This is designed to help you better understand the symptoms of chest pain and palpitations in long COVID. These symptoms are common in long COVID patients and can be worrying and frustrating. In most cases these symptoms will improve over time with simple self-management techniques and without medical intervention.
Other causes of chest pain or palpitations may, however, present for the first time after COVID infection, and might not be related to COVID. Your clinician will discuss your symptoms with you and may ask for a medical opinion or investigations if needed. This booklet will also highlight when you should seek urgent medical attention.
Chest pain
There are a few types of chest pain that you can experience. Thinking about the presentation of your symptoms can help us work out the nature of the pain and how to manage it. We also know that pain response and perception can be altered in long COVID which is why harmless symptoms can sometimes seem or feel more severe than they are.
Non-specific or non-cardiac chest pain
This can occur anywhere in the chest. The location may vary during repeated episodes. However, it is often felt in a localised area just below the left nipple. It may be sharp or dull. It can last a split-second to hours in duration. It is not bought on by physical activity. Causes for this type of pain are rarely identified and common in long COVID.
Musculoskeletal chest pain
This may be limited to a small area or to a particular area or be felt as more widespread muscle soreness (called myalgia). The affected area is tender to touch and made worse by specific movements such as turning of the chest or stretching. Myalgia is common during acute viral infections such as COVID and, together with non-specific/ non-cardiac pain, may be experienced during the COVID recovery illness. This type of pain can also be associated with trying new postures, activity, or exercises. If you have been inactive for a long period of time and begin to increase your activity levels you may be more prone to musculoskeletal chest pain because you use muscles that haven’t been exerted for a while. This will settle with time.
Pleuritic chest pain
This is sharp and worse on breathing in. It usually points towards an inflammation of the pleura (the lining of the lungs) or of the pericardium (the lining of the heart, causing pericarditis, in which case the pain is normally made worse by laying flat and relieved by sitting forward). It is treated with simple painkillers such as paracetamol and
anti-inflammatory medicines.
Severe COVID infection may trigger inflammation of the heart muscle, a condition called myocarditis. This is looked for routinely in people who are advised to attend hospital for severe COVID symptoms.
Pain from the lining of the lungs can be caused by a blood clot in one or more of the arteries supplying the lungs. The onset of pain is usually sudden and often experienced with other symptoms, such as shortness of breath.
Angina-type chest pain
This is the most common symptom arising from narrowed or blocked heart arteries. It is typically experienced as a constricting feeling, a tightness or heaviness across the chest. It may radiate to one or both arms, to the neck, jaw, or teeth.
Stable angina is triggered by physical activity such as walking quickly or running, walking up inclines, or climbing stairs. It is relieved rapidly by slowing down or resting. It tends to be worse in the cold.
Unstable angina is the worsening of symptoms in previously stable angina, and usually occurs at low levels of activity or at rest. Pain due to a heart attack is of similar in nature to angina, but it is usually more severe and ongoing, and may be associated with nausea, vomiting, sweating, anxiety, and feeling unwell.
There is no known link between Long COVID and angina therefore if you have no cardiac history this is an unlikely cause however do not ignore chest pain which is brought on by physical exertion and relieved by rest. This may be angina that has presented in conjunction with long COVID.
Anxiety or extreme emotion can also cause feelings of chest pain or discomfort and so it is worth considering whether this could be contributing to your symptoms.
When should I seek medical attention?
You should seek urgent medical attention by phoning 999 if you experience sudden, severe chest pain which persists for more than 15 minutes, experience sudden chest pain which is associated with nausea or vomiting, sweating, or shortness of breath or if you experience sudden chest pain which is associated with loss of consciousness. You should discuss any new chest pain with your GP or long COVID clinician especially if you are worried about it.
Palpitations
Palpitations are heartbeats that are more noticeable to you. Your heart may feel like its pounding, fluttering, or beating irregularly, often just for a few seconds or minutes. Sometimes you may feel an extra or missed beat. These are known as ectopic beats.
Palpitations may seem alarming, but in most cases, they are harmless and are not a sign of a serious problem.
Palpitations are very common and are not just specific to the COVID recovery period. They may be caused by your increased awareness of a normal heart rhythm, for example due to anxiety, pregnancy, fever, or exercise. They may also occur with certain drinks such as coffee or energy drinks as well as some medications.
In a small number of cases, palpitations can be due to the occurrence of an abnormal heart rhythm. An abnormal heart rhythm is known as a ‘cardiac arrhythmia’. Cardiac arrhythmias are rarely dangerous.
When should I seek medical attention?
You do not usually need to see a GP if the palpitations pass quickly and only happen occasionally. They are unlikely to be caused by a serious problem and probably will not need treatment.
But it’s a good idea to see a GP if the palpitations last a long time, do not improve or get worse, you have a history of heart problems, or you’re concerned about the palpitations.
When should I seek urgent medical attention?
You should seek urgent medical attention by phoning 999 if you experience palpitations which are associated with chest pain, dizziness, blackouts, or loss of consciousness.
Monitoring heart rate and blood pressure
It may be that your Long COVID clinician wants to monitor your heart rate and rhythm or blood pressure to see if there are any abnormalities relating to your palpitations or symptoms. We can monitor your blood pressure with a standard machine that you can use at home. There are two ways that we can monitor heart rate and rhythm at home.
Kardia monitor
This is a small handheld device that works as a ‘mini’ electrocardiogram (ECG) and checks heart rate and rhythm. It can be used when you experience symptoms or as a ‘spot-check’ of your heart rate or rhythm. It links to an app on your phone and provides you with an ECG reading that can then be assessed by a clinician.
The benefits of the Kardia monitor are that it is small, portable, and easy to use. If your symptoms are quite infrequent you can keep hold of it for a number of days or weeks to try and capture a reading while you are symptomatic.
If we decide it is necessary to monitor your heart rate and rhythm, then we will set you up with a Kardia monitor and demonstrate how to use it. We will also explain how and when to send the readings to us.
24 hour ECG
This is a three lead ECG that you will wear over a 24 hour period to get a continual ECG trace. It will monitor your heart rate and rhythm. The 24 hour monitor can be applied by your clinician and will need to be returned the next day. The readings are then downloaded and analysed before we can give you your results.
You cannot shower while wearing the monitor and if you don’t experience symptoms regularly then you may not capture any palpitations in a 24 hour period therefore we would likely trial the Kardia monitor prior to this.
Symptom Diary
We will ask you to keep a symptom diary to record the date and time of your symptoms, what the monitor records (if you have one) and what activity you are doing at the time. You can also record other things such as if you are feeling stressed, tired, or dizzy at the time or have had something that could trigger your palpitations such as caffeine or alcohol. This can provide us with an insight into any potential triggers for your palpitations that we can then manage.
Fatigue diary
To request a fatigue diary to be sent to you, please contact the Long COVID team via:
- Email: rdash.long-covid@nhs.net
Document control
- Document reference: DP8801/07.22.
- Date reviewed: July 2022.
Page last reviewed: June 28, 2024
Next review due: June 28, 2025
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