Heart Palpitations Long COVID: Causes, Symptoms, and Treatment Options

For many COVID-19 survivors, recovery doesn't always mark the end of their health journey. Long COVID—a condition where symptoms persist long after the initial infection—has left countless individuals dealing with troubling cardiovascular symptoms, particularly heart palpitations. These uncomfortable sensations of racing, fluttering, or pounding heartbeats have emerged as one of the most commonly reported long-term effects.

Many long COVID patients experience heart palpitations, often accompanied by fatigue, shortness of breath, and chest discomfort. While typically not life-threatening, these symptoms can significantly impact quality of life, making simple daily activities challenging. The connection between viral infections and heart rhythm disturbances isn't new to medical science, but the widespread nature of these symptoms following COVID-19 has prompted increased attention from healthcare professionals worldwide.

Health Rising DPC offers personalized care and extended appointment times for patients dealing with complex health issues like long COVID symptoms, providing the comprehensive attention these conditions often require.

What Are Heart Palpitations in Long COVID?

Heart palpitations in Long COVID refer to the sensation of abnormal heart rhythms that persist after the acute phase of COVID-19 infection. These cardiac symptoms often manifest as a heightened awareness of one's heartbeat, with patients describing various uncomfortable sensations. Multiple studies have linked SARS-CoV-2 infection to cardiovascular complications that may continue for months after initial recovery.

Common Symptoms and Sensations

Long COVID heart palpitations typically present as one or more distinct sensations in the chest area. Patients commonly report feeling their heart:

• Racing or tachycardia: Unusually rapid heartbeat, sometimes exceeding 100 beats per minute while at rest

• Fluttering: A sensation similar to butterflies or vibration in the chest

• Pounding: Forceful heartbeats that feel louder or stronger than normal

• Skipping beats: Feeling like the heart has momentarily paused or missed a beat

• Flip-flopping: A feeling that the heart has suddenly changed rhythm or position

These palpitations may occur randomly throughout the day or night and can be triggered by specific activities or stress. Many Long COVID patients notice that their palpitations worsen during mild physical exertion, after consuming caffeine, or during periods of anxiety. The intensity and duration vary considerably between individuals, with some experiencing brief episodes lasting seconds while others endure prolonged periods of irregular heartbeats lasting hours.

The Link Between COVID-19 and Cardiovascular Symptoms

COVID-19 affects multiple organ systems beyond the respiratory tract, with the cardiovascular system being particularly vulnerable to both direct and indirect effects of SARS-CoV-2 infection. Research has established clear connections between COVID-19 and various heart-related complications, including heart palpitations that persist long after recovery from acute infection. These cardiovascular manifestations represent a significant component of Long COVID syndrome and require specific attention from healthcare providers.

Potential Mechanisms Behind Long COVID Palpitations

Several biological mechanisms potentially explain the development of heart palpitations in Long COVID patients. The SARS-CoV-2 virus may directly invade heart tissue through ACE2 receptors, causing inflammation of the heart muscle (myocarditis) or the surrounding membrane (pericarditis). Systemic inflammation triggered by COVID-19 can disrupt the autonomic nervous system, which controls heart rate and rhythm, leading to dysautonomia and irregular heartbeats.

The body's immune response to the virus sometimes produces autoantibodies that attack cardiac tissues, creating ongoing inflammation and electrical conduction disturbances. Micro-clotting throughout the vascular system might restrict blood flow to the heart, potentially triggering compensatory responses that manifest as palpitations.

Common triggers for Long COVID palpitations include:

• Physical exertion: Even mild activity can provoke episodes

• Dehydration: Reduced blood volume stresses the cardiovascular system

• Stress and anxiety: Emotional factors amplify autonomic nervous system dysregulation

• Positional changes: Standing up quickly can trigger POTS-like symptoms

• Caffeine and alcohol: These substances exacerbate existing cardiac irregularities

Post-COVID dysautonomia, particularly POTS (Postural Orthostatic Tachycardia Syndrome), represents a significant pathway through which heart palpitations develop in Long COVID patients. The virus's disruption of normal oxygen delivery to tissues may also force the heart to work harder, resulting in compensatory tachycardia and the sensation of palpitations.

How Common Are Heart Palpitations in Long COVID Patients?

Heart palpitations rank among the most frequently reported cardiac symptoms in Long COVID patients, affecting approximately one in three individuals with post-COVID conditions. Research from multiple countries consistently shows that 20-30% of Long COVID sufferers experience persistent heart rhythm disturbances. This prevalence varies somewhat based on study methodology, patient demographics, and the severity of the initial COVID-19 infection.

Several population studies have documented the widespread nature of this symptom:

• Healthcare worker studies reveal higher rates of reported palpitations among medical professionals who contracted COVID-19

• Patient-led research initiatives consistently highlight heart palpitations among the top 10 Long COVID symptoms

• Cardiology clinic referrals show significant increases in patients seeking care for new-onset palpitations following COVID-19 infection

The prevalence of heart palpitations tends to be higher in younger patients and those who experienced mild to moderate initial COVID infections. Women report these symptoms more frequently than men, with some studies indicating nearly twice the prevalence rate. Interestingly, heart palpitations often persist longer than many other Long COVID symptoms, with patients reporting continued episodes 6-12 months after their initial infection.

Diagnosing Heart Palpitations in Long COVID

Accurate diagnosis of heart palpitations in Long COVID patients requires thorough evaluation by healthcare providers. Physicians typically conduct a comprehensive assessment that includes medical history, physical examination, and specialized tests to identify the underlying causes. The diagnostic process aims to distinguish between benign palpitations and those that might indicate more serious cardiac complications.

Tests Your Doctor May Recommend

Healthcare providers use several diagnostic tools to evaluate heart palpitations in Long COVID patients. These tests help determine whether the palpitations stem from cardiac issues directly related to post-COVID syndrome or other causes that may require different treatment approaches.

Common diagnostic tests include:

• Electrocardiogram (ECG) - Records electrical activity of the heart, capturing abnormal rhythms present during the test

• Holter Monitor - A portable ECG device worn for 24-48 hours to detect irregular heartbeats during daily activities

• Event Monitor - Similar to a Holter monitor but worn for longer periods (up to 30 days) and activated when symptoms occur

• Echocardiogram - Uses ultrasound to create images of the heart's structure and function, checking for COVID-related damage

• Blood Tests - Measure markers of inflammation, cardiac enzyme levels, and thyroid function that might contribute to heart palpitations

• Stress Test - Monitors heart function during exercise to determine if physical exertion triggers palpitations in Long COVID patients

• Tilt Table Test - Evaluates how blood pressure and heart rate respond to position changes, particularly helpful in diagnosing POTS

For persistent or concerning heart palpitations in Long COVID, doctors might recommend more specialized cardiac tests. These additional evaluations help distinguish between Long COVID-related palpitations and pre-existing or new cardiac conditions that emerged following COVID-19 infection.

Treatment Options for Long COVID Heart Palpitations

Managing heart palpitations related to Long COVID requires a multifaceted approach tailored to each patient's specific symptoms and underlying causes. Treatment strategies typically combine conventional medical interventions with targeted lifestyle modifications to reduce the frequency and severity of palpitation episodes.

Medical Interventions

Medical treatments for Long COVID heart palpitations address both the symptoms and potential underlying mechanisms. Beta-blockers like metoprolol and propranolol help regulate heart rhythm by blocking adrenaline effects, reducing palpitation frequency in many patients. Anti-arrhythmic medications such as flecainide or amiodarone may be prescribed for more persistent rhythm disturbances. For patients with POTS (Postural Orthostatic Tachycardia Syndrome), medications like fludrocortisone or midodrine help stabilize blood pressure and reduce position-related palpitations.

Low-dose anticoagulants might be recommended for patients with increased clotting risk. Targeted anti-inflammatory treatments help address systemic inflammation contributing to cardiac symptoms. Autonomic rehabilitation programs, supervised by specialized physiotherapists, assist patients with dysautonomia-related palpitations. For severe cases unresponsive to other treatments, electrophysiology procedures like ablation may be considered to address specific arrhythmias.

When to Seek Immediate Medical Attention

Heart palpitations in long COVID patients occasionally indicate serious medical situations requiring immediate attention. Recognizing these warning signs can prevent dangerous complications and ensure timely treatment. Certain symptoms accompanying heart palpitations serve as red flags that should never be ignored.

Seek emergency care immediately if heart palpitations occur with:

• Chest pain or pressure - especially if it radiates to the jaw, neck, or arms

• Severe shortness of breath - struggling to breathe even at rest

• Dizziness or fainting - loss of consciousness or feeling like you might pass out

• Confusion or altered mental status - difficulty thinking clearly or unusual behavior

• Extreme weakness - sudden inability to perform normal activities

• Profuse sweating - unexplained cold sweats with palpitations

Long COVID patients should also contact emergency services if palpitations persist continuously for more than 30 minutes or recur frequently within a short timeframe. Those with pre-existing heart conditions need extra vigilance, as heart palpitations might signal worsening of their underlying condition. Immediate medical attention is crucial when palpitations are accompanied by a significantly high or low heart rate that doesn't normalize quickly.

Long-Term Outlook and Recovery

Heart palpitations associated with Long COVID typically follow a gradual improvement pattern over time. Most patients experience a reduction in frequency and intensity of palpitations within 6-18 months after initial infection. Recovery timelines vary significantly among individuals, with some achieving complete resolution while others managing residual symptoms longer-term.

Factors Affecting Recovery

Several key factors influence how quickly patients recover from Long COVID heart palpitations:

• Severity of initial infection - Those with milder acute COVID cases often recover faster

• Pre-existing conditions - Cardiovascular issues may prolong recovery

• Age - Younger patients typically see quicker improvement

• Treatment adherence - Consistent following of medical advice accelerates recovery

• Lifestyle modifications - Implementation of recommended changes supports healing

Conclusion

Heart palpitations represent a significant challenge for many Long COVID patients with potential impacts on daily functioning and quality of life. While these symptoms can be distressing they typically aren't life-threatening and tend to improve over time for most individuals.

Effective management involves a combination of medical intervention lifestyle adjustments and careful monitoring. Patients should work closely with healthcare providers to develop personalized treatment strategies that address their specific symptoms and triggers.

As research continues to evolve our understanding of the complex relationship between COVID-19 and cardiovascular health improves. For those currently experiencing heart palpitations after COVID-19 infection knowing when to seek help and implementing appropriate self-management techniques can significantly improve outcomes and facilitate recovery.

Frequently Asked Questions

What is Long COVID and how common are heart palpitations in patients?

Long COVID refers to persistent symptoms that continue weeks or months after initial COVID-19 infection. Heart palpitations are among the most common cardiac symptoms, affecting approximately 20-30% of Long COVID patients. These palpitations often occur alongside fatigue, shortness of breath, and chest discomfort, significantly impacting quality of life. Women report these symptoms nearly twice as often as men.

What do heart palpitations in Long COVID feel like?

Heart palpitations in Long COVID can manifest as racing, fluttering, pounding, skipping beats, or flip-flopping sensations in the chest. Episodes may occur randomly or be triggered by activities, stress, or mild physical exertion. The intensity and duration vary between individuals, with some experiencing brief episodes while others endure prolonged irregular heartbeats.

What causes heart palpitations in Long COVID patients?

Several biological mechanisms may explain heart palpitations in Long COVID, including direct viral invasion of heart tissue, systemic inflammation, and autoantibodies attacking cardiac tissues. Post-COVID dysautonomia, particularly Postural Orthostatic Tachycardia Syndrome (POTS), is a significant pathway. Common triggers include physical exertion, dehydration, stress, positional changes, and consumption of caffeine and alcohol.

How are heart palpitations in Long COVID diagnosed?

Diagnosis involves a comprehensive evaluation by healthcare providers, including medical history, physical examination, and specialized tests. Diagnostic tools include electrocardiograms (ECG), Holter monitors, event monitors, echocardiograms, blood tests, stress tests, and tilt table tests. These help distinguish between benign palpitations and more serious cardiac complications requiring specific treatment.

What treatments are available for heart palpitations in Long COVID?

Treatment requires a multifaceted approach tailored to individual symptoms and causes. Medical interventions may include beta-blockers, anti-arrhythmic medications, and treatments for POTS. Lifestyle modifications like proper hydration, dietary changes, stress management techniques, and improved sleep hygiene are crucial. Compression garments and positional strategies can also help manage symptoms effectively.

When should I seek emergency care for heart palpitations?

Seek immediate medical attention if palpitations are accompanied by chest pain, severe shortness of breath, dizziness, fainting, confusion, extreme weakness, profuse sweating, or if they persist for more than 30 minutes. Patients with pre-existing heart conditions should be particularly vigilant, as palpitations may indicate a worsening of their underlying condition.

What is the long-term outlook for heart palpitations in Long COVID?

Most patients experience gradual improvement within 6-18 months after their initial infection. Recovery timelines vary based on infection severity, pre-existing conditions, age, treatment adherence, and lifestyle modifications. Ongoing research is developing new treatment protocols. Patient support groups and symptom tracking provide valuable emotional support and help with healthcare provider communication during recovery.

Is there a difference in how heart palpitations affect men versus women with Long COVID?

Yes, studies show women report heart palpitations nearly twice as often as men with Long COVID. While the exact reasons aren't fully understood, researchers believe hormonal differences, immune response variations, and potentially different viral impacts on cardiovascular systems may contribute to this gender disparity. Healthcare providers are increasingly recognizing these differences when developing treatment plans.