A four-time Ironman competitor from Scottsdale is also a COVID-19 long-hauler — someone who experiences COVID-19 symptoms long after the acute phase of the illness.
The most serious lasting symptom for Derek, a 48-year-old Scottsdale investment advisor, is myopericarditis. His cardiologists suspect that this inflammation in and around the heart muscle was caused by COVID-19 and is affecting his heart rhythms.
Derek discovered he had COVID-19 before experiencing any symptoms. In March of 2020, his primary care physician, L. Markham McHenry, MD, began offering COVID-19 tests to patients who had recently had a respiratory infection. Derek took the test and learned he had COVID-19 on April 2, 2020.
Asymptomatic at first, he soon became short of breath and then experienced extreme fatigue. He never lost his sense of smell or taste, common COVID-19 symptoms, and he was never hospitalized. He doesn’t know how he caught it, but he’s grateful that his wife and 10-year-old son never got it.
“I soon had to talk myself into getting out of bed; I was that tired,” Derek said. “Anything I did took a ton of effort. Just talking on the phone was an effort — I had a hard time putting things together due to brain fog.”
His other COVID-19 symptoms included:
- The COVID cough. Thankfully, his pulmonologist has ruled out lung damage.
- Insomnia
- Memory issues that only he noticed
- Diminished distance vision
- Inability to tolerate exercise. “If I did too much, even walking, it kind of crushed me two days later,” he said.
He still has these symptoms today, plus the most serious — heart rhythm irregularities.
Rapid pulse
By the end of May, Derek started feeling better and had resumed light weightlifting at the gym. But on June 4, he suddenly asked his wife why his pulse was so rapid. His doctor did an EKG, found an irregular heartbeat and referred him to Maulik Shah, MD, a cardiologist.
“Derek demonstrated atrial fibrillation and atrial flutter, paroxysmal — an erratic heart rate that begins suddenly and then stops on its own within seven days,” said Dr. Shah. “I suspected the symptoms were related to COVID-19. At the time, doctors didn’t realize that COVID-19 can affect the heart chronically even in healthy people and certainly not in athletes.”
Atrial flutter and atrial fibrillation are fast electrical rhythms in the atria, the upper chambers of the heart, and are associated with heart failure and stroke. The difference is that atrial flutter is an organized arrhythmia that’s difficult to control medically. Atrial fibrillation, commonly referred to as Afib, is a chaotic heart rhythm that requires a more extensive ablation procedure to burn away malfunctioning tissue in the heart.
Dr. Shah prescribed blood thinners to help prevent the risk of stroke linked to Afib. In addition, Derek wore a Holter monitor for several days to detect heart rhythm abnormalities.
Meanwhile, Derek kept careful track of when his pulse started racing or felt odd, and saw Dr. Shah regularly.
Turning to ablation
“I was wary of starting anti-arrhythmia medications because of their possible side effects,” Derek said. Dr. Shah introduced the idea of ablation, which would burn away small areas of heart tissue affected by the atrial flutter.
In July, Dr. Shah referred Derek in July to Rahul Doshi, MD, an electrophysiologist, a cardiologist specializing in heart rhythm irregularities.
“Derek was a young person who didn’t want to have symptoms and struggle with his arrhythmia forever,” Dr. Shah noted. “We wanted to be able to provide him solutions. He needed a world-class expert because his case was complicated, and we’re still learning about the impact of COVID on the heart. Dr. Doshi is that expert.”
Dr. Doshi ordered a cardiac MRI in July and another in November. The tests revealed myopericarditis — inflammation in the heart muscle and around the heart.
Although he found it shocking, Derek was relieved to have a concrete diagnosis that explained why he was having so much trouble walking upstairs or just out to the mailbox.
“Dr. Shah and I hoped that Derek’s symptoms would resolve spontaneously as the inflammation improved,” said Dr. Doshi. However, the atrial flutter was difficult to control, so at the end of October, Derek agreed to the ablation procedure. It’s done by using catheters in the heart via a vein in the right groin.
"The catheters record the heart’s electrical signals and use high-frequency radio waves to burn away tiny areas responsible for the arrhythmia," said Dr. Doshi. "The procedure was successful."
Doctors Shah and Doshi hope the Afib resolves spontaneously as the inflammation fades. “However, the longer it continues, the more likely Derek will need an Afib ablation as well,” Dr. Doshi said.
The cardiologists agree that it’s very challenging to treat heart issues caused by COVID-19 as we continue learning about the disease. “But we’re able to apply what we have known for years about these arrhythmias and heart disease in general. And we have access to the most advanced types of treatment at HonorHealth.”