Cardiovascular complications in the Post-Acute COVID-19 syndrome (PACS)
Sheref A Elseidy1, Ahmed K Awad2, Monica Vorla3
1Internal medicine department, University of Texas health sciences, Houston, TX.
Insights
Post-COVID-19 syndrome can cause persistent fatigue and breathing difficulties. Cardiac complications, including myocarditis and rhythm abnormalities, are common, necessitating further research into diagnostic tools like cardiac MRI for risk stratification.
Area of Science:
- Cardiology
- Infectious Diseases
- Pulmonology
Background:
- The COVID-19 pandemic, caused by SARS-CoV-2, has led to a wide range of clinical presentations and long-term sequelae.
- Post-COVID-19 syndrome (PASC) affects survivors of all disease severities, with poorly understood mechanisms.
- Cardiovascular complications are a significant concern in PASC, impacting various aspects of heart function.
Purpose of the Study:
- To review the cardiovascular manifestations of Post-COVID-19 syndrome.
- To explore the utility of various diagnostic modalities in evaluating myocardial damage.
- To highlight the need for further evidence on PASC cardiac symptom classification and advanced imaging techniques.
Main Methods:
- Literature review of studies on COVID-19 and its cardiovascular sequelae.
- Analysis of diagnostic tools including ECG, echocardiogram, and cardiac MRI (CMR).
- Examination of biomarkers like CRP, creatinine, and troponin for risk stratification.
Main Results:
- Common PASC symptoms include dyspnea, fatigue, chest pain, and palpitations.
- Elevated CRP, creatinine, troponin, and hypokalemia in acute COVID-19 correlate with increased risk of cardiac sequelae.
- Cardiac damage can present as myocarditis, pericarditis, and rhythm abnormalities.
Conclusions:
- Cardiovascular complications are frequent in PASC, requiring comprehensive evaluation.
- Cardiac MRI shows promise but requires more evidence for routine diagnostic use in PASC.
- Further research is needed to classify PASC cardiac symptom severity and validate advanced diagnostic tools.
Abstract:
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) or coronavirus disease 2019 (COVID-19) initially surfaced in December 2019 from Wuhan, China, sweeping the world with various strains, forcing the WHO to declare a pandemic epidemic in March 2020. Furthermore, COVID-19 manifests with a wide array of presentations from fever and fatigue to severe respiratory and cardiovascular complications. Post-COVID-19 syndrome is poorly understood affecting COVID-19 survivors at all levels of disease severity. The disease is most associated with post-discharge dyspnea and fatigue. However, other persistent symptoms as chest pains, palpitations, smell, and taste dysfunctions. Patients with high concentrations of CRP and creatinine in the acute phase of Covid-19 are more prone to cardiac sequelae. Therefore, high levels of cardiac-sensitive troponin and hypokalaemia can also be used for risk stratification. Furthermore, Cardiac damage can manifest as myocarditis, pericarditis, rhythm abnormalities. The use of different diagnostic modalities like electrocardiogram (ECG), echocardiogram, and cardiac magnetic resonance imaging (MRI)(CMR) to evaluate the myocardial damage were studied. However, Cardiovascular complications are a common manifestation of PASC, classification of severity of cardiac symptoms and the emergence of CMR as a diagnostic tool needs more evidence.
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