COVID-19 damages a healthy young father’s heart, requiring a transplant

Al Brown thought he’d won the battle against COVID-19. The healthy 31-year-old spent a week in University of Chicago Medicine Ingalls Memorial Hospital in May 2020, receiving oxygen to help him breathe. But a few weeks after being discharged, he started having sharp pains in his chest. His legs and ankles swelled, and small tasks made him unusually tired.

Brown was readmitted to the hospital and received a shocking diagnosis: heart failure caused by COVID-19. His doctors at UChicago Medicine immediately listed him for a heart transplant, and after only 12 days on the waiting list, he underwent successful transplant surgery in October 2020.

“When they told me it was my heart, I was more shocked than anything,” Brown said. “I had no previous health issues. I’d never even taken medication for anything before this, so I didn’t know why COVID-19 was affecting me so much.”

What happened to Brown is also occurring worldwide. In a small and seemingly random group of people with COVID-19, the virus travels into the organs and damages them, sometimes so severely that a transplant is required.

“I don’t think we understand yet the exact mechanisms for why this happens, but I know we will in the near future,” said heart transplant surgeon Valluvan Jeevanandam, MD, director of the UChicago Medicine Heart and Vascular Center. “I think it’s going to lead to increased demand for organ transplants. We will start seeing more people with COVID myocarditis, and if it lingers, they will need a heart transplant.”

Researchers are now studying the long-term effects of COVID-19, even in people who had mild cases. One study of relatively young and healthy patients showed that 78% of people who recovered from COVID-19 had “cardiovascular involvement,” regardless of preexisting conditions. Other studies suggest that COVID-19 can cause myocarditis, or inflammation of the heart muscle, which can weaken the heart and, in extreme cases like Brown’s, cause it to fail.

UChicago Medicine cardiologist experts on COVID-19 myocarditis said this happens to less than 3% of patients hospitalized with COVID-19.

There does not seem to be a specific risk profile to identify patients who are more or less likely to suffer myocarditis. Anecdotally, it does seem more common in younger patients, particularly those in their 20s to 40s.

Brown’s primary cardiologist, Ben Bow Chung, MD, searched hard for evidence that something other than COVID-19 caused Brown’s sudden and scary heart failure. However, all signs pointed to the virus. He had no risk factors, no other medical conditions and no family history.

“We tested him for a number of things and he was not positive for any of them,” Chung said. “We just knew there was general damage to the heart. There were signs on his MRI of chronic myocarditis that he may have developed in May, when he had COVID-19.”

Chung and his team even looked at the pathology of Brown's heart after transplant surgeons removed it, and found no evidence of anything that would cause inflammation.

“Because he was young and healthy, he could hide the symptoms of heart failure. Young people like Mr. Brown who have heart failure can seem like they’re well for a long period of time, but when they get sick, they can fall off a cliff,” Chung said. “By the time he was back in the hospital, his heart was functioning at only 10% capacity.”

Starting in March, Brown began doing a customized, cardiac rehab program three times a week at UChicago Medicine. His program includes an hour of walking and running on a treadmill, biking and weightlifting. He also attends educational sessions about his heart, nutrition, stressors, medication and anatomy.

“I feel like a brand new person,” said Brown, a father of two.

UChicago Medicine exercise physiologist Tyler Lawrence, MS, ACSM-CEP, AACVPR-CCRP, described Brown’s recovery as remarkable, attributing it to his dedication and hard work in the program.

“He’s progressing quicker than most patients we’ve had,” he said. “He’s one of our star students.”

Even as researchers look for answers as to why this would happen to a perfectly healthy person, UChicago Medicine’s transplant team is prepared to treat more patients like Brown.

“We’re the best transplant program in the country in terms of outcomes,” Jeevanandam said. “Our average wait time is just over a month, which is seven times faster than the national average. Our transplant rate is one of the highest in the country. Having an outstanding transplant program at UChicago Medicine allows us to confidently handle the volume and complexity of any patient with advanced heart failure, even if the patient had COVID-19.”