Why do I have a rapid heartbeat after COVID?

By Tyler Ellington, D.O.

Cardiology, Oklahoma Heart Institute – Owasso

People who have recently been ill with COVID-19 commonly complain of heartbeats that are faster than normal. This can be due to several factors.

One important consideration is timing. Rapid heartbeat a day or two after fever could be caused by dehydration and will be expected to improve with an increase of fluid intake. In the weeks after recovering from COVID infection, some patients notice rapid heart rates at rest. These are most commonly found to be normal rhythms from the heart’s natural pacemaker but are sped up because the brain's influence on the heart has been impaired.

Ordinarily, the brain decreases the heart rate by stimulating the vagus nerve, a pair of nerves running from the brain to the heart. Research is ongoing but the mechanism may be similar to how the virus interferes with smell and taste. For most patients, this is considered a benign condition, bothersome for some individuals, but not life-threatening.

A similar condition has been treated for years in patients that have not had COVID infection. This condition is known as postural orthostatic tachycardia syndrome or POTS for short. Patients experiencing these symptoms should discuss them with their physician.  Cardiac arrhythmias may also occur as a result of severe illness and systemic inflammation, as seen in COVID-infected patients. These often come with faster heart rates than normal, 150 beats a minute or greater. Often the pulse follows an irregular pattern.

These conditions should be evaluated with your physician. Your physician will likely order an electrocardiogram (ECG), and possibly set up long-term monitoring. A regular ECG records 10 seconds of heart rhythm. Sometimes longer-term monitoring (from 24 hours up to 30 days) is needed to identify a rhythm problem.

Cardiomyopathy is a rare complication of COVID infection. This occurs by severe inflammation, causing myocarditis with damage to heart muscle cells. Being ill in an ICU setting can sometimes cause a stress cardiomyopathy. In either case, patients may develop congestive heart failure. Patients with congestive heart failure often have elevated heart rates when they are retaining too much fluid or as a compensatory response to a drop in the heart's output. These patients typically have other symptoms in addition to the rapid heartbeat, such as shortness of breath, extreme fatigue, chest tightness, dizziness, lightheadedness or passing out.