appearance of transient extrasystole in the weeks following vaccination or Covid infection (even paucisymptomatic, as in his case) is reported by many patients we see daily in the clinic. There is therefore very probably a correlation between the body's immune response and the appearance of extrasystoles, rather than a direct correlation between the viral infection and the extrasystoles, being present, albeit with lower intensity, even after vaccination (which does not involve the inoculation of a virus but only of the viral RNA to produce the spike protein). They have rarely been observed following Covid (and more likely in males). forms of myocarditis
or cardiac involvement due to infection or inflammation, sometimes responsible for extrasystoles.

Recommended exams

It is possible that, moving away from the Covid infection over time, the extrasystoles progressively decrease spontaneously (sometimes within a few months). In the meantime, for greater safety, it could carry out some first level checks, among which an echocardiogram (to evaluate the morphology and function of the heart and valve structures), a 24h Holter ECG (for the quantification and qualitative evaluation of the extrasystoles themselves), of an exercise test on a cycle ergometer (to evaluate the behavior under stress of extrasystoles with a view to resuming physical activity, even if its subjective sensation is already indicative of regression during effort), in addition to routine blood tests and evaluation of thyroid function. Once I have obtained the results of the above checks, I would carry them out an outpatient cardiology visit with ECG for a final evaluation.

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