What causes chest pain after COVID-19?

People who experience severe COVID-19 may feel a persistent ache in their chest muscles.

Symptoms

Post-COVID-19 muscular pain, or myalgia, can feel different for everyone who has it. It may be noticeable during or after COVID-19. Some people may feel it in one particular area of the chest, while for others, it is more widespread.

Soreness upon touching the area is common, and specific movements such as turning or stretching the upper torso can make it feel worse. Exercise may cause muscular chest pain after COVID-19.

Treatment

Relieving joint and muscle pain after COVID-19 may come down to gentle exercise. Gentle stretching and flexibility exercises such as yoga and tai chi can help. Light strength exercises, such as using resistance bands or climbing the stairs, may also support recovery.

A person should speak with a doctor before exercising to manage post-COVID-19 muscular chest pain.

Pleuritic pain can develop due to inflammation of the pleura, a layer of cells between the lungs and the chest wall. It can also occur because of pericarditis, in which inflammation develops in the heart’s outer layer.

Symptoms

Pleuritic pain is a sharp pain that worsens whenever a person breathes in. Pleurisy is an unusual presentation of COVID-19.

Pleuritic COVID-19 pain due to pericarditis may start to feel better when a person sits up and leans forward and may briefly feel better while taking shallow breaths.

Treatment

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for pleuritic chest pain. A doctor may prescribe stronger, narcotic pain relief medications for people with severe pleuritic pain. However, these suppress the coughing reflex, so NSAIDs are the preferred treatment.

Taking a dosage of 50–100 milligrams of indomethacin has shown positive effects on pain and lung function in studies on pleuritic pain.

When doctors are treating chest pain in people following COVID-19, they must also rule out a pulmonary embolism, which can also cause pleuritic pain.

Angina develops when the heart muscle does not receive enough oxygen in the blood. COVID-19 often causes low blood oxygen levels, which may contribute to angina.

Symptoms

Angina causes pain in the chest that can feel like pressure or tightness.

Sometimes, angina can cause similar sensations elsewhere in the upper body, including the:

• jaw
• neck
• shoulders
• arms
• back

Unlike pleuritic pain, angina feels more like squeezing than sharpness and does not respond to how a person breathes.

It often flares up during exercise, cold temperatures, large meals, or stressful situations.

Treatment

Angina requires a range of possible treatments depending on its severity.

A doctor may prescribe one of several medications to manage angina, including:

• ACE inhibitors to reduce blood pressure
• a low dose of aspirin to prevent blood clots
• beta-blockers, which slow the heartbeat and reduce pressure on the heart
• calcium-channel blockers, which reduce blood pressure and expand coronary arteries
• nitrates to widen arteries and improve blood flow to the heart
• ranolazine, which reduces the amount of oxygen the heart needs to work
• statins, which can reduce inflammation in blood vessels

Severe angina or angina that develops suddenly can require surgical intervention. This may include angioplasty or a coronary artery bypass.

In angioplasty, a doctor inserts a thin tube (a catheter) into the person and inserts a tiny balloon through it. Then, they inflate the balloon to widen the affected blood vessels.

In a coronary artery bypass, a surgeon moves a blood vessel from another part of the body to divert blood flow away from a blocked or damaged coronary artery.

Not all of these will be relevant in the treatment of COVID-19-induced angina. However, it is important for a person to speak with a doctor about post-COVID-19 angina as soon as possible, especially if it develops suddenly.

When the immune system responds to severe viral infection, it sends white blood cells to counter the threat of the virus, increasing blood flow to the area. If the SARS-CoV-2 virus affects the heart valve or muscle tissue, it can lead to heart inflammation.

If the heart muscle tissue develops inflammation, doctors refer to it as myocarditis. Pericarditis – inflammation of the outer lining of the heart – can also develop.

According to the American Heart Association (AHA), COVID-19 increases a person’s risk of heart inflammation.

Symptoms

Myocarditis may cause no symptoms at all. However, it can cause chest discomfort and pain. Symptoms that may occur alongside this pain include:

• difficulty breathing
• feeling extremely tired
• finding exercise more difficult than usual or impossible
• high temperature (fever)
• lower abdominal pain
• passing out
• racing or pounding heartbeat
• swelling in the lower limbs, also known as edema
• weakness

Pericarditis causes pleuritic pain that feels better when a person sits up and leans forward. They may also notice:

• a rapid heartbeat
• fever
• breathlessness

Treatment

A doctor will initially prescribe medications to relieve pain, reduce inflammation, and calm the immune system.

Medications for myocarditis include corticosteroids and intravenous immunoglobulin (IVIG).

Corticosteroids reduce the body’s immune response, while IVIG, which a doctor administers directly into the veins, reduces inflammation and controls the immune response.

For pericarditis, a doctor may recommend:

• corticosteroids
• pain and inflammation relief medications, including:
  • NSAIDs
  • aspirin
  • colchicine
• IVIG

To treat severe myocarditis and pericarditis symptoms, a doctor can refer a person for several surgical options, including:

• Pericardiocentesis: This involves a surgeon removing excess fluid in the heart’s outer layer.
• Defibrillator or pacemaker implantation: This procedure allows a person to regain control over an irregular heartbeat.
• Pericardectomy: This treatment removes the outer layer of the heart. A doctor will only consider it if no other treatment has been successful

Another type of chest pain after COVID-19 is nonspecific chest pain. It may:

• feel dull or sharp
• happen in shorts waves
• last for hours
• not have exercise as a trigger

It has no link to the heart, and its cause may be difficult to pinpoint. A person should consult a doctor to determine the diagnosis and treatment.

It is safest to call 9-1-1 upon noticing the following chest pains or accompanying symptoms:

• sudden or severe chest pain that does not resolve
• sudden chest pain alongside:
  • sweating
  • breathlessness
  • nausea or vomiting
• sudden chest pain and fainting

A person should get in touch with a doctor even if chest pain is obvious for a while, seems to get better, then comes back. Doctors advise that it is dangerous to ignore any chest pain.

Chest pain can be a long-term symptom of infection by SARS-Cov-2. It is often possible to identify the cause as pleuritic pain, muscular pain, angina, or pain due to heart damage. A range of treatments is available depending on the underlying cause.

Getting medical support for chest pain is vital because it can indicate a serious health problem. However, many COVID-19-related causes of chest pain are manageable and get better over time.