Yes, COVID-19 can cause heart problems, and the risk is significant. A CDC analysis found that SARS-CoV-2 infection increases the risk of myocarditis, or inflammation of the heart muscle, by roughly 16-fold compared to baseline rates. Heart complications range from mild rhythm disturbances to serious conditions like heart failure, and they can develop during the acute illness or emerge weeks to months later.
How COVID-19 Damages the Heart
The virus enters human cells by latching onto a protein called ACE2, which sits on the surface of cells throughout the body. While the lungs have the highest concentration of this protein, heart and blood vessel cells carry it too. In severe cases, the virus directly infects these cardiac cells. Postmortem studies have found high levels of viral material in the hearts of roughly 40% of patients examined.
Once inside, the virus causes damage in two main ways. First, it can directly injure heart muscle cells and the lining of blood vessels, triggering inflammation and cell death. Researchers have found viral particles inside blood vessel walls alongside clusters of immune cells, a pattern called endotheliitis. Second, ACE2 normally plays a protective role in heart function, helping regulate blood pressure and reduce inflammation. When the virus hijacks and depletes ACE2, that protective function is disrupted, leaving the heart more vulnerable to injury from both the virus and the body’s own immune response.
Types of Heart Problems Linked to COVID
The cardiovascular complications of COVID-19 fall into several categories, each with different levels of severity and frequency.
Heart Inflammation
Myocarditis is perhaps the most discussed cardiac complication. Before the pandemic, myocarditis occurred in roughly 9 out of every 100,000 people. COVID-19 pushed that rate to about 150 per 100,000, with an estimated 11 excess cases per 100,000 infected individuals. The risk is highest in males, adults over 50, and children under 16. Among boys aged 12 to 17, the rate climbed to approximately 450 cases per million infections.
Irregular Heart Rhythms
Atrial fibrillation, a condition where the heart beats in a fast, disorganized pattern, is the most common rhythm disturbance in COVID-19 patients. New-onset atrial fibrillation develops in about 4% of hospitalized patients who had no prior history of rhythm problems, and the overall risk of new atrial fibrillation during infection ranges from 10 to 18%. In some cases, the irregular heartbeat appears before respiratory symptoms do.
Blood Clots and Stroke
COVID-19 promotes clot formation throughout the body, including in the arteries that supply the heart and brain. Hospitalized patients show significantly elevated risks of both thrombosis (clots in blood vessels) and cerebrovascular events like stroke compared to people who never had COVID.
Ischemic Heart Disease and Heart Failure
Even people with mild infections who were never hospitalized carry a modestly increased risk of ischemic heart disease (reduced blood flow to the heart) compared to people who were never infected. A large study of an urban population in the Bronx found that non-hospitalized COVID patients had about a 10% higher risk of developing ischemic heart disease and arrhythmias, and more than double the risk of inflammatory heart disease, compared to controls who never tested positive. For hospitalized patients, the risks across all cardiovascular categories were substantially higher.
Who Faces the Greatest Risk
People with pre-existing heart conditions are more likely to develop severe cardiovascular complications from COVID-19. The CDC specifically identifies heart failure, coronary artery disease, cardiomyopathy, and possibly high blood pressure as conditions that increase the risk of getting very sick. But heart damage is not limited to people with prior cardiac history. Previously healthy individuals, including young athletes, have developed myocarditis and other complications after infection.
Severity of the initial illness matters too. Hospitalized patients face dramatically higher cardiovascular risks across the board compared to those who recover at home. That said, even mild, non-hospitalized cases show measurable increases in certain heart conditions, particularly inflammatory heart disease and ischemic heart disease.
Infection vs. Vaccination Risk
Concerns about heart inflammation from mRNA vaccines prompted direct comparisons between the two risks. A systematic review and meta-analysis found that the risk of myocarditis is more than seven times higher after a COVID-19 infection than after vaccination. The infection increased myocarditis risk by a factor of 15, while vaccination increased it by a factor of 2. Both carry some degree of risk, but the infection itself poses a far greater threat to the heart.
Heart Problems in Children
Children face a unique complication called Multisystem Inflammatory Syndrome in Children, or MIS-C, which typically develops two to six weeks after infection. It presents with fever, abdominal pain, vomiting, diarrhea, skin rash, and red eyes. The heart is frequently involved: many affected children show elevated markers of heart damage, and some develop weakened heart function or dilated coronary arteries. In severe cases, children present with dangerously low blood pressure and shock. Neurological symptoms like headache or confusion can also occur, though they are usually temporary.
Symptoms That Signal Heart Involvement
During or after a COVID-19 infection, several symptoms may point to cardiac complications. These include chest pain or tightness, a racing or pounding heartbeat (palpitations), shortness of breath that seems disproportionate to your activity level, and unusual fatigue. Some people notice these symptoms during the acute infection, while others develop them weeks later as part of long COVID.
Doctors typically assess heart involvement by measuring proteins released when heart muscle cells are damaged. Levels above a specific threshold, the 99th percentile of normal values (adjusted for sex), indicate myocardial injury. Additional testing may include imaging of the heart and monitoring for rhythm disturbances. If you experience persistent chest pain, palpitations, or unexplained shortness of breath after a COVID infection, these warrant a medical evaluation rather than a wait-and-see approach.