Early into the pandemic, cases in Wuhan and at Massachusetts General Hospital observed the elevated troponin phenomenon in patients with prior cardiovascular conditions such as congestive heart failure, coronary artery disease, and hypertension, as well as in those without a previous history. of heart problems Soon other hospitals were reporting and documenting elevated troponin levels in COVID-19 cases causing myocarditis, an inflammation of the heart muscle, as well as arrhythmias, heart failure, and even cardiac arrest, and sudden death.

The phenomenon first observed in acute COVID-19 infections also started showing up in cases with milder symptoms, and in asymptomatic patients. In a report published in JAMA in July 2020, 78 patients out of 100 who had recovered from the common symptoms associated with COVID-19 in magnetic resonance imaging (MRI) tests showed ongoing myocarditis. Of these patients, 60 had never had a previous history of cardiovascular disease. The July study included two-thirds of the 100 in total who never required hospitalization. Many of those studied were asymptomatic.

Later in the year, a September 2020 study looking at a small sampling involving 26 athletes from The Ohio State University who had been infected with COVID-19, showed scarring of the heart in 8 and prolonged myocarditis in 4. In this study, none of the athletes had shown elevated troponin levels. Scans were done 11 to 53 days after a two-week quarantine.

A December case published in JACC, the Journal of the American College of Cardiology Foundation, reported elevated troponin levels and heart failure symptoms in a 2-month-old infant infected with COVID-19.

What has concerned doctors is that COVID-19 patients may have long-term heart problems that last well beyond the end of the viral infection. Another issue of concern is that the myocarditis being observed in many cases is atypical. In other words, not the usual type of myocarditis seen from other medical conditions.

Some physicians speculate that the elevated troponin levels, and subsequent myocarditis may not just be from COVID-19, but potentially may come from other viruses that opportunistically attack the body in its weakened state.

So elevated troponin levels more often than not are linked to COVID-19 and abnormal imaging findings of patients’ hearts and blood vessels. This is not a universal rule. But it is a pretty good indicator in the majority of researched cases.

The concern by doctors now is just how long these conditions persist after the infection has passed. A new clinical trial has been proposed to follow 900 COVID-recovered patients for a period of three years to determine just how long cardiac symptoms and potential toxicity last.

When I arrived they took a new swab for testing, as well as blood work, and a chest X-ray. I will know the COVID-19 test results in the next few days. But it was the blood work that set me on a strange new path of life-changing proportions.

My first blood work showed normal with one exception, Troponin, a complex of proteins that show up in blood when there is a heart injury. This was something that needed investigation.

Before I continue yesterday’s saga, some of my readers know that I had been scheduled for knee replacement surgery at the end of April of this year. In preparation for the operation seven weeks earlier I had a complete medical assessment. I aced all the lab tests and physical examination, my x-rays were clear, my heart function normal, my electrocardiogram textbook, and my blood pressure, the same.

Because of COVID-19, however, all elective surgery across the country was canceled. It will be months before they catch up with the tens of thousands of canceled procedures. I suspect I won’t be in an operating room until 2021.

But let’s get back to yesterday.

What would have triggered a sudden Troponin elevation in my blood? These proteins indicate a potential stroke or cardiac event. But I had felt nothing. I never was light-headed, never in distress. All I had was hoarseness, not even a sore throat, and I had occasional coughing. It turns out that COVID-19 was the likely culprit triggering elevated Troponin and that the virus had attacked my heart muscle leading to atrial fibrillation (aFib).

In the ER, I had completed the three reasons for coming and was getting ready to leave when I was asked to hang around. I was told they wanted to do an electrocardiogram. So they hooked me up to some leads and did a tracing. With that complete I figured, okay, now I can leave. But that’s not what happened. I was suddenly told I was being moved to a stepped-up unit in the ER, placed in an isolation room, and hooked up to a heart monitor. The nurse in attendance after getting all the leads attached turned on the monitor and said, “Oh boy, you are in aFib. Don’t look at the monitor!” I tried not to but it was pretty clear when I did that something bizarre was happening to my heart.

The doctor who admitted me came in and told me I needed a chest ultrasound to get a better picture of my lungs and heart. By that time the second blood test that had been ordered would show them definitively if Troponin levels were rising, a sign of a potential cardiac event. Six hours later, the Troponin levels had risen only slightly. That meant I would be going home that day eventually and not staying in the hospital.  Instead, I would be referred to a cardiologist. At that moment I realized that the entire medical regimen of my last fifteen years was coming to an end. I would now have to adjust to a whole new panoply of drugs to help me manage my new state of health.

COVID-19 had now become personal. I had been writing about it since the early onset in Wuhan, and now it had reached my door. No longer an observer, I was very much one of its victims. It was COVID-19 that likely was producing elevated Troponin levels in me just as it was doing in a large number of patients whose hearts were being damaged by the virus.

Going forward for the next few weeks, I expect I will be seen by a cardiologist. For now, I am on blood thinners to ensure I don’t shed clots and end up having a stroke. At the same time, I am on a low-dose beta-blocker to control my aFib. I need to manage my osteoarthritis with alternate pain medication. And if I can get my aFib stabilized, maybe the cardiologists can do cardioversion to shock my heart back into its normal rhythm. Needless to say, when I left the hospital ER after 3:30 p.m. yesterday, I was in a very different headspace. My once dependable heart, so reliable for my first 71 years, was now life-threatening, and the likely cause was this virus that no one had heard of six months before.

Looking back, my wife and I had done everything right.

We had practiced social distancing. We had worn masks anytime we were outdoors. We wore gloves always, washed our faces and hands with religious zeal, and tried not to touch our faces, and we even used separate towels and washed them frequently. This was a discipline that came naturally to us having raised a daughter with congenital heart disease. But it didn’t matter that we had been cautious and followed the recommendations of Health Canada. The virus had penetrated our shields and practices, and now we were living with the consequences.

If you are reading this blog posting, consider this virus as far more than an upper respiratory health threat. If you are not practicing social distancing, please do. If you don’t wear a mask when outside, please do. We probably picked up COVID-19 while shopping, she at a drugstore, and me at a grocery store. In such confined spaces, social distancing is harder, and shelved items and surfaces can be viral hotbeds. Now we shop online and, if we can, have stuff delivered or arrange for curbside pickup.

COVID-19 got us and it can get you in ways you never imagined. You need to have a healthy respect for this new infectious agent which will be with us from now on, and it won’t be the last pandemic we face. Others will follow as we continue to impinge upon the natural world, the source of potential trans-species viruses and bacteria that are waiting there to make the leap to 7.75 billion of us.