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Long COVID and the heart

When you have COVID-19 symptoms for weeks or months after the initial infection, the condition is called long COVID. Here we look at long COVID symptoms, its effects on the heart, and tips for management and recovery.

Middle aged Asian woman sitting on a white couch holding her head

What is long COVID?

Long COVID has a wide range of new, recurring or ongoing health-related symptoms that people experience typically at least four weeks after being infected with COVID-19. Anyone who has had COVID can experience long COVID. Long COVID is not one illness. Your healthcare provider will make a diagnosis of long COVID based on a number of factors. They consider your medical history, including if you had COVID-19 confirmed by either a positive test, symptoms or exposure, as well as doing a medical examination.

Long COVID is also known as post-COVID syndrome, post-COVID conditions (PCC), long-haul COVID, post-acute COVID and chronic COVID.

Because long COVID is an area of evolving research, the information and guidance on managing long COVID is developing and changing.

How common is long COVID?

The estimate is around 65 million individuals worldwide have long COVID. However, this is a conservative estimate based on an incidence rate of 10% of infected people and there are more than 651 million documented COVID-19 cases worldwide. Because some COVID-19 cases have not been documented, the real number of cases of COVID and therefore long COVID is most likely higher than 65 million.

Who is at risk of long COVID?

The highest percentage of people diagnosed with long COVID are between the ages of 36 and 50 years. However, anyone can develop long COVID, which is why there is ongoing research into why some people are more likely to develop long COVID than others.

Most long COVID cases are in non-hospitalised patients with a mild acute illness, as this population represents the majority of overall COVID-19 cases. COVID-19 reinfection may also trigger long COVID.

Some factors may increase your risk of getting long COVID, including:

  • people who have experienced more severe COVID-19 illness, especially those who were hospitalised or needed intensive care.
  • people who had underlying health conditions prior to COVID-19.
  • people who did not get a COVID-19 vaccine.
  • people at risk of health inequities

The best way to reduce the risk of getting long COVID is to have your COVID-19 vaccination and stay up to date with boosters. This lowers the chances of catching of COVID-19 in the first place.

Evidence also shows that being vaccinated reduces the risk of developing long COVID after having the COVID-19 virus.

Is there a test for long COVID?

There is no single diagnostic test for long COVID. The diagnosis is made based on ongoing symptoms after having a COVID-19 infection and after excluding any other diagnosis.

Long COVID symptoms

There are a wide range of long COVID symptoms which can affect people differently. Symptoms may change over time, they may change in severity, or you may develop new symptoms. 

These are some of the more commonly reported symptoms of long COVID. 

General symptoms: 

  • fatigue 
  • fever 
  • abdominal pain 
  • joint pain 
  • muscle pain 
  • nausea and vomiting 
  • diarrhoea 
  • weight loss 
  • reduced appetite 
  • sleep issues. 

Cardiovascular symptoms: 

  • chest tightness 
  • chest pain 
  • skipped, extra or irregular heartbeats (palpitations). 
  • Respiratory symptoms: 
  • breathlessness 
  • cough. 

Neurological symptoms: 

  • loss of concentration or memory issues (‘brain fog’, cognitive impairment) 
  • headache 
  • sleep disturbance 
  • pins and needles or numbness 
  • dizziness 
  • delirium in older people 
  • lack of strength in arms or legs (mobility impairment) 
  • visual disturbance. 

Ear, nose, and throat symptoms include: 

  • ringing in the ears (tinnitus) 
  • earache 
  • sore throat 
  • dizziness 
  • loss of taste or smell 
  • blocked nose (nasal congestion). 

Chest pain, breathlessness and long COVID

Chest pain and shortness of breath can be symptoms of long COVID. However, they can also be symptoms of a heart attack. If you have any of the following symptoms, call 111 immediately

  • severe shortness of breath or difficulty breathing 
  • severe chest pain or discomfort 
  • drowsiness. 

If you have severe chest pain, difficulty breathing or drowsiness, call 111 immediately.

What are the effects of long COVID on the heart?

People who have had COVID-19 may be more likely to develop new health conditions such as diabetes, heart conditions, blood clots or neurological conditions, compared with people who have not had COVID-19. 

Research has shown that after the first four weeks following COVID-19 infection, people are at increased risk of heart disease and stroke including heart attacks, heart rhythm problems, heart failure, pericarditis, myocarditis, blood clots to the lungs and POTS (POTS is a condition associated with a rapid increase in heart rate after standing up which can cause dizziness, fainting and palpitations). These can occur even in people not hospitalised during the acute phase of their COVID-19 infection.

What is the treatment for long COVID?

Long COVID is a new condition and researchers and healthcare professionals are still investigating the best ways to treat and manage long COVID. Currently there is no one specific medication or treatment for managing long COVID.

Tips for managing long COVID symptoms and recovery

Managing and recovering from long COVID will be different for each person.  

Once other diagnoses have been excluded, the management of long COVID tends to be largely supportive. This means managing the symptoms that are affecting your health and wellbeing the most.  

Management of long COVID requires a broad approach, based on your symptoms, and often involves a range of healthcare professionals. 

Your healthcare provider can connect you to support services including: 

  • nutrition and diet advice 
  • occupational therapy 
  • physiotherapy 
  • speech and language therapy 
  • clinical exercise physiologists 
  • mental health and wellbeing support. 

It’s important to get enough rest and not rush your recovery. Recovering from a viral infection often takes an extended period of time. Talk with your healthcare provider about accessing resources on fatigue management and pacing activities.

How to keep track of long COVID symptoms

Your symptoms may change over time, and symptom severity can also fluctuate from mild to debilitating. Talk to your healthcare provider if you get any new symptoms or your symptoms get worse. 

A symptom diary is a good way to keep track of your symptoms. There are several apps available for this. Alternatively, keep track of your symptoms on paper or in a notebook, or using this template for tracking long COVID symptoms from the National Institute for Health Innovation in New Zealand. 

It can be useful to take your symptom diary with you when you see your healthcare provider.

How long does long COVID last?

The recovery timeframe for long COVID is different for each person and difficult to predict. As it is a relatively new condition, this is an area of evolving research.

Should I get a COVID-19 vaccination or booster if I have long COVID?

There are no documented guidelines on getting a vaccination while you have long COVID. Currently it is done on a case-by-case basis depending on the symptoms you’re experiencing.  

Please speak with your healthcare provider and they can advise based on your personal medical circumstances.

Clinical rehabilitation guideline for long COVID in New Zealand

The Ministry of Health guideline provides a useful summary of common symptoms, guidance on diagnosis, and current best practise to improve outcomes. The guideline is to assist GPs, hospital clinicians, specialists, and people with long COVID. 

See the Clinical Rehabilitation Guideline for People with Long COVID (Coronavirus Disease) in Aotearoa New Zealand

A list of resources is included to support people with long COVID, including phone lines, videos and websites (see section 3.7). 

Long COVID is an evolving area of research and guidance is likely to change frequently.

Where can I get support?

COVID-19 Healthline on 0800 358 5453 

Facebook group Long Covid Support Aotearoa

Facebook group COVID-19 Long Haulers Support

Twitter @LongCovidNZ

Complex Chronic Illness Support – provides support for people with chronic complex illnesses including long COVID