Barriers to Long COVID Recovery: Hit or Miss with Electrocardiograms

February 8, 2022 Delainne B.

Electrocardiograms — also called ECGs or EKGs — are often done in a doctor's office, a clinic, or a hospital room. EKG machines are standard equipment in operating rooms and ambulances. Some personal devices, such as smart watches, offer EKG monitoring.

Why an ECG may be done:

An echocardiogram is a painless imaging process using ultrasound. It is noninvasive way to help diagnose many common heart problems in people of all ages.

An electrocardiogram measures electrical activity of the heart to detect cardiac problems. This is also a painless test in which adhesive tabs are placed on the skin and attached to wire leads that record the electrical activity of the heart and generates a visual tracing of your cardiac activity.

Your doctor may use an electrocardiogram to determine or detect:

Abnormal heart rhythm (arrhythmias)
If blocked or narrowed arteries in your heart (coronary artery disease) are causing chest pain or a heart attack
Whether you have had a previous heart attack
How well certain heart disease treatments, such as a pacemaker, are working

You may need an ECG if you have any of the following signs and symptoms:

Chest pain
Dizziness, lightheadedness or confusion
Heart palpitations
Rapid pulse
Shortness of breath
Weakness, fatigue or a decline in ability to exercise

Here is a video that explains normal sinus rhythm, bradycardia, tachycardia:

The American Heart Association doesn't recommend using electrocardiograms to assess adults at low risk who don't have symptoms. But if you have a family history of heart disease, your doctor may suggest an electrocardiogram as a screening test, even if you have no symptoms.

If your symptoms tend to come and go, they may not be captured during a standard ECG recording. In this case your doctor may recommend remote or continuous ECG monitoring. There are several different types.

Holter monitor. A Holter monitor is a small, wearable device that records a continuous ECG, usually for 24 to 48 hours.
Event monitor. This portable device is similar to a Holter monitor, but it records only at certain times for a few minutes at a time. You can wear it longer than a Holter monitor, typically 30 days. You generally push a button when you feel symptoms. Some devices automatically record when an abnormal rhythm is detected.

If your electrocardiogram is normal, you may not need any other tests. If the results show an abnormality with your heart, you may need another ECG or other diagnostic tests, such as an echocardiogram.

Treatment depends on what's causing your signs and symptoms:

Your doctor will review the information recorded by the ECG machine and look for any problems with your heart, including:

Heart rate. Normally, heart rate can be measured by checking your pulse. An ECG may be helpful if your pulse is difficult to feel or too fast or too irregular to count accurately. An ECG can help your doctor identify an unusually fast heart rate (tachycardia) or an unusually slow heart rate (bradycardia).
Heart rhythm. An ECG can show heart rhythm irregularities (arrhythmias). These conditions may occur when any part of the heart's electrical system malfunctions. In other cases, medications, such as beta blockers, cocaine, amphetamines, and over-the-counter cold and allergy drugs, can trigger arrhythmias.
Heart attack. An ECG can show evidence of a previous heart attack or one that's in progress. The patterns on the ECG may indicate which part of your heart has been damaged, as well as the extent of the damage.
Inadequate blood and oxygen supply to the heart. An ECG done while you're having symptoms can help your doctor determine whether chest pain is caused by reduced blood flow to the heart muscle, such as with the chest pain of unstable angina.
Structural abnormalities. An ECG can provide clues about enlargement of the chambers or walls of the heart, heart defects and other heart problems.

If your doctor finds any problems on your ECG, he or she may order additional tests to see if treatment is necessary.

A group member posted this echocardiogram (ECG/EKG) print out asked for information about it. This is a highly complex question and should only be answered by a cardiologist or other experienced healthcare provider, but here is some basic information.

The strip our member shared shows an abnormal rhythm that should be reviewed by a cardiologist or other trained medical provider. It could be considered “normal sinus rhythm” because the pattern is repeated at even intervals, but the size and timing waves are not what you would see in normal heart function.

The group member is appropriately concerned about the strip but did not know what to do about it. It is possible that this strip indicates a blood flow issue which could be caused by constricted blood vessels possibly due to inflammation or blockage that needs to be addressed medically.

With today’s healthcare crisis with overloaded hospitals and doctors’ offices and shortage of experienced providers, the concerns on this strip could be missed or not communicated to the patient. On the insurance end, if the reviewer does not read the entire report submitted by the doctor, they may erroneously deny further testing.

Follow up with your healthcare provider or get a second opinion:

If you are concerned that you have cardiac symptoms and you get an ECG in a hospital or urgent care facility, but they send you home with no treatment, ask for a copy of the strip and follow up with your PCP as soon as possible.

Your primary care provider can review the strip and develop a treatment plan that may include bloodwork, medication or a referral to a cardiologist or other specialist.

Common Long COVID bloodwork tests that are frequently ordered may include but are not limited to: CBC, Liver panel, kidney function, full thyroid panel including reverse T3 and T4, electrolyte levels, Vitamin D, full iron panel, ferritin, and inflammatory markers including CRP, ANA, and rheumatoid factor.

Sample questions for your doctor:

I feel like there is something wrong with my heart, can you please take a minute to explain this strip to me?
I went to the ER yesterday and they did an ECG, but it doesn’t look right to me. Should I see a cardiologist?

Note: Hyperferritinemia, or high ferritin levels, are common in Post COVID syndrome (Long COVID) and may cause cardiac dysrhythmias.

What may be happening on the insurance side:

Insurance reviewers or automated note readers may read the MD comment that would say “Normal sinus rhythm with…” followed by a comment on an issue such as “…premature ventricular contractions.”

We have seen inexperienced reviewers stop reading the doctor’s note after they see the words “normal sinus rhythm” and mistake this for a normal ECG, then deny further testing, even though there is clearly something wrong documented.

If this happens to you, ask questions and advocate for yourself with your doctors’ office and insurance company. Abnormal strips could be harmless or “normal” for you, due to things like abnormal structures like a malformed valve, but they could also indicate a medical issue such as myocarditis, heart attack or embolism.

Things you can do to help yourself

Minimizing physical & psychological stressors is essential in recovery from Long COVID.

Nutrition: Try to eat protein and fresh vitamin rich foods daily and avoid chemicals, preservatives, sugars, fast foods, prepared foods and high histamine foods.
Don’t skip meals. Your body needs protein , vitamin C, and vitamin D to heal from any injury or illness. A low histamine or low carbohydrate (sugar) diet is recommended by doctors treating Long COVID (PASC), and many people report a reduction in symptoms within 1-3 days of the diet change, including decreases in sneezing, itching or hives, irritable bowel syndrome, body pain, along with a reduction in swelling and inflammation.
Hydration: A minimum of eight 8 oz glasses of plain water daily is recommended.
Avoid drinks with chemical additives. You can easily make a fresh electrolyte drink yourself by adding a dash of mineral rich Epsom salt and a piece a fruit like a raspberry for flavor instead of spending money on commercial drinks like Gatorade that contain chemicals and sit in plastic bottles for long periods of time. Remember that caffeine and alcohol have dehydrating effects.
Sleep hygiene: Getting 7-9 hours of sleep so your body can repair itself. You need at least 4 hours of uninterrupted sleep to get into the restorative phase of sleep.
Avoid stimulating activities after dinner like thrilling movies or books, arguments, negative news or frustrating stimuli.
If you wake up frequently or with a startle, you may be experiencing drops in your oxygen level, which signal your brain to release adrenaline to force you to take a breath. This could be a temporary inflammation issue or more enduring sleep apnea. Ask your doctor for a sleep study to evaluate your need for a CPAP or BiPAP, a machine that pushes air into your lungs when it senses an apneic episode (periods of not breathing).
Stress management: Stress affects every component of your life.
The only thing you can control about stress is your reaction to it. Try to avoid or minimize your exposure to stressful situations: Turn off the news, make family visits that end unpleasantly short, wait for the morning to have intense discussions, let go of things that annoy you but don’t really matter in the big scheme of things, avoid intense conversations or entertainment in the evening.
Exercise within tolerance: Pace yourself and do not push your body to extremes in any way.
For some this may mean seated breathing exercises, walking to the mailbox. Rest when your body says to slow down. Gradually build on your activity endurance as your body cues you to progress. This can be hard to gauge, because when you feel good you naturally do more, but if you do too much you may experience symptom flare ups 1-3 days later as the post exertion inflammation builds. Some people describe this as post exertional malaise, others experience severe recovery set backs.
Breathwork: You can literally stop the fight or flight reaction by taking slow deep breaths.
Deep slow breathing shuts down the adrenaline flow, slows your heart rate, lowers your blood pressure and decreases stress related histamine release. When you do this, your blood reroutes back to your brain and nervous system to allow you to think clearly. It also allows your body to use its energy and oxygen to heal your inflamed nerves and organs.

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Keep moving, keep breathing.

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