By Russell R. Barksdale, Jr.
Many of my colleagues have accepted the community’s frustration with vaccinatio updates and exhaustive “long COVID” discussions, until they experience the overwhelming increase in prevalence following spring break and holidays. While not seasonal, overall, the community seems to accept COVID outbreaks as nothing more significant nor impactful as the common flu, until they see direct evidence of alarming cardiovascular events.
A Neurology study showed that COVID patients who suffered strokes were typically younger and had fewer conventional risk factors, suggesting that COVID itself may serve as a potent prothrombotic trigger. Another independent study reflects the risk of stroke was increased by 52%, heart failure by 72%, and arrhythmias by 71% in the 12 months following a COVID infection.
The risk of myocardial infarction was also elevated by approximately 4.5-fold in the first 2 weeks following COVID infection. It should not come as a surprise that there is a well-documented connection between COVID and an increased risk of cardiovascular events, including stroke and heart attacks. This relationship is multifactorial and stems from the way SARS-CoV-2, the virus responsible for COVID, affects the body at both systemic and vascular levels.
1. Inflammatory Response and Endothelial Dysfunction
COVID triggers a significant inflammatory response in the body. In severe cases, this can lead to a cytokine storm, where excessive inflammatory cytokines are released.
This intense inflammation can damage the inner lining of blood vessels (endothelium), making them more prone to dysfunction. Endothelial dysfunction is a known precursor to both clot formation and atherosclerotic plaque instability—two major contributors to heart attacks and strokes.
2. Hypercoagulable State
Patients with COVID often exhibit a hypercoagulable state, meaning their blood has an increased tendency to clot. Elevated D-dimer levels and other coagulation abnormalities have been consistently reported, even in patients with mild or asymptomatic infections.
This pro-thrombotic environment raises the risk of: Ischemic stroke (due to clots obstructing cerebral arteries) Myocardial infarction (heart attack, often due to coronary artery thrombosis)
3. Direct Cardiac Involvement
SARS-CoV-2 can directly infect myocardial cells via ACE2 receptors, leading to myocarditis or stress cardiomyopathy. These conditions can weaken the heart muscle, increase arrhythmia risk, and destabilize existing coronary artery disease, potentially precipitating an acute coronary event.
4. Increased Demand and Hypoxia
In patients with pre-existing cardiovascular disease, COVID exacerbates the strain on the heart due to systemic infection, fever, tachycardia, and reduced oxygen levels (hypoxia). This imbalance between oxygen supply and demand can precipitate myocardial ischemia.
5. Post-Acute Sequelae (Long COVID)
Even after recovery, individuals can experience lingering cardiovascular risks. Emerging evidence suggests increased rates of stroke and heart attacks for months after acute infection, especially among those hospitalized or with moderate-to-severe illness. This may be due to residual inflammation, endothelial injury, or autonomic dysfunction.
This evolving understanding emphasizes the critical need for cardiovascular monitoring in patients recovering from COVID, especially those with hypertension, diabetes, or known heart disease. Tools like telemedicine and home monitoring—including blood pressure, pulse oximetry, and heart rate tracking—are valuable for early detection and prevention.
As a community, we normalized wearing seatbelts, using car seats, quitting smoking, and improving diet and exercise. These are preventive measures we adopted to reduce long-term health risks. We must bring the same proactive mindset to COVID. This includes supporting education, recognizing lingering cardiovascular risks, and maintaining vigilance—not fatigue—in our public health response.
Prevention, early detection, and continuous care post recovery are essential in managing the long-term impact of this virus and its evolving variants.
Russell R. Barksdale, Jr. PhD, MPA/MHA, FACHE
President and CEO, Waveny LifeCare Network
